Choking deaths pose serious threat to the wellbeing of people with disability
Speech Pathology Australia welcomes the Victorian Disability Services Commissioner’s report, “A review of disability service provision to people who have died 2017-18”, tabled in the Victorian Parliament yesterday, 19 December.
The preliminary cause of 10 of the deaths were recorded as choking on food or aspiration pneumonia – a life-threatening but often avoidable infection caused by inhaling food, fluid, saliva, or vomit into the lungs.
The Disability Services Commissioner identified:
- that in a high number of cases, safe mealtime advice provided by a speech pathologist was not followed by the disability service, which placed people with disability at significant risk of health complications and death;
- a lack of communication assessments and communication plans in place to support people with a disability to communicate their specific needs and choices and to raise health concerns.
The Victorian Disability Services Commissioner report comes on the heels of the NSW Ombudsman’s most recent report (2014-2017) that confirmed that people with disability who have oral eating and drinking difficulties and live in residential accommodation services are at increased risk from choking, or respiratory illness associated with chronic aspiration.
The NSW Ombudsman previously found that in 2012 and 2013 that the deaths of 239 people with disability in residential care were reviewable. In these cases, the underlying causes of death of people included respiratory diseases (24%) ― mainly pneumonia and aspiration pneumonia ― and external causes, mainly choking on food (7%).
Speech pathologists are the professionals who provide assessments and develop mealtime management plans, including advising on changes to the texture of food and fluids to enable safe and effective eating and drinking. People with disability who have problems eating, drinking and swallowing should be assessed by a speech pathologist.
Because adults with cognitive impairment may not be able to communicate difficulties with swallowing, support staff and health care providers need to be alert to the behavioural changes that may indicate a deterioration in their swallowing abilities.
An analysis of the cases reported to the Disability Services Commissioner over the past year indicated 31 per cent of people who were described as being non-verbal, but able to communicate with aids or gestures, were not provided with essential communication plans or aides. Carers and support staff must be aware of their important role in implementing and complying with mealtime management plans and the risks of not doing so.
There were also instances where the recommendations of a speech pathologist regarding the necessary modification to the texture of the person’s food and fluids were not followed. It is clear from the Commissioner’s report that more needs to be done to ensure that people with disability are provided with communication accessible and friendly environments. Only in this way can they communicate their health needs and concerns, especially in relation to feeding and swallowing.
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