Advertisement

Foreign body asphyxia

A preventable cause of death in the elderly

      Abstract

      Background

      To assess the prevalence of food/foreign body asphyxia in the elderly Viennese population in order to reduce the incidence of these fatal events.

      Methods

      This is an autopsy-based, retrospective study in Vienna, Austria. Participants included all nonhospitalized (n =200) cases of choking in 1984 to 2001, from a total 42,745 consecutive autopsies performed at the Institute of Forensic Medicine. In addition, data from hospitalized adult cases of fatal choking (n =73) in 1984 to 2001, from the mortality registrar of Vienna, were included.

      Results

      The nonhospitalized choking victims were analyzed according to age (18 to 64 vs ≥65 years), sex, circumstances of death, and predisposing factors. Hospitalized cases were analyzed according to age, sex, and whether an autopsy was already performed by pathologists at the institution where they died. In the study period, 273 adults died of food/foreign body asphyxia, 73% of them out of the hospital and 27% in hospitals. Food/foreign body asphyxia in the elderly was characterized by a significantly higher asphyxiation of soft/slick foods (p <0.007) with agomphiasis (p <0.002), occurring most frequently during lunch (49%), and in 2.5% during feeding of neurologically impaired. In contrast, younger individuals choked significantly more often on large pieces of foreign material (p <0.002) and showed a significantly higher rate of blood alcohol concentration (p <0.001).

      Conclusions

      This study demonstrates that semisolid foods are the cause of a large number of asphyxiations, especially among the elderly. Knowledge of the fact that semisolid foods are a high-risk factor in elderly individuals should be distributed in public and private healthcare systems, and awareness could be a first step in reducing the incidence of food/foreign body asphyxia.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Haugen R.K.
        The cafe coronary—sudden deaths in restaurants.
        JAMA. 1963; 186: 142-143
        • Berzlanovich A.
        • Muhm M.
        • Sim E.
        • Bauer G.
        Food/foreign body asphyxia—an autopsy study.
        Am J Med. 1999; 107: 351-355
        • Statistics Austria
        Mortality records 1984–2001. Statistics Austria, Vienna2002 (data set)
        • Mittlemann R.E.
        • Wetli C.
        The fatal cafe coronary.
        JAMA. 1982; 247: 1285-1288
        • Irwin R.S.
        • Ashba J.K.
        • Braman S.S.
        • Lee H.Y.
        • Corrao W.M.
        Food asphyxiation in hospitalized patients.
        JAMA. 1977; 237: 2744-2745
        • Gelperin A.
        Sudden death in the elderly population from aspiration of food.
        J Am Geriatr Soc. 1974; 22: 135-136
        • Hu T.
        • Huang L.
        • Cartwrigth W.S.
        Evaluation of the costs of caring for the senile demented elderly.
        Gerontologist. 1986; 26: 158-162
        • Fioritti A.
        • Giaccotto L.
        • Melega V.
        Choking incidents among psychiatric patients.
        Can J Psychiatry. 1997; 42: 515-520
        • Finestone H.M.
        • Foley N.C.
        • Woodbury M.G.
        • Greene-Finestone L.
        Quantifying fluid intake in dysphagic stroke patients.
        Arch Phys Med Rehabil. 2001; 82: 1744-1746
        • Pontoppidan H.
        • Beecher H.K.
        Progressive loss of protective reflexes in the airway with the advance of age.
        JAMA. 1960; 174: 77-81
        • Kendall K.A.
        • Leonard R.J.
        Bolus transit and airway protection coordination in older dysphagic patients.
        Laryngoscope. 2001; 111: 2017-2021
        • Feinberg M.J.
        • Ekberg O.
        Deglutination after near-fatal choking episode.
        Radiology. 1990; 176: 637-640
        • Hsieh H.H.
        • Bhatia S.C.
        • Andersen J.M.
        • Cheng S.C.
        Psychotropic medication and nonfatal cafe coronary.
        J Clin Psychopharmacol. 1986; 6: 101-102
        • Stallings Harris C.
        • Baker S.P.
        • Smith G.A.
        • Harris R.M.
        Childhood asphyxiation by food—a national analysis and overview.
        JAMA. 1984; 251: 2231-2235
        • Heimlich H.J.
        A life-saving maneuver to prevent food-choking.
        JAMA. 1975; 234: 398-401
        • Heimlich H.J.
        • Patrick E.A.
        Best technique for saving any choking victim’s life.
        Postgrad Med. 1990; 87: 38-48
        • Eller W.C.
        • Haugen R.K.
        Food asphyxiation—restaurant rescue.
        New Engl J Med. 1973; 289: 81-82