Grilled cheese could be a deadly killer when it comes to Quebec’s elderly, according to a recent coroner’s report.

The report was initiated after two residents of the same St-Jean-sur-Richelieu long-term care facility died in similar incidents involving choking in recent years.

Coroner Andre-H. Dandavino recommended that both the local health authority and the provincial Health Department review the risks associated with grilled cheese sandwiches following the deaths of Clemence Thibodeau in 2015 and Monique Leboeuf in 2012.

According to Dandavino, the coroner bureau found a total of eight deaths due to choking on the sandwich over the past couple of years. 

Dandavino said he doesn’t want to get rid of the food from all hospitals or long-term care centres, but wants there to be a more in-depth investigation on the choking hazards grilled cheese can cause for certain people. 

Hard, cold lumps can be hard to swallow

He explained that when grilled cheese is prepared in a facility or hospital rather than being warm and soft, it hardens and gets colder because it takes a while to get to the patient. 

“It makes like a ball and it's difficult to swallow,” once chewed which is what happened in those two cases of his that sparked the inquiry. 

The Quebec Health Department says it is heeding the coroner’s recommendations and is finishing a comprehensive review of the risks of choking on food in the province’s network of facilities.

A spokesperson says the department isn’t focusing on grilled cheese in particular but rather on wider measures to reduce choking and improve patient safety. 

Elderly people can choke on toast, as well as peanut butter and toast, said nutritionist Stéphanie Chevalier. Grilled cheese isn’t the only hazard. 

“They’re not dangerous for all older adults. They’re dangerous when you start having problems with mastication and swallowing, which is also called dysphagia.”

Elderly need to be evaluated

Chevalier explained there are several phases of dysphagia, in which you would transition toward a diet that is pureed.The degrees of stages should be evaluated by a dietician or a health professional that has been trained to diagnose dysphagia. 

“If this was done properly, we would be in a better position to evaluate each resident in a long term care residence to evaluate their capacity to masticate and swallow, and then you can adapt the diet.”

Chevalier said in her opinion, the problem is that the evaluation isn’t done regularly, and that residents should also be re-evaluated consistently, because these problems can evolve. 

Georgia Graphos, chief of food services and clinical nutrition at the Donald Berman Maimonides Geriatric Centre, said they’re doing just that.

They evaluate the different needs for their residents on a regular basis.

“Some residents have chewing and/or swallowing difficulties, so we provide them with the safest texture, but we also try to meet their personal preferences. It’s very important, because they’re a milieu de vie facility.” 

Graphos also explained there are numerous foods that could be a choking hazard, but their level of risk depends on what a patient’s challenges are.

“It can be chewing, because they’re wearing dentures, or because they’re not wearing dentures and they don’t have all their teeth. They could be having trouble with foods that are piece-y, like peas or rice that have trouble holding together, that are not cohesive. It could be dried foods that break up in the mouth like crackers that are difficult to swallow because of a lack of saliva. It could also be liquids, if you're having a delay in your swallowing mechanism, the liquid could go down before they’re ready.” 

What to do if you’re eating at home alone 

According to Silvana Mauro, the managing rehab services and long term care at the Donald Berman Maimonides Geriatric Centre, several things can be done to try to avoid a choking situation. There are also warning signs to watch out for. 

“If you're eating and you find yourself coughing, just be aware that it might be a sign that you're having trouble in regards to swallowing, and you should consult a physician.” 

Consult a physician if you get teary eyed when you’re eating as well. 

And slow down. “If you're also eating rapidly and shoving food in your mouth, slow it down, take the time to chew, take the time to swallow before you eat again.”

She also said to make sure to keep well hydrated “so you don't have a dry mouth, since we’re gonna have a reduction in saliva as we get older.” 

And a big one: don’t talk while eating. “We tend to socialize, and tend do wanna have fun and talk and drink and chew. But we can't multitask at a certain point in time, when we have deficits”. 

-With files from The Canadian Press and CTV News Montreal's Amanda Kline