Do not yield to accidental falls without a fight

Dear Tingasiga:

Deaths of prominent Ugandans caused by falls in bathrooms have rightly focused citizens’ attention on this common and potentially dangerous accident.

A person’s life can be profoundly altered, even ended in seconds. Those who survive can have severe disabilities, with chronic pain, loss of independence, and medical complications from reduced mobility. The cost of their healthcare and personal support can be prohibitive, even bankrupting. 

All who walk, including infants, are at risk of falling and sustaining severe injury. Lack of adequate Vitamin D increases the risks of these falls resulting in broken bones.

A recent American study from Los Angeles, California, published in the Journal of Surgical Research, found that the ages of those injured from falls ranged from 0 to 92 years. The mean age at injury was 45 years, and those aged 41-60 years were at the highest risk.  

I am a living example of a consequential fall at a young age. While walking from a parking lot to a street a few meters from my place of work in Toronto, I fell face down and hit my head on a concrete pavement. With blood dripping from my forehead, I walked over to the nearest emergency department. 

But not before looking at the spot where I had fallen. I had tripped on a security chain that someone had placed very low near the ground to prevent cars from entering the parking lot from that street. This was a newly placed chain in an area with which I was very familiar. I had walked along the usual path without looking down. 

The careless placement of that chain, without prominently displayed signs to warn pedestrians of the danger, was the easy thing to blame. However, it was my assumed familiarity with the place, and my false confidence that cost me some blood, earned me a scar, and taught me an unforgettable lesson. I was only 35.

Now that I am a senior citizen, I am even more conscious of the risk that I face each time I get up to walk even a very short distance. There is a significant increase in the rate of accidental falls after the age of 65 years. Each year in the United States of America, 1 in 4 older adults falls. 

Approximately 3 million older American adults visit emergency departments with fall-related injuries. Nearly one million of them are admitted to hospitals, and more than 32,000 die because of accidental falls. The American experience is like that in other high-income countries.

Whereas I do not know the figures for Uganda, it is very likely that this is as significant a problem in our country as it is in most parts of the world. The uneven terrain in our homes and villages, the unavoidable navigation of treacherous paths, often through slippery slopes, and prevalent co-morbid risk factors that are associated with accidental falls, place us at significant risk in Uganda.  

These common risk factors include heart and blood vessel disease, nerve and muscle disorders, diabetes, alcohol intoxication, and use of medications that may affect balance or awareness. Visual impairment is another risk factor. It probably contributed to my accidental fall.

Most of these accidental falls occur in places that are very familiar to the victims. In North America, falls occur (in order of frequency) in bedrooms, on stairs, in bathrooms, kitchen/dining rooms, driveway/garage, the house garden and backyard, sitting room, and the verandah. 

The story in the upscale neighbourhoods of urban Africa might be close to this. In rural villages in Africa, the risks are compounded by poor lighting at night, and outhouses being the commonest toilet facilities. 

Seven concerning observations I have made during my visits to Uganda are: (1) the rareness of ramps in homes and many public buildings, (2) the preference for very smooth, shiny floor tiles in bathrooms and other living areas, (3) the presence of deep bathtubs in homes; (4) the rareness of grab bars in bathrooms and toilets; (5) poor lighting along paths, even in upscale neighbourhoods, (6) open manholes and very irregular surfaces along sidewalks, and (7) steep straight line staircases in some homes.  

There is a need to have a national conversation on building and home environment standards, with a focus on injury prevention. Obvious measures for preventing these accidental falls include remaining constantly alert to the potential hazards for tripping; regularly exercising to maintain strong muscles, bones, balance and overall health; regular visits to the doctor to ensure good visual, hearing, heart and neurological health; maintenance of adequate hydration to avoid fainting due to low blood pressure; health professional-guided use of medications, and avoidance of over-the counter drugs; keeping the number of prescribed medications to an absolute minimum for the condition under treatment; learning about all the known potential side effects of whatever medication and supplements you take; avoidance of intoxication; minimizing the obstacles by removal of clutter and those popular throw-rugs from the home; installation of non-slip floor tiles; placement of non-slip mats in bathtubs and shower stalls; removal of those closed deep bathtubs, and replacing them with walk-in bathtubs or shower stalls only; closing all manholes with hard-to-steal covers; maintenance of sidewalks; avoidance of stairs whenever possible; painting the edges of stairs to enhance their visibility; installing stair guardrails; and wearing non-slip, properly fitting shoes. 

Accidental falls are part of the risks of living. We who have passed the age of 65 are at particularly high risk. However, we must not surrender to that fate without a fight. If we are to fall and sustain injuries, let it not be because we have neglected to pay attention to prevention measures. 

My heart goes out to the families of those who have died because of these accidental falls. My beloved paternal first cousin Kenyangye ka Bihagaro bya Rukooko died on March 26. The cause of her death was a long-term complication of a hip fracture that she sustained in a fall on November 19, 2019, near her home in Kahondo ka Byamarembo, Kigyezi.  

She endured pain, immobility, humiliating dependence on others, and secondary psychological distress for more than four years. The lack of accessible public medical care and the financial impediments to accessing private treatment took a huge toll on her, and her family. She was 84 years old. 

Mulera is a medical doctor.         
[email protected]