Why Choking Still Happens in Aged Care Settings
Choking is one of the leading causes of preventable death in aged care settings.
Understanding why choking happens is an important step towards improving mealtime safety and reducing risk.
Choking can occur due to a range of factors, and in many cases involves more than one contributing element.
These may include:
swallowing difficulties (dysphagia)
inappropriate food or fluid textures
suboptimal positioning
level of supervision or assistance provided
cognitive or behavioural factors
variations in care practices
Choking may occur due to a single factor, but more often involves a combination of these contributing elements.
1. Dysphagia Is Not Always Identified Early
Many individuals in aged care live with dysphagia (swallowing difficulties), but it may not always be recognised early.
Signs can be subtle, such as:
coughing during meals
prolonged eating time
pocketing food in the mouth
reduced appetite
Without early identification and referral to a speech pathologist, individuals may continue eating textures that are unsafe for them.
2. Inconsistent Food and Fluid Textures
Even when texture-modified diets are prescribed, inconsistency can still occur.
This may happen when:
different staff prepare food differently
recipes are not standardised
IDDSI testing is not used regularly
textures change during plating or serving
A meal that appears appropriate may not actually meet the required texture level, increasing choking risk.
3. Lack of Supervision During Mealtimes
Supervision plays a key role in mealtime safety.
Some individuals may:
eat too quickly
take large mouthfuls
fatigue during meals
require prompting or pacing
Without the appropriate level of supervision, these risks may go unnoticed until it is too late.
4. Positioning Is Often Overlooked
Positioning plays an important role in supporting safe swallowing.
For many individuals, an upright and well-supported posture helps optimise control during eating and drinking.
If an individual is:
slouched
leaning to one side
not adequately supported when seated or in bed
their ability to manage food and fluids safely may be reduced.
Ensuring appropriate positioning before and during meals is a simple but important step in supporting safer swallowing.
5. Cognitive and Behavioural Factors
Some individuals in aged care may have cognitive impairment, such as dementia, which can impact mealtime behaviours.
This may affect:
attention during eating and drinking
ability to follow mealtime instructions or strategies
awareness of food in the mouth
pacing during meals
For example, an individual may:
take large or rapid mouthfuls
become distracted during meals
require prompting to continue eating or drinking
These factors can influence how safely a person eats and drinks, and may increase the need for supervision or support during mealtimes.
6. Gaps Between Training and Practice
While many facilities provide dysphagia training, challenges often arise in day-to-day practice.
Common issues include:
staff turnover
reliance on memory rather than systems
limited ongoing competency checks
inconsistent communication between teams
Training alone is not enough. Systems and routines are needed to ensure consistency across staff and shifts.
7. Environmental Factors and Distractions
The mealtime environment can influence safety.
Busy or noisy settings may lead to:
reduced focus on eating
missed signs of difficulty
rushed mealtimes
Creating a calm and supportive environment can help individuals better manage eating and drinking.
What Can Help Reduce Choking Risk?
Improving mealtime safety requires a combination of clinical support, staff awareness, and consistent systems.
Key steps include:
early identification and referral for swallowing assessment
following speech pathology recommendations
using IDDSI testing methods consistently
ensuring appropriate supervision levels
supporting correct positioning
reducing distractions during meals
ongoing dysphagia training and competency checks
Small, consistent actions can make a meaningful difference.
The Role of Dysphagia Training
Dysphagia training plays an important role in helping staff understand:
what is dysphagia
what increases choking risk
how to prepare and check food and fluids
how to support individuals safely during meals
More importantly, effective training helps teams apply this knowledge consistently in real-life settings.
