Retiree’s death ruled a misadventure; even rice is tricky for elderly, say docs
IT BEGAN like any other Sunday for retiree Ho Tack Thiam. His son, daughter and son-in-law had arrived at the nursing home where he had been living for over six years to take him out to lunch. The Sunday meal with his family was a weekly outing for the 81-year-old, who suffered from dementia and had lived at a Buangkok Green nursing home for the expert care he needed. That particular day – Aug 29 – turned tragic when Mr Ho choked on some noodles and lost consciousness at the coffee shop where they were eating. He died at Tan Tock Seng Hospital two days later.
At the coroner’s inquiry yesterday, State Coroner Imran Hamid returned a verdict of misadventure. Investigating officer Yow Kien Seng told the court that family members drove Mr Ho to the YY Kafei Dian coffee shop along Beach Road at about 11am. Soon after the dishes were served and the group started eating, the retiree was seen having difficulty swallowing. When his difficulty continued, family members rendered first aid. Then an ambulance was called and he was taken to Tan Tock Seng Hospital. Upon arrival, he was found to be in cardiac arrest and was placed on life support to stabilise his blood pressure and to keep him breathing.
Doctors noticed signs of severe brain injury, and his family was told that there was little chance he would recover. When his blood pressure and blood oxygen levels fell two days later, the family decided to take him off life support. He died soon after, at about 1pm. The court heard that Mr Ho suffered from dementia and high blood pressure. A medical report tendered at the coroner’s inquiry also indicated that during the initial stages of resuscitation at the hospital, medical staff had noticed noodles blocking his throat. He was admitted to the hospital’s intensive care unit but did not regain consciousness.
The cause of death was consistent with choking on food and no foul play was suspected, said Inspector Yow. An autopsy revealed sternum and rib fractures, but these were very likely caused during the resuscitation efforts, the report added. Also, a computer tomography scan did not reveal any acute bleeding in the brain or a major stroke. No family members were present at the inquiry. When The Straits Times visited the family home in Yishun, the dead man’s son was away on an overseas trip and his daughter-in-law declined to comment. She said she did not see her father-in law often.
Doctors that The Straits Times spoke to said it was possible for people to choke on items that were not typically round, such as noodles. Rounded objects like fishballs and meatballs may be easier to choke on because they can be swallowed whole, but even noodles when swallowed the wrong way could lead to choking, said Dr Goh E Shaun, associate consultant emergency physician at Khoo Teck Puat Hospital. “It only takes an object the size of a small fishball or a large marble to completely obstruct an adult human airway,” he said.
Dr Goh said this could be due to factors such as poor dentition – teeth alignment – or simply rushing through a meal without chewing properly. He added that elderly patients with poor dentition and medical history such as a stroke would have difficulty chewing well and forming a proper food mass before swallowing. “As a result, they are more likely to choke on not just fishballs or noodles but also just about anything, including even rice or water,” he said.
Dr Benjamin Leong from the Emergency Medicine Department at National University Hospital advises people to chew their food properly before swallowing, and to avoid laughing or talking loudly while eating, or taking overly large mouthfuls.