Preventing falls and improving mobility in older adults

Every year, around a third of people over 65 in England fall – and for those over 80, the figure rises to half. Falls are the leading cause of emergency hospital admissions among older people, accounting for over four million bed days annually at an estimated cost of £2 billion.

But the damage extends far beyond broken bones.

A fall can shatter confidence, shrink someone's world to a single room, and set off a spiral of declining mobility that is difficult to reverse. Pain and spinal conditions compound the problem – yet tools to identify who is most at risk, and to intervene before a fall happens, have been limited.

Our approach and partners

Working with clinicians, patients, Age UK, and industry partners Danone and Good Boost, ARC OxTV supported a programme of interconnected research tackling mobility decline from multiple angles.

The Oxford Pain, Activity and Lifestyle (OPAL) cohort study followed 5,400 older adults over five years to pinpoint what puts people at risk of losing mobility – and specifically how pain accelerates that decline. The Better Outcomes for Older people with Spinal Trouble (BOOST) trial tested whether a group rehabilitation programme could improve mobility and reduce falls for people with lumbar spinal stenosis, a common spinal condition that progressively limits walking.

A feasibility study (MMoST) explored whether combining protein supplements with exercise could strengthen older people's capacity to stay active. And a qualitative study examined whether social prescribers could help bridge the gap between NHS physiotherapy and community-based falls prevention.

What we found – and why it matters

1. A 14-question tool to spot mobility decline before it starts. The OPAL study produced a practical screening tool covering age, income, walking pace, confidence, use of walking aids, number of health conditions, and pain severity. This gives older people and health professionals a way to identify risk early – and act on it.
2. Group rehabilitation that works for spinal stenosis. The BOOST trial showed that a combined physical and psychological group programme was clinically effective and cost-effective at improving mobility over 12 months, with evidence suggesting benefit for falls outcomes. An implementation study then optimised the programme for routine NHS delivery.
3. A free online training course for clinicians. To make the BOOST programme available beyond the trial sites, the team developed an open-access online course – now hosted by the University of Exeter – that trains health professionals to deliver it.
4. New evidence on the role of pain. The OPAL data revealed how pain drives mobility decline and falls in older adults, including during the disruption of the COVID-19 pandemic. This evidence is shaping the development of new interventions.
5. Lessons on recruitment and community pathways. The MMoST feasibility study found that community advertising recruited older adults more effectively than NHS referral routes, though the approach needs refinement. Early clinical outcomes favoured the exercise-plus-protein group, signalling a question worth pursuing. The social prescribing study found that a direct pathway from physiotherapy to community physical activity services may be more effective than relying on social prescribers alone.

What this means

The OPAL screening tool gives older people and their clinicians a structured way to recognise declining mobility early enough to do something about it – before a fall forces the issue. The BOOST programme offers a proven, deliverable rehabilitation option for the many older adults living with spinal stenosis, and the free training course means NHS physiotherapy services can now adopt it more easily.

Together, these resources shift falls prevention towards earlier identification and community-based intervention – exactly the direction set out in the 10 Year Health Plan for England.

What needs to happen next

The OPAL screening tool needs external validation before wider adoption – work is underway with stakeholders to understand how it could be used in practice. Promising findings from across these projects are informing the design of new interventions, but testing them requires funding.

A priority for the next phase is ensuring falls prevention reaches underserved populations – those who currently find services hardest to access. ARC OxTV's successor programme has committed to supporting initial work on this. The OPAL dataset remains a valuable resource and can support economic evaluations using linked Hospital Episode Statistics data, strengthening the investment case for prevention.