Aspiration occurs when food, liquid, saliva, or other material enters the airway instead of being swallowed normally. Choking occurs when food or another object partially or completely blocks the airway.
Older adults and medically compromised patients may be at increased risk because of difficulty swallowing, also called dysphagia. Risk factors can include stroke, Parkinson’s disease, dementia, neurological disorders, decreased alertness, weakness, certain medications, and conditions that affect the muscles or nerves involved in swallowing (MedlinePlus, 2025; CDC, 2024).
Assessing Swallowing and Aspiration Risk
Healthcare facilities should recognize patients and residents who may have difficulty swallowing. Warning signs can include coughing or choking while eating or drinking, difficulty starting a swallow, food remaining in the mouth, a wet or gurgling voice after swallowing, or repeated respiratory infections.
When swallowing problems are suspected, further evaluation may be needed. This may include a swallowing assessment by a speech-language pathologist and, when appropriate, specialized testing to determine whether food or liquid is entering the airway.
Aspiration and Choking Precautions
The precautions needed depend on the patient’s individual condition and swallowing ability. Patients at risk may need supervision or assistance during meals, upright positioning while eating and drinking, and a modified diet or liquid consistency. Staff should follow swallowing
recommendations, allow adequate time for eating and drinking, and monitor for coughing, choking, or other signs of difficulty. Changes in a patient’s ability to swallow should be recognized and addressed promptly.
Failure to Recognize or Prevent Aspiration
Not every aspiration or choking event can be prevented. However, when a patient has known or recognizable swallowing difficulties, failing to properly assess the risk or follow appropriate precautions can lead to serious harm.
Aspiration can result in airway obstruction, lung irritation, or aspiration pneumonia, while complete choking can prevent oxygen from reaching the lungs and brain. Swallowing problems can also contribute to dehydration, malnutrition, and other serious complications.
A complete airway obstruction is a medical emergency. Without oxygen, brain damage can begin in as little as about four minutes, and prolonged oxygen deprivation can result in severe brain injury or death (MedlinePlus, 2026).
For this reason, predictable swallowing difficulties should be recognized and appropriate precautions followed. When a facility fails to assess a patient’s swallowing ability, provide necessary supervision, follow diet or swallowing recommendations, or respond promptly to choking or aspiration, preventable injury may occur.
If you or someone close to you has been in a hospital, nursing home, rehabilitation center, or other care facility and suffered a serious injury from aspiration or choking that you believe could have been prevented, call our injury team at the Law Offices of Judy Greenwood for a FREE CONSULTATION at 215-557-7500.
References
MedlinePlus. (2025). Swallowing Disorders. U.S. National Library of Medicine. https://medlineplus.gov/swallowingdisorders.html
Centers for Medicare & Medicaid Services. (2024). State Operations Manual: Appendix PP – Guidance to Surveyors for Long Term Care Facilities.
https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulati ons/nursing-homes
MedlinePlus. (2026). Choking – Adult or Child Over 1 Year. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/000049.htm
Centers for Disease Control and Prevention. Guidelines for Prevention of Healthcare-Associated Pneumonia.
