Preventing deaths of people with disabilities in care: Breathing, swallowing and choking risks

The NSW Ombudsman reviews the deaths of people with disabilities in care and makes recommendations to reduce preventable deaths.

Many people with disabilities face risks that make them highly susceptible to death from respiratory diseases and from choking on food. It is important that they receive support to minimise those risks, in order to reduce preventable deaths.

Choking on food

Deaths from choking on food can be prevented. It is important that the person’s choking risks are identified and that they receive support as soon as possible to address them.

You can be at risk of choking on food if you have:

  • swallowing problems
  • eating problems (including eating too fast, or without chewing)
  • mouth and dental problems that affect chewing
  • a history of choking
  • medication side effects, including:
    • drowsiness
    • dry mouth
    • involuntary movements

Respiratory disease

Respiratory diseases are a major cause of death of people with disabilities in care. The most common respiratory diseases causing these deaths are:

  • ASPIRATION - food, fluids and saliva going into the lungs. Aspiration can occur while eating, during a seizure, or by stomach contents coming back up and spilling into the lungs. It can cause pneumonia and irreversible lung damage.
  • PNEUMONIA - infection in one or both lungs.
  • DISEASES IN THE LOWER PART OF THE LUNGS - including asthma, Chronic Obstructive Pulmonary Disease (COPD), and emphysema.

People in disability accommodation services tend to die from respiratory disease at a much younger age than the general population – typically over 25 years younger. Many people with disabilities are vulnerable to death from respiratory disease because they have multiple risk factors.

You are at risk of respiratory disease if you:

  • have feeding and swallowing problems (including difficulty sitting upright and relying on others to feed them)
  • have eating problems (such as swallowing large mouthfuls of food, eating too fast, or without chewing)
  • have frequent chest infections
  • have difficulty moving around
  • have gastrointestinal problems (such as reflux and repeated vomiting)
  • are drowsy, or are not alert when eating or drinking
  • have dental problems or gum disease
  • have conditions such as epilepsy, cerebral palsy or Down syndrome
  • smoke

Supporting someone with breathing, swallowing or choking risks

Identify the risks

It is important that you help the person with disability that you support to identify any breathing, swallowing or choking risks they may have.

  • Assist them to have a comprehensive yearly health review with their GP (including a medication review). Make sure that the doctor has full information about the person’s health, medication, support needs and any changes.
  • Be aware of the different factors that can place people at risk of choking. It is not just people with swallowing problems who are at risk – most of the people with disabilities in care who choked on food in 2010 and 2011 had risks related to eating too fast, not chewing enough, and taking food that was not meant (or safe) for them.
  • Take notice of any changes in the person’s health, and help them to get medical assistance without delay. Changes may include not wanting to eat or drink, drowsiness, vomiting, coughing, and changes to their mobility, breathing, and mental health.
  • Work with the person and their GP to identify what you need to do to support them to prevent or manage respiratory illness, and to reduce their choking risks.
  • Assist the person to see health care providers and specialists as required, such as speech pathologists (for people with eating or swallowing problems), dentists and respiratory specialists.
  • Know the person’s eating and drinking requirements, and follow the recommendations and instructions of health care providers.
  • Know what to do if the person starts choking, becomes sick, or is hurt, including how to provide first aid.
  • Report any health incidents (such as gagging or nearly choking on food) and take action to make sure that the person receives support to prevent it from happening again.

Many people with disabilities die from respiratory illness within a very short period of time. Even small health changes – such as reduced interest in eating or drinking, increased body temperature, and coughing – can be serious, and require you to take action in getting medical assistance.

Resources and further information

Reviewable deaths

Preventative and community-based health programs

Contact us for more information

Our business hours are: Monday to Friday, 9am–5pm (Inquiries section closes at 4pm). If you wish to visit us, we prefer you make an appointment. Please call us first to ensure your complaint is within our jurisdiction and our staff are available to see you.

Level 24, 580 George Street
Sydney NSW 2000
General inquiries 02 9286 1000
Facsimile 02 9283 2911

Toll free (outside Sydney metro) 1800 451 524
Tel. typewriter (TTY) 02 9264 8050

Telephone Interpreter Service (TIS): 131 450
We can arrange an interpreter through TIS or you can contact TIS yourself before speaking to us.

© Crown Copyright, NSW Ombudsman, May 2013
ISBN: 978-1-921884-97-9 05/2013

This work is copyright, however material from this publication may be copied and published by State or Federal Government Agencies without permission of the Ombudsman on the condition that the meaning of the material is not altered and the NSW Ombudsman is acknowledged as the source of the material. Any other persons or bodies wishing to use material must seek permission.

Publication metadata

ISBN 978-1-921884-97-9
Category Fact sheets
Publication Date 8 May 2013