More than a slip: Dangers of falls in old age

By Sam Efararo

Renowned nationalist, lawyer, statesman and first Premier of the old Western Region, Chief Obafemi Awolowo died in the bathroom of his Ikenne home on May 9, 1987. Although the exact circumstances of his death were never officially established, some have speculated that the 78-year-old elder statesman may have slipped while taking his bath.

Whether or not that was the case, his death reminds us of a reality often overlooked in Nigeria: falls are a major health threat facing older adults.

Studies from Spain, Italy and Brazil consistently show that between one-quarter and one-third of adults aged 70 years and above experience at least one fall each year. Nigerian studies have reported prevalence ranging from about 23 per cent to more than 40 per cent, depending on the community studied.

Why do older people fall?

Ageing can bring changes in balance, gait and muscle strength, making it easier to lose one’s footing. But falls are rarely caused by age alone. Arthritis, poor vision, dizziness, chronic pain and other medical conditions can increase the risk. So can environmental hazards such as slippery floors, poor lighting and uneven walkways.

A study at Irrua Specialist Teaching Hospital, Edo State, identified several risk factors among participants, including smoking, chronic medication use, musculoskeletal pain, geriatric depression, environmental hazards, cognitive impairment and abnormal gait and balance.

Researchers have also documented falls occurring during everyday activities such as bathing, lifting firewood, clearing farmland, climbing onto a motorcycle, crossing a drainage channel or pothole, standing in church or a bank, sitting down, lying down and simply walking.

The environment matters greatly. One study found that older adults living in homes free of environmental hazards were about 2.5 times less likely to experience a fall than those living in hazardous environments.

The consequences can go far beyond a bruise or cut. Falls can cause hip fractures, head injuries, prolonged hospitalisation, disability, loss of independence and premature death. Some older adults who survive serious falls never regain their previous level of mobility.

There is also a psychological consequence. Fear of falling again can cause an older person to reduce physical activity. This may lead to muscle weakness, social isolation and an even greater risk of another fall.

Preventing falls therefore requires more than telling older people to “be careful”. Family members, caregivers, communities and healthcare workers all have roles to play.

Doctors should pay attention to conditions that can increase fall risk, including sudden drops in blood pressure when standing, gait and balance problems, vision disturbances, environmental hazards and episodes of loss of consciousness.

Families can also make homes safer by clearing walkways, improving lighting, reducing slippery surfaces and ensuring that bathrooms and stairways have appropriate support.

Older adults who experience dizziness, unsteadiness, new weakness or repeated falls should tell a healthcare professional rather than simply avoiding activity. Medication may need review, while problems with vision, hearing, balance or blood pressure may require attention.

Staying physically active is also important. Appropriate walking, strength and balance exercises can help maintain muscle strength, coordination and confidence. For people who already have significant balance problems, exercise should be guided by an appropriate health professional.

Nigeria has policies intended to improve the welfare of older persons, including the National Policy on Ageing and provisions of the National Health Act. But implementation remains a challenge, and fall prevention deserves greater attention as the country’s population ages.

A fall is often treated as an accident. But for an older person, it can be the beginning of a long period of disability. That is why prevention deserves attention before the first fall occurs.

Helping older Nigerians remain safely on their feet is also helping them remain independent, active and dignified.

Takeaway Fall Prevention Tips

Watch medications: Some medicines used for blood pressure, arthritis and insomnia can cause dizziness or a sudden drop in blood pressure. Report dizziness or unsteadiness to a healthcare professional so medicines can be reviewed where necessary.

Make the environment safer: Clear walkways of clutter, loose rugs and extension cords. Pay particular attention to slippery bathroom floors. Improve lighting along dark corridors and staircases, and consider safety bars and handrails where appropriate.
Wear suitable footwear: Avoid high heels, floppy slippers and shoes with slippery soles. Sturdy footwear with a secure fit and non-slip soles can provide better support.

Check vision and hearing: Poor vision, cataracts, glaucoma and hearing problems can contribute to falls. Regular checks can help identify problems that need attention.

Keep moving: Fear of falling should not automatically lead to inactivity. Walking, strength and balance exercises can help maintain muscle strength, coordination and confidence. Older people with significant balance problems should seek appropriate professional guidance before starting a new exercise programme.