Fall prevention for elderly parents in Nigeria: a home safety guide, and what to do after a fall

Why falls matter more as parents age

Falls are the second leading cause of unintentional injury deaths worldwide, according to the World Health Organization. An estimated 684,000 people die from falls each year, and more than 80% of those deaths happen in low- and middle-income countries like Nigeria. Adults over 60 suffer the greatest number of fatal falls. Around 37.3 million falls a year are serious enough to need medical attention.

In the United States, the CDC reports that more than one in four older people falls each year, yet less than half tell their doctor. Falls are the most common cause of traumatic brain injury in older adults, and falling once doubles the chance of falling again. The WHO notes that 20 to 30% of older Americans who fall suffer moderate to severe injuries such as bruises, hip fractures or head trauma.

The injury is only part of the story. After a fall, many older people become frightened of falling again. They move less, stay in one chair, and avoid the bathroom or the stairs. Their muscles weaken, their balance gets worse, and the risk of another fall goes up. A parent who was walking to church or the market can lose that confidence within weeks.

A hip fracture is the injury families fear most, and with reason. It almost always means surgery, a hospital stay and weeks or months of rehabilitation. The NHS says some people never get back the strength and movement they had before, and may need a walking aid or help at home afterwards.

Why older people fall

A fall rarely has one cause. Usually two or three things come together: weak legs, a wet floor and a dark corridor, for example. These are the most common reasons older people fall at home, and how they show up in a Lagos house.

• Muscle weakness and poor balance, often from sitting for long periods.
• Poor eyesight, including cataracts, old glasses or not wearing glasses at night.
• Medicines, especially blood pressure tablets, sleeping tablets, some antidepressants and water tablets. Taking several medicines together raises the risk.
• Dizziness on standing up, when blood pressure drops as your parent gets out of bed or a chair.
• Not drinking enough in the heat. Dehydration and skipped meals can leave your parent lightheaded.
• Foot problems such as corns, swelling or numb feet from diabetes, and poor footwear like loose slippers or wet bathroom slippers.
• Needing the toilet urgently at night and hurrying in the dark.
• Dementia or confusion, which can affect judgement and how your parent sees steps and edges.
• The after-effects of a stroke, such as weakness on one side or problems with balance.
• Alcohol, even in small amounts, especially with medicines.

If your parent has had more than one fall, or keeps feeling unsteady, that is a sign to look for the cause rather than just being more careful.

Signs your elderly parent needs more help at home

Stroke care at home in Lagos

A room-by-room safety check for a Lagos home

Walk through the house slowly, ideally with your parent, at the times they actually move around: early morning, evening and at night. Use this checklist.

Bathroom. This is where many falls happen, because tiled floors get wet and soapy.

• Put a non-slip mat inside the shower or bath area and a dry, rubber-backed mat outside it.
• Fit a grab rail by the toilet and another inside the shower. A towel rail will not hold body weight.
• If there is a step up into the shower, mark the edge with a bright strip and add a rail to hold.
• For bucket baths, let your parent sit on a sturdy plastic chair or shower stool with rubber feet, with the bucket at waist height rather than on the floor.
• Check the toilet height. If your parent struggles to stand from a low toilet, a raised toilet seat or a frame around it helps.
• Wipe up water straight after bathing and keep soap within reach so your parent does not bend or stretch.

Bedroom.

• The bed should be at a height where your parent can sit with feet flat on the floor and knees level with the hips.
• Put a night light or a lamp they can reach without getting up.
• Keep a charged phone by the bed, every night.
• Clear the path from the bed to the toilet: no slippers, bags or boxes on the floor.
• Encourage your parent to sit on the edge of the bed for a minute before standing.

Stairs and steps.

• Rails on both sides of the stairs, firmly fixed.
• Good light at the top and bottom, with switches at both ends if possible.
• Nothing left on the steps: no shoes, bags or water kegs.
• Mark the edges of steps with paint or tape in a contrasting colour, especially single steps between rooms.

Living room.

• Remove loose rugs or fix them down firmly.
• Keep generator and extension cables against the wall and out of walkways.
• Move low stools and side tables out of the main path.
• Avoid polishing tiles to a shine. Polished tiles are slippery, especially in socks.
• Give your parent a firm chair with arms, at a height that is easy to rise from.

Kitchen.

• Move things your parent uses every day to shelves between waist and shoulder height.
• No climbing on stools or chairs to reach high cupboards.
• Wipe up oil, water and spills at once.

Compound and outside.

• Check for uneven or loose interlocking stones and get them relaid.
• Cover open gutters and drains near paths.
• In the rainy season, clear puddles and scrub away moss and algae, which make concrete very slippery.
• Add a rail to any outside steps, including the steps at the front door.
• Make sure the gate opens easily and your parent does not have to step over a high bar.

Power cuts at night. When the light goes off, an older person getting up for the toilet is walking in total darkness. It is one of the most dangerous moments of the night for an older person.

• Keep a rechargeable lamp or torch by the bed, and check it is charged.
• If the home has an inverter or solar, make sure it powers at least one light on the path from the bed to the toilet.
• Small plug-in or battery night lights along the corridor help.
• Consider a commode or urinal by the bed if your parent needs the toilet several times a night.

Strength and balance exercises to do together

The NHS advises strength and balance activities at least twice a week. Stronger legs and better balance are among the most effective ways to prevent falls, and it is never too late to start. Check with your parent's doctor or a physiotherapist first, especially if they have heart problems, recent surgery or a past fall.

These simple exercises can be done at home with a caregiver standing close by.

• Sit to stand: from a sturdy chair with arms, your parent stands up slowly and sits back down with control. Start with five and build up. Use hands to push up at first, then try without.
• Heel raises: holding a kitchen counter or the back of a heavy chair, your parent rises up onto their toes and lowers slowly, ten times.
• Walking: a short walk every day, inside the house or around the compound in the cooler part of the morning, with a caregiver beside them.

Stop if your parent feels dizzy, short of breath or has chest pain. A physiotherapist can set a programme that suits your parent. Many hospitals and private clinics in Lagos have physiotherapy departments, and some physiotherapists visit at home.

Footwear and walking aids

Shoes matter more than most families expect. Loose slippers that slide off the heel, and wet rubber bathroom slippers worn around the house, cause many falls. Your parent needs well-fitting shoes or slippers that hold the heel and have a thin, non-slip sole. Avoid walking in socks on tiles.

A walking stick should reach the crease of your parent's wrist when their arm hangs down by their side. Too tall or too short and it makes balance worse. A walking frame gives more support for someone who is very unsteady. Please do not let your parent borrow someone else's stick or frame. It may be the wrong height or the wrong type. Ask a physiotherapist or nurse to check the fit.

Medicines and health checks

Many falls have a medical cause that can be found and treated. If your parent has fallen or feels unsteady, ask their doctor to look at the following.

• A medicine check. Bring every tablet, including anything bought from a chemist, and ask whether any could cause dizziness or drowsiness, and whether doses can be adjusted. Never stop a medicine without speaking to the doctor.
• Blood pressure lying and standing. A big drop on standing is a common and treatable cause of falls.
• Eyes. A check for cataracts and up-to-date glasses.
• Hearing. Poor hearing is linked to poor balance and is easy to check.
• Feet. Corns, long nails and numbness from diabetes all affect walking.
• Bone health. Calcium, vitamin D and, where needed, treatment for osteoporosis make a fracture less likely if a fall does happen.

Also make sure your parent eats regular meals and drinks enough water, particularly in the hot season.

Hospitals in Lagos for older parents

What to do if your parent falls

Whether you are there or a caregiver finds your parent on the floor, the first few minutes matter. Stay calm and do not rush to pull them up.

First, check for injury. The NHS advises taking a couple of minutes to check for pain or injuries before trying to get up. Look and ask about:

• Pain anywhere, especially in the hip, groin, back or neck.
• Bleeding or cuts.
• A knock to the head, or any confusion, drowsiness or vomiting.
• Whether they can move both legs and both arms.
• Signs of a hip fracture: severe pain in the hip or groin, a leg that looks shorter or turned outwards, and being unable to stand or put weight on that leg.

Do not move your parent if they may have hurt their head, neck, back or hip, or if they cannot get up. Get emergency help. Call the transport you arranged and take your parent to your designated hospital, ideally in a vehicle where they can lie flat. Phone the hospital on the way. Keep those numbers written on the fridge and saved in every family member's phone before you ever need them. While you wait, keep your parent warm with a blanket or wrapper and stay with them.

If your parent is not hurt and feels able to get up, help them in stages. Never lift them by the arms or under the armpits, as this can injure both of you. The NHS advises not trying to lift someone yourself.

• Let them rest on the floor for a moment.
• Help them roll onto their side.
• From there, they push up onto their hands and knees.
• Bring a sturdy chair close. Holding it with both hands, they bring one foot forward flat on the floor.
• They push up slowly, turn and sit on the chair.
• Let them sit and rest before doing anything else.

If they cannot manage these steps, do not force it. Keep them comfortable and warm on the floor and get help.

After any fall, watch your parent closely. If they hit their head, watch for 24 to 48 hours for confusion, headache, vomiting, unusual sleepiness or weakness on one side. This is especially important if they take blood thinners such as warfarin, because bleeding inside the head can develop slowly. Any of these signs means hospital at once.

Even if your parent seems fine, book a doctor's visit. A fall is often a warning sign of something else, such as an infection, a medicine problem or low blood pressure.

Hip fracture and recovery at home

A broken hip almost always needs surgery. The NHS says that in the UK the operation usually happens on the same day or the day after arriving at hospital, using screws, plates or a partial or full hip replacement. In Lagos it can take longer, and hospitals usually ask for a deposit first, so ask about costs as soon as you arrive. Ask the hospital when physiotherapy will start and keep asking, because it is what helps your parent stand and walk again. Healing usually takes several weeks or months.

Recovery at home is where families need the most help. Your parent will need help with washing, dressing, toileting and moving safely, plus daily exercises from the physiotherapist. Because they spend more time in bed or in a chair, there is a real risk of bed sores, chest infections and blood clots. Turning, good food, enough fluid and getting up as advised all help.

Caring for a bedridden parent at home

Post-hospital care at home

Reducing the risk when you live abroad

Many families caring for a parent in Lagos live in the UK, the US or Canada. You cannot fit a grab rail from London, but you can do a lot.

• On your next visit, walk through the house with this checklist at night as well as by day.
• Order grab rails, non-slip mats, rechargeable lamps and a shower stool online for delivery in Lagos, and arrange a handyman to fit the rails properly.
• Make sure your parent's phone is always charged and kept close, including at night.
• Arrange for someone to check on your parent every day, by visit or by call, and agree what happens if they do not answer.
• Keep the transport number and the designated hospital's number where everyone in the family can see them.

Caring for parents in Nigeria from abroad

How Home Care Nigeria helps

Our caregivers are supervised by a named registered nurse. They help your parent bathe, dress and move around the house safely, which is when many falls happen. After every visit you receive a signed report that notes your parent's mobility and records any fall or near miss. If something worrying happens, we alert you straight away.

If your parent is coming home after a fall or a hip operation, we can provide post-hospital care, and live-in care is available for parents who need someone there day and night.

Personal care at home

Post-hospital care

See a sample visit report

Tell us about your parent

Common questions