PEOPLE are increasingly choking to death in aged care, an alarming fact made worse by the lethal multiplier laid bare in early Royal Commission talk – a lack of adequate supervision.

Experts say any Royal Commission’s terms of reference into Australia’s aged-care crisis must take in the rising death toll from choking on food, the second highest cause of preventable death in aged care [1].

Particularly at risk are people suffering the effects of stroke, dementia or Parkinson’s diseases.

By that circumstance they require help to eat, or supervision while eating, but also need to be receiving the proper texture modified food to reduce the choking risk –that is often unappealing, fortified pureed or chopped meals.

Some “protections”, including supervision, already exist for these vulnerable people under the Australia New Zealand Food Standards Code where it deals with food for special medical purposes at standard 2.9.5 [3].

 

• About 40-60 per cent of people in aged care have trouble with chewing and swallowing to the point where they are at risk of choking on food.
• People over the age of 65 years have 7x the risk of choking on food as children aged 1-4 yrs

 

Aged-care service providers are required to be compliant with the standard though it’s unclear if they are so well aware of their obligations under the Act.

Reports out of Monash University show that external causes of death including falls, choking and suicide increased from 1.2 per 1000 admissions in 2001-02 to 5.3 per 1000 admissions in 2011-12.  Choking deaths at 7.9 per cent was the second most frequent mechanism of death in Australian nursing homes of deaths reported to Coroners between 1 July 2000 and 30 June 2013.

Dr Julie Cichero, a speech pathologist internationally recognised for her work in the field of feeding and swallowing disorders and an honorary  University of Queensland researcher agrees, citing recent government reports that choking deaths in aged care for people with disability are increasing [2].

“Choking deaths are a combination of eating and/or food-related behaviour problems and are increased if there is inadequate supervision,” Dr Cichero says.

Her point is backed up by government reports released at the end of August that state: “A momentary lapse in supervision while staff responded to other resident’s needs was all that was needed for a fatal choking event to occur.”

She says a 2015 NSW Ombudsman’s report in reviewable deaths of people with disability in residential care specifically recommended the following:

• Active supervision of people with swallowing and/or choking risks around food
• Ensuring staff had clear guidance about the person’s choking risks and what they need to do, and
• Staff being alert to choking risks of individuals and always following support plans and other guidance to manage the risks.

 

“In order to enact these recommendations, there needs to be appropriate clinical assessment of choking risk, and appropriate carer training around choking risk, including the need for meal time supervision,” Dr Cichero says.

“Speech Pathologists are the health professionals with expertise to assess, manage and make recommendations around food choking risks.  Speech Pathologists also provide training to care staff and indicate where supervision is necessary.”

Dr Cichero wants the Royal Commission’s terms of refence to include choking deaths in aged care.

“I think at a minimum making sure there is assessment for choking risk, but also for nutritional adequacy is important for aged care,” she says.

“Following on from identification of potential choking or malnutrition problems, then making sure people who care for the residents are (a) trained, (b) recognise risks, (c) know who to contact for help, and (d) that there sufficient staffing ratios for them to meet their duty of care.

“The recommendations for prevention of choking deaths in aged care from Prof Joseph Ibrahim Department of Forensic Medicine at Monash University, provide an excellent blue print.”

Some numbers from media reports since the Royal Commission was announced

• About 240,000 people, and one in four Australians over the age of 85 will live in aged care this year.
• About half of them suffer some form of dementia, around one-third from severe dementia.
• It is estimated that more than 80,000 new aged-care places will be required in the next decade.
• Most facilities are more than 20 years old.
• Despite funding rising by $1 billion/year to nearly $20 billion this year, demand outstrips supply, complaints and risks rise.
• The average stay in aged care is 2.3 years.
• The aged-care sector is made up of 902 residential care providers, 702 home care providers, and 1621 home support services.
• More than half of all residential care providers are not-for-profits, 63 per cent operate just one residential care home, three are ASX-listed.

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• ASEAN market ripe for Australian food innovation
• Supermarkets competitive lansdcape explained
• Farm production value stable despite drought

 

Dr Julie Cichero is an Honorary Senior Fellow at the University of Queensland’s School of Pharmacy, Faculty of Health and Behavioural Sciences. She is an expert researching, among other things related to swallowing, thickened liquids and texture modified foods. Measurement and standardisation of names and definitions for texture modified foods and thickened liquids used for individuals with dysphagia (feeding and swallowing problems).

 

 

 

 

[1] The Conversation ‘Many Older people in care die prematurely, and not from natural causes’, May 2017 http://theconversation.com/many-older-people-in-care-die-prematurely-and-not-from-natural-causes-77942
[2]Ombudsman NSW (2015) Report of Reviewable Deaths in 2012 and 2013, Volume 2: Deaths of people with disability in residential care.
[3] Food Standards Australia New Zealand Act 1991

 

 

Cherie Hugo ABC interview from Rob Layton on Vimeo.