Exploring the social context of choking and its implications for care

Using grounded theory methodology this study retrospectively explored the social context of choking for at-risk adults and their carers through the lens of Australian coronial reports from 2000 - 2010. The data were the police, autopsy, finding, and inquest reports compiled as part of a coronial investigation into a choking fatality, which is a reportable death in Australia. Data were obtained through access to the National Coronial Information System (NCIS). The population of interest were adults who were clinically considered more at risk of choking than the general population. An increased risk of choking has been established in adults of advanced age and those with medical conditions associated with dysphagia (swallowing problems). Two hundred and fifty six (256) adults were identified as potentially having a predisposition to choking based on the combined criteria of age and/or medical history. Coroner's reports have been used internationally in studies exploring choking phenomena. These studies have identified many factors contributing to choking, with the aim of reducing fatality through the control of these recognised risk factors. The clinical management of choking for at-risk adults is currently closely aligned with the biomedical model of health care and focuses on reduction of risk and death prevention for the at-risk adult. There is however, an increasing awareness that such an alignment might be too narrow to address issues arising for at-risk adults and their carers living with choking risk and its expression. Coroners' reports are rich sources of information. They not only identify specific factors that may have contributed to a person's death but also provide insights into the social context of the death and all who may be affected by it. The social context of choking has not been widely explored, despite the contribution such knowledge could make to understanding in the area. The aim of this study was to explore the social context of choking and its implications for care. To meet this aim, grounded theory methodology was chosen for its capacity to analyse and elucidate complex data, build understanding of multifaceted phenomena and formulate theory. Exploration of the social context of choking identified that there are challenges for both at-risk adults and carers in this area of care which are not being addressed by current prevention-focused management. Based on these findings it is theorised that an expanded model of care is required, that includes a broader concept of 'considered support' rather than the management of risk and death prevention alone. Considered support in the proposed expanded model does not negate the appropriateness of attempting to prevent choking, but it broadens care to address the concerns of at-risk adults and their carers which fall outside the ability to control and prevent choking.