Swallowing Foreign Objects Is No Laughing Matter For Dementia Patients In Nursing Homes

swallowed objectWho doesn’t remember the shock of their first time at the circus when the fire-eater or knife-swallower made their way to center ring to perform their stunts?  Surely, even when these trained performers make their way into the big top, there is always a risk of danger.

Certainly, not to make light out of a serious issue, there are similar swallowing-related dangers facing patients who may not be able to appreciate the dangers.  I have worked on a number of cases involving disabled patients who have swallowed foreign objects during admissions to nursing homes, hospitals and group homes.

Most of these foreign-object cases involve patients with Alzheimer’s and other psychiatric conditions who remain unable to appreciate the dangers associated with swallowing materials that may be on hand in their rooms.

Commonly encountered swallowed foreign objects including:

  • Plastic knives and forks
  • Food packaging
  • Sterile gloves
  • Pens
  • Toothbrushes
  • Coins
  • Razorblades
  • Dental implants / dentures

What makes many of the foreign object ingestion cases particularly horrific for the patient is the fact that many of the foreign objects are extremely dangerous is the fact that many objects go undetected by staff until a problem manifests itself in the form of a severe medical complication — such as choking or internal bleeding.

Given the prevalence in ingesting foreign materials or objects amongst Alzheimer’s, dementia and psychiatric patients, facilities need to be mindful of this real tendency and take steps toward minimizing the chances a patient can access these materials:

  • Facilities should take steps towards identifying which patients have a history of ingesting foreign materials
  • Medical devices should be kept under locked conditions
  • Staff should remove non-edible food wrappers and coverings from meals prior to serving staff
  • Staff should supervise patients with a swallowing proclivity

Due to the fact that many of these patients are simply unable to perceive the dangers associated with ingesting foreign objects, facilities need to be mindful of the inherent risks associated with keeping materials accessible to their patients and implement safeguards to prevent patients susceptible to this type of behavior from accessing materials.

Resources:

Intentional Swallowing of Foreign Bodies and Its Impact on the Cost of Health Care, Science Daily, November 4, 2010

Foreign body aspiration in dentistry- a review (PDF) The Journal Of The American Dental Association 1996;127;1224-1229 by SM Cameron, WL Whitlock and MS Tabor

CT Features of Esophageal Emergencies (PDF) Radiographics by Catherine A. Young, MD, JD • Christine O. Menias, MD • Sanjeev Bhalla, MD • Srinivasa R. Prasad, MD (2008)

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