Visual failure in the elderly and dysphagia

A 91-year-old man presented with a history of acute dysphagia. Clinical examination found reduced oxygen saturations and lung basal crepitations. Blood tests revealed mild anaemia, leukocytosis and acute renal failure. Chest X-ray demonstrated two oesophageal foreign bodies (FBs) and consolidation at the left lung base. Dysphagia resolved following the removal of two coins at oesophagogastroduodenoscopy, the man did not recall ingesting coins. His coin ingestion was attributed to poor visual acquity and he was referred for eye examination and advised to keep coins separate from food and medication. Children and the aged are likely to swallow FBs; causes of ingestion include reduced ability to chew and/or distinguish between objects. Most FBs pass spontaneously, however those that become stuck are likely to impact in the oesophagus. It is important to consider visual acuity for both compliance with medication and to prevent ingestion of FBs.