Guest Blog: Speak and Swallow Speech Therapy

Guest Blog: Speak and Swallow Speech Therapy

Choking Risk in Aged Care and Disability Facilities in Australia

Do you have someone else’s life in your hands? If you are an aged care or disability care provider, the likelihood is you will one day need to step in to save a life. Choking is an emergency situation that can occur at any time, suddenly, without warning. Choking is the second most common cause of preventable death in aged care (Ibrahim et al., 2015), and the leading external cause of death for people with disabilities (UNSW, 2019).

While these statistics are shocking, they’re an important reminder of why it is essential that disability and aged care support teams are equipped and confident in managing choking risks. Keep on reading to find out more about why choking is such a high risk in these settings and how LifeVac® can help. 

Choking Risk in Aged Care Facilities

Individuals living in aged care facilities are at a high risk for choking incidents. This elevated risk is related to the higher prevalence of swallowing difficulties in this setting, with 30-50% of Australian aged care residents experiencing changes in their chewing and swallowing (Erikson, 2019).

Swallowing difficulties, known clinically as dysphagia, are not a normal part of aging but rather a symptom of underlying pathology (Cichero, 2018). Dysphagia can result from damage to the brain or structures of the head and neck and is common in people who’ve had a stroke. Up to 50% of stroke survivors will develop dysphagia (Gonzalez-Fernandez et al., 2013). Swallowing difficulties are also common in people with neurodegenerative conditions such as Parkinson’s Disease, Motor Neuron Disease, and Dementia – where progressive neurological decline compromises coordination and safety when swallowing.

While swallowing difficulties look different for everyone, here are some common symptoms of dysphagia:

  • Choking when eating or drinking
  • Frequently clearing the throat
  • Taking more time to chew foods
  • Difficulty swallowing dry or chewy foods
  • Food being left inside or around the mouth
  • Gurgly or wet voice after swallowing
  • Drooling or inability to control saliva
  • Pain when swallowing
  • Fear of swallowing food or drinks
  • Sensation of food or medications getting “stuck” in the throat or neck region
  • Difficulty triggering or initiating a swallow
  • Unexplained weight loss
  • Recurring chest infections
  • Becoming fatigued during or after a meal
  • Discoordination of routine during mealtimes (i.e. lifting cup and spoon up and down)
  • Mouthfuls requiring multiple swallows
  • Watery eyes (not related to other medical conditions)
  • Regurgitation of foods or drinks
  • Excessive tongue movements
  • Food or drink falling out of the mouth

Speech Pathologists are allied health professionals that are involved in the assessment and management of swallowing difficulties. Speech Pathologists can assess dysphagia risk and advise on strategies to minimise choking risk, including adjustments to feeding, timing, posture, and environmental strategies as well as the texture modification of foods and drinks. These detailed recommendations are often provided in the form of a Mealtime Management Plan document that is discussed with and implemented by care teams and loved ones to ensure the safety and enjoyment of mealtimes for the person with dysphagia. It is an ongoing document that is reviewed regularly to suit the individual’s preferences, needs, and presentation.

Choking Risk in Disability Care Facilities

It is also known that choking risk is high in disability care facilities, with 66% of residents in long term care impacted by swallowing difficulties. A report from the NSW Ombudsman found that between 2002 and 2017, 65% of disability services residents who died had swallowing difficulties. Choking was a factor in the deaths of 30 people, according to the report released in August (2018). The report determined that “dysphagia has significant and often fatal implications for the health of people with disability” (NSW Ombudsman, 2018).

Because of the established choking risk for individuals living in disability care facilities, it is crucial that disability care teams and external disability support workers are aware of the immediate measures required to manage a choking event: including how to call for assistance and perform choking first aid. Disability support teams also benefit from having access to a LifeVac® if first aid methods fail. This portable airway clearance device has the backing of multiple peer-reviewed medical publications with independent testing on safety, effectiveness, and ease of use and has undergone a TGA clinical and safety review.

Choking Risk and Quality of Life

Individuals living in aged care and disability care settings face a heightened risk of choking, largely due to the prevalence of long-term swallowing difficulties. This is particularly evident in those with progressive neurological conditions, where swallowing ability gradually declines over time. In such cases, continuous support from care teams and loved ones is essential to ensure both safety and mealtime enjoyment.

Although it is natural to focus on reducing mealtime risk, often by modifying food and drink textures, it’s equally important to recognize the broader role that eating and drinking play in our daily lives. Beyond nutrition and hydration, mealtimes are an opportunity for rich social and cultural experiences (Salomon & Trollor, 2019). Unfortunately, research shows that individuals with dysphagia often experience social isolation, feelings of exclusion, and associated mental health challenges such as anxiety and depression due to swallowing difficulties impacting shared meals with family and friends. These factors can negatively affect quality of life and even contribute to increased mortality rates (George & Jagtap, 2021).

The enjoyment of food and drink remains one of life’s greatest pleasures — a source of identity, culture, and connection. Yet for individuals with swallowing difficulties, this can come with risk. To address these concerns, many Speech Pathologists and healthcare professionals advocate for a quality-of-life approach often referred to as “eating and drinking with acknowledged risk.” This approach supports the individual’s right to continue consuming preferred foods and drinks, even when these may pose a higher choking or aspiration risk. It centres on person-centred care, balancing safety with dignity and autonomy.

This is closely aligned with the principle of dignity of risk, which acknowledges that all individuals, regardless of age or ability, have the right to make informed choices — including the choice to take certain risks to preserve their self-esteem, independence, and quality of life (Anglican Care, 2018). In fact, regulatory frameworks such as The Aged Care Quality Standards (Quality Standard 1) require services to support individuals to take risks in order to live the best life they can (ACQSC, 2020) The NDIS Code of Conduct (Clause 1) also mandates that providers respect each person’s freedom of expression, self-determination, and decision-making in line with relevant laws (NDIS, 2018).

Whether persons with dysphagia are following a modified diet and strict recommendations or choosing to eat and drink despite known swallowing risks, a compassionate and informed care team is essential. This may include the use of supportive tools such as TGA listed, non-invasive LifeVac® and ensuring that staff and carers are trained in mealtime safety, modified diets, and emergency responses.

At Speak and Swallow Speech Therapy, we’re proud to share that we know of multiple clients with dysphagia whose life the LifeVac® device has saved, including individuals with progressive neurological conditions like Progressive Supranuclear Palsy.

Ultimately, preserving the joy of shared mealtimes — even in the presence of risk — is not just a clinical decision, but an ethical and deeply human one.

 

References:

Cichero, J. (2018). Age-Related Changes to Eating and Swallowing Impact Frailty: Aspiration, Choking Risk, Modified Food Texture and Autonomy of Choice. Geriatrics, [online] 3(4), p.69. doi:https://doi.org/10.3390/geriatrics3040069.

George, R.G. and Jagtap, M. (2021). Impact of Swallowing Impairment on Quality of Life of Individuals with Dysphagia. Indian Journal of Otolaryngology and Head & Neck Surgery, 74(3). doi:https://doi.org/10.1007/s12070-021-02798-0.

González-Fernández, M., Ottenstein, L., Atanelov, L. and Christian, A.B. (2013). Dysphagia after stroke: an overview. Current Physical Medicine and Rehabilitation Reports, [online] 1(3), pp.187–196. doi:https://doi.org/10.1007/s40141-013-0017-y.

Ibrahim, J.E., Bugeja, L., Willoughby, M., Bevan, M., Kipsaina, C., Young, C., Pham, T. and Ranson, D.L. (2017). Premature Deaths of Nursing Home residents: an Epidemiological Analysis. Medical Journal of Australia, [online] 206(10). Available at: https://www.mja.com.au/journal/2017/206/10/premature-deaths-nursing-home-residents-epidemiological-analysis.

NSW Ombudsman (2014). Deaths of people with disability in residential care. [online] Available at: https://cmsassets.ombo.nsw.gov.au/assets/Reports/Report-of-Reviewable-Deaths-in-2014-2017.pdf

Salomon, C. and Chair, J. (n.d.). A scoping review of causes and contributors to deaths of people with disability in Australia SUMMARY OF KEY FINDINGS. [online] Available at: https://www.ndiscommission.gov.au/sites/default/files/2024-09/summary-findings-24.pdf 

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