Age, weak muscle tone, chronic illnesses, and changes in the throat and esophagus increase the rate of airway obstructions in the elderly. A recent study that used spirometry measures as a clinical indicator of airway obstructions in patients aged 60-93 found an obstruction rate of 22.5% t. This suggests that many elders live with partial obstructions that compromise overall function and health. When they experience an injury or illness, it’s easy for a partial obstruction to become a life-threatening full obstruction. Here’s what you need to know.
Risk Factors for Airway Obstruction
The aging process itself is a risk factor for airway obstructions. Declines in muscle tone, weaker immunity, and similar factors conspire to subject elders to more respiratory problems and a higher risk of obstructions.
Some specific risk factors include:
- Chronic obstructive pulmonary disease (COPD). According to a study of airway obstruction in elders with COPD-asthma, factors that increase the risk of obstruction include advancing age, being male, smoking, low body mass index (BMI), and high serum staphylococcus levels.
- Exposure to infections. Infectious and aspiration pneumonia are major factors in airway obstructions among elders.
- Dysphagia and other swallowing disorders. Numerous conditions can lead to swallowing issues, but dementia is a common culprit. Dementia can further complicate airway obstructions by interfering with patient compliance and understanding.
Challenges of Maintaining a Patent Airway
First responders must be mindful of the unique challenges present among elders facing an airway obstruction. As with any patient, a comprehensive respiratory assessment is critical. Some additional factors to be mindful of include:
- Gingivitis and tooth decay are common among elders, many of whom have dentures or other dental structures. These structures can become dislodged during airway suctioning, further complicating obstructions.
- Loss of muscle tone and weakening tissue put elders at a heightened risk of iatrogenic injuries during suction.
- Cognitive and mobility impairments can make safely positioning an elder for suctioning more difficult. Patients with dementia may need additional support and may be combative if they don’t understand the need for treatment.
Prevention and Risk Management
The single most important strategy for preventing airway obstructions in seniors is managing chronic and acute conditions. Elders should be educated about the risks of untreated COPD and mindful of the compounding effects of smoking, a sedentary lifestyle, and other risk factors.
Pneumonia and flu prevention strategies are equally important. Consider working with other local agencies to offer free flu vaccines and pneumococcal pneumonia immunizations.
Even the best prevention efforts will not protect all elders from airway obstructions. EMS teams must be mindful of how airway obstructions present in elders. In addition to gagging, coughing, and an inability to clear the airway, FEV1/FVC is an important clinical indicator.
Research suggests that diagnostic criteria for airway obstructions in elders are different. Drawing upon a sample of 367 healthy seniors, the study concluded that FEV1/FVC <0.65 indicates an airway obstruction in men, and <0.67 points to an airway obstruction in women. First responders must be mindful of how age-related changes make diagnostic criteria used in other groups inadequate and misleading for seniors.
Why Equipment and Training Matter
The right equipment can be life-saving for seniors in the event of airway obstruction. Emergency portable suction machines allow you to go to the patient, rather than risking transporting a vulnerable senior. It’s also important to use the right catheter. Catheters that are too large can dislodge dental structures and injure the throat, so preparation demands having a variety of disposables on hand.
Many EMS teams use airway suction only occasionally, so it’s easy for a portable suction machine to sit in the corner of an ambulance untested and unused. This puts elders at risk because a battery or equipment failure can critically undermine suction power. To mitigate this risk, your team must test your equipment daily and regularly train and drill suction skills. When seconds count, the ability to safely clear the airway—especially in vulnerable populations—is an essential skill.
The right equipment lasts longer, works better, and can save lives. For help choosing the right suction device for your agency, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.
Editor's Note: This blog was originally published in November 2018. It has been re-published with additional up-to-date content.
