Could eating dinner be a danger to your health? Choking is a risk if you or your loved one have difficulty swallowing, a condition called dysphagia.

In fact, research has found that nearly 40 percent of nursing home residents have some difficulty swallowing.1 Even sleeping can result in choking trauma if the bed is poorly constructed. Bed-rail gaps can trap the resident’s head and prevent breathing.

Risk Factors

Many medical conditions can affect the muscles and nerves in the throat and cause difficulty swallowing:2

  • Stroke or brain injury
  • Diseases that affect the nervous system such Parkinson’s or multiple sclerosis
  • Alzheimer’s disease
  • Gastroesophageal reflux disease (GERD)
  • Tumors of the throat

Many medications can also affect the ability to swallow. Even nonmedical conditions, such as ill-fitting dentures, can interfere with swallowing.

The dangers of choking or strangulation are not limited just to the dining room. Strangulation can occur when a resident gets caught between the mattress and the bed rails: bed-rail entrapment. The US Food and Drug Administration (FDA) has been warning of this danger for years.3 This tragic problem occurs when the design of the bed, mattress, or rail causes a gap that can trap a resident’s head or neck. Often a facility sources each of these bed components from different manufacturers, which leads to an increased risk of deathly gaps in the bed.

Duty of Nursing Homes

Nursing homes present themselves to the community as experts in dealing with elderly residents and the conditions that affect them. The best practice is prevention or identification of risk factors. Every nursing home has a duty to assess all new residents; part of that assessment includes ability to chew and swallow. Members of the caregiving team include nurses, a speech pathologist, a dietician, and, of course, the resident’s physician. All of these professionals should be aware of the risk factors for difficulty swallowing.

If the team does a proper interdisciplinary assessment, the results should lead to interventions set forth clearly in the resident’s care plan. Some common interventions include a pureed diet, thickened liquids, supervision or assistance with eating, minimal use of sedatives, and eating in a chair. When carefully administered, these precautions should prevent most incidents of choking.


Choking or strangulation of nursing home and assisted living residents should never occur. If you suspect that your loved one suffered unexplained injury or death, an investigation is needed. We have investigated and prosecuted many such cases of nursing home abuse and negligence.

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1. Humbert IA, Robbins J. Dysphagia in the elderly. Phys Med Rehabil Clin N Am 2008;19(4):853-866