According to the Centers for Disease Control and Prevention (CDC), adults age 65 and older have the highest risk of choking-related deaths, and the risk increases significantly after age 75. Most choking incidents in older adults involve food blocking the airway. The CDC classifies choking as unintentional suffocation, which is one of the leading causes of injury-related death among older adults.
Common Reasons Older Adults Are at Higher Risk
Older adults may have:
- Difficulty swallowing
- Dentures or missing teeth
- Dry mouth or reduced saliva
- Stroke or neurological conditions
- Dementia or cognitive impairment
- Medication side effects
These factors can increase the risk of choking during meals.
Warning Signs to Watch For
Contact your supervisor or nurse if you notice:
- Coughing during meals
- Food remaining in the mouth
- Difficulty swallowing
- Changes in eating habits
- Choking episodes
- Wet or gurgly voice after eating
Common Choking Foods for Older Adults
The following foods are more likely to cause choking because they may be hard, dry, sticky, round, or difficult to chew and
swallow:
- Tough meats (steak, pork chops, chicken with skin, bacon)
- Hot dogs and sausages
- Bread (especially dry bread, bagels, pizza crust, toast)
- Crackers, biscuits, muffins, cookies
- Rice and stuffing
- Pancakes or waffles (without moisture)
- Peanut butter and nut butters
- Sticky foods (caramel, taffy, marshmallows)
- Nuts and seeds
- Popcorn
- Chips and pretzels
- Hard candy
- Raw fruits (apples, grapes, berries)
- Raw vegetables (carrots, celery, broccoli, cauliflower)
- Cherry tomatoes and olives
- Meatballs
- Corn on the cob
- Sandwiches or thick breads
- Dry cereal
- Soup with chunks
- Cereal with milk
- Fruit in juice
- Ice cream and sherbet
- Gelatin (Jell-O)
- Popsicles and water ice
- Milkshakes
Tip: Cut food into small pieces, encourage slow eating, and always follow the participant's care plan for safe mealtime practices.
DCW Best Practices for Preventing Choking
-
Ensure participant is sitting upright while eating
- Encourage slow eating and small bites
- Avoid rushing meals
- Follow care plan and diet instructions
- Stay with the participant during meals
- Watch for signs of swallowing difficulty
What To Do If a Client Is Choking
Brief Guidelines for Direct Care Workers (DCWs)
If a client is choking, act quickly and stay calm.
Signs of Choking
Watch for:
- Inability to speak
- Difficulty breathing
- Weak or no coughing
- Clutching the throat
- Blue or pale skin
- Panic or distress
What To Do
1. Ask if they are choking
If the person can cough or speak, encourage them to keep coughing.
2. Call for Help
- Call 911 immediately if the person cannot breathe, speak, or cough
- Alert supervisor according to agency policy
3. Perform Abdominal Thrusts (Heimlich Maneuver)
If trained and the person cannot breathe:
- Stand behind the person
- Place fist above the belly button
- Give quick inward and upward thrusts
- Continue until object is cleared or help arrives
4. If the Person Becomes Unconscious
- Call 911 immediately (if not already called)
- Begin CPR if trained
- Continue until emergency responders arrive
Important Safety Reminders
- Stay calm
- Act quickly
- Never leave the person alone
- Follow your agency emergency procedures
- Document and report the incident
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