Choking Incidents Among the Elderly: A Growing Concern
David Palumbo encountered a chilling choking episode in his career. This event took place in September 2019 at an Italian restaurant in Providence, Rhode Island. An 88-year-old diner was found unconscious, a chunk of bread blocking his airway. It felt like time crawled as first responders struggled with CPR and the Heimlich maneuver.
Inside the ambulance, the man’s skin turned blue, and firefighters feared the worst. Palumbo, who is a captain in the fire department, utilized a scissors-like tool known as Magill forceps to remove the bread from the man’s throat.
“Choking calls are fairly common in the city,” Palumbo noted, emphasizing that many incidents resolve before help arrives. “But this was definitely the worst I’ve ever dealt with.”
Luckily, the man survived and fully recovered, Palumbo shared.
Unfortunately, not all elderly individuals are as fortunate. Choking takes the lives of over 4,100 Americans aged 65 and older every year, with this demographic making up about 75% of all choking fatalities in the U.S., based on federal health statistics.
While the overall death rate remains relatively stable, the actual number of cases is increasing, likely due to the growing senior population.
In light of this, several companies are promoting anti-choking devices targeted at senior citizens. Health professionals are debating the effectiveness of products named LifeVac, SaveLix, VitalVac, and Dechoker.
Dr. Nathan Charlton, an emergency medicine professor at the University of Virginia, who also advises the American Red Cross, highlighted that there’s limited evidence supporting these products. The Red Cross is still examining them.
Understanding the Risks of Choking for Older Adults
Choking happens when food or another object obstructs the windpipe, obstructing airflow to the lungs.
Typical signs include a person clutching their neck and difficulty speaking. If oxygen is not restored within four minutes, brain damage can occur, and death may follow shortly after.
Older adults face heightened risks for various reasons. Aging can weaken mouth and throat muscles. Additionally, older individuals produce less saliva, and certain chronic conditions or medications complicate swallowing. Dentures may also pose a choking hazard.
Effective Strategies to Prevent Choking
To mitigate choking risks, it’s advisable to cut food into smaller pieces, chew slowly, drink plenty of fluids during meals, and avoid talking or laughing while chewing.
If someone is choking, back slaps can be an effective, traditional first aid approach.
The Heimlich maneuver, developed in the 1970s, can also be utilized. It involves standing behind the choking individual, wrapping your arms around their abdomen, and forcefully thrusting inward and upward with a clenched fist. This method aims to expel air from the lungs, dislodging the obstruction.
The American Red Cross recommends alternating between back blows and abdominal thrusts in sets of five.
But what if the choking victim is alone?
Dr. Charlton indicated that someone could perform a self-administered Heimlich maneuver by thrusting their abdomen against the back of a sturdy chair.
Manufacturers of new anti-choking devices suggest that their products could be beneficial in such cases.
“Elderly individuals may not be able to maneuver onto a chair or counter to perform self-relief,” remarked Arthur Lih, the CEO of LifeVac.
Potential Risks of Anti-Choking Devices
While these devices vary in design, they generally resemble a face mask connected to a tube or bellows, typically priced between $30 and $100.
In use, a choking individual places the mask on their face, presses down on the handle, and pulls up to create suction that removes the obstruction.
Some studies indicate that certain devices may cause injuries like tongue damage or bleeding and swelling in the throat. Reports to the U.S. Food and Drug Administration (FDA) suggested that some products failed to generate sufficient suction, resulting in bruising on the face and lips.
An injury report prompted the FDA to inspect and issue a warning letter to Dechoker in 2021.
Manufacturers emphasize that their products are FDA-registered, but that doesn’t equate to approval. The FDA had previously informed consumers that it has not endorsed over-the-counter anti-choking devices, citing unestablished safety and effectiveness.
Lih mentioned the FDA’s actions were in response to the influx of various anti-choking devices with differing designs and quality.
The Call for More Research on Choking Responses
Currently, a shared understanding, even among device manufacturers, is that traditional methods like back blows and abdominal thrusts should be the first line of defense. (The use of the forceps that Palumbo employed is not recommended for the general public.)
Nonetheless, Lih stated that thousands of nursing homes and emergency response agencies have begun purchasing newer anti-choking devices.
A notable example is the police department in Acworth, Georgia, which invested in around 75 LifeVac devices after an officer successfully used her own device to save an elderly woman. Now, every patrol car is equipped with one, according to Sgt. Eric Mistretta.
Manufacturers assert that their products have saved countless lives worldwide, but quantifying their effectiveness is not straightforward, noted Dr. Cody Dunne, a researcher from the University of Calgary.
The early data mostly stems from individual case reports or small trials involving mannequins or cadavers.
“I believe the evidence is gradually accumulating,” he commented, but called for more thorough studies. For instance, it would be beneficial to compare choking incidents in nursing homes equipped with these devices versus those that aren’t.
Dunne remarked that the understanding of traditional techniques like the Heimlich maneuver is also evolving. He co-authored a study that concluded back blows are more effective than the Heimlich maneuver or chest compressions.
“We’re only starting to gather solid evidence on these older choking remedies, let alone the new options,” he concluded.
