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, many 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 — that falls are among the leading health threats facing older adults worldwide.
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 every year. Nigerian studies paint a similar picture, with reported prevalence ranging from about 23 per cent to over 40 per cent depending on the community studied.
Why Older Adults Fall
According to the experts, falls among Nigerian elders are related to their advancing age which naturally results in reduced balance, gait impairment, and overall frailty, making them more susceptible to losing their footing. Thus, falls are primarily driven by a mix of physical health conditions such as arthritis and visual impairment and environmental hazards such as slippery floors and poor lighting. Of course, there are also the socio-economic pressures like inadequate access to healthcare. Older adults who live alone, are said to suffer from a poor quality of life, or have a fear of falling which tend to limit physical activity. This often results in further muscle weakness and an unsteady gait
Various studies also cite underlying medical issues being strongly associated with falls in Nigerian elders. These include unmanaged dizziness, and chronic pain conditions. The study at Irrua Specialist Teaching Hospital, Irrua, Edo State, for instance, identified smoking, chronic medications, musculoskeletal pain, geriatric depression, environmental hazard, cognitive impairment and abnormal gait and balance, as significant risk factors found among study participants.
According to researchers, activities being carried out when falls occurred included bathing, lifting firewood, clearing farmland, climbing onto a motorcycle, crossing a drainage channel or pothole, becoming dizzy while trying to sit down, standing in church, standing in a bank, trying to lie down and walking. Researchers also 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.
Beyond bruises and cuts, falls can result in hip fractures, head injuries, prolonged hospitalisation, disability, loss of independence and premature death. Many older adults who survive a serious fall never regain their previous level of mobility. Fear of falling again often causes them to reduce physical activity, leading to muscle weakness, social isolation and further decline.
The Consequences
Older adults should take practical precautions against falls during their daily activities, both at home and outdoors. Not only that, family members, caregivers and communities all have a role to play in reducing fall risks for older adults..
Experts also recommend that Nigerian physicians remain alert to medical conditions that increase the risk of falls such as; sudden drop in blood pressure (orthostatic hypotension), gait and balance issues, vision disturbances, environmental hazards, vertebrobasilar insufficiency (i.e. a temporary or permanent drop in blood flow to the back part of the brain) and loss of consciousness, during clinical visits and hospital admissions to guide treatment options for incidents of falls.
Nigeria has developed policies intended to improve the welfare of older persons, including the National Policy on Ageing and the National Health Act. However, implementation remains weak, and specific strategies for preventing falls in senior citizens have received little attention. The elderly could actually benefit a lot from the Basic Health Care Provision Fund in the National Health Act which legally guarantees emergency medical treatment without upfront payment but this is rarely implemented in most hospitals, especially the private institutions.
All said, falls should never be dismissed as an inevitable part of ageing. Most falls are preventable, and preventing them is often far easier than treating their devastating consequences. As Nigeria’s population grows older, making homes, communities and healthcare services safer for older adults must become a national priority. Helping older Nigerians remain on their feet is one of the simplest ways of helping them remain healthy, independent and dignified.
Fall Prevention Tips
Falls are a common public health problem amongst the elderly which often put them at the risk of injury and sometimes, untimely death. Experts however say they can be prevented both by the elders themselves and people around them. Here are some tips on how to achieve this.
- Watch your medications. According to experts, many common medications for blood pressure, arthritis, and insomnia can cause dizziness or sudden drop in blood pressure (orthostatic hypotension). Cases of dizziness should therefore be reported to healthcare providers once they occur for review to prevent falls. The Mayo Clinic in its advisory this month disclosed that eye and ear issues may increase risk of falls urging that elders should discuss their health conditions and how comfortable they are when they walk. “For example, do you feel any dizziness, joint pain, shortness of breath, or numbness in your feet and legs when you walk? Your healthcare professional may evaluate your muscle strength, balance and walking style, called gait, as well.”
- Make the environment free of hazards for elders: Clear all walkways of extension cords, clutter, and loose rugs from elders’ environments. Watch out for hazards such as slippery floors especially in the bathroom, while bright lighting should be installed along dark hallways and staircases. Safety bars should be installed in elders’ bathrooms while handrails should be a common feature in public buildings and hallways for general support.
- Wear elder-friendly Footwear: Avoid high heels, floppy slippers and shoes with slick soles as they can make you slip, stumble and fall. Consider wearing sturdy, closed-back footwear with non-slip rubber soles instead.
- Check vision and hearing regularly: Many older people don’t realise that poor vision, cataracts, glaucoma and hearing loss can increase the risk of falls.
- Keep moving: Experts advise elders not to avoid physical activities out of fear of falling. Activities such as walking, strength training and gentle workout (with professional guide) could reduce the risk of falls by improving strength, balance, coordination and flexibility. “If you avoid physical activity because you’re afraid you might fall, tell your care team. They may recommend carefully monitored exercise programs or refer you to a physical therapist. The physical therapist can create a custom exercise program to improve your balance, flexibility and muscle strength,” the Mayo Clinic says in its advisory.
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