In August 2020, Public Health England’s COVID-19 Cabinet commissioned the Health Economics and Modelling Team (HEMT) to undertake work to identify the wider public health impacts of COVID-19 and carry out modelling in priority areas to quantify these impacts. One of the areas identified as high priority for further work was older people.
This study looks at how the wider impacts of COVID-19 have affected older people (over 65 year olds), with a focus upon deconditioning and falls. Deconditioning – the loss of physical, psychological, and functional capacity due to inactivity – can occur rapidly in older adults, is not straightforward or quick to remedy and, among other health impacts, increases the risk of falls.
This, in turn, creates a risk that, without mitigation, would result in an increase in the rate of falls starting in the summer of 2021 as older adults engage in more physical activity as lockdown restrictions are lifted. This increase is likely to continue if levels of physical activity remain at their current reduced levels. This may increase demand for falls services, the strain on hospitals due to emergency admissions and health and social care costs.
This study models the likely effect of the decrease in strength and balance activity observed during the pandemic on people who experience a fall, the number of falls and associated health and social care costs. It also includes scenario analyses, looking at the impact different changes in strength and balance activity levels may have on the rate of falls and health and social care costs. The modelling is informed by strength and balance physical activity and falls prevalence datasets reported in the recent Sport England’s Active Lives Adult Survey (mid-March to mid-May 2020) and Projecting Older People Population Information, respectively. The strength and balance activity levels recorded were compared against 2019 levels from the corresponding period.
Strength and balance activity includes activities such as Pilates, tai chi, bowls, swimming, and the Otago exercise programme, but does not include some very popular types of physical activity – most notably walking, which is not proven to reduce falls risk. The relationship between changes in activity and falls prevalence, has been estimated using a meta-regression derived from information taken from a Cochrane systematic review of exercise interventions for preventing falls in older adults, which includes over 100 randomised controlled trials. Health and social care costs of falls are referenced from the PHE Falls Prevention ROI Tool .
The report contains recommendations which are intended to address deconditioning and improve older adult mental and physical health while simultaneously reducing falls risk. The report recommends that older adults who have deconditioned increase their levels of strength and balance activities so that they can also safely resume activities they engaged in before the pandemic, such as other forms of physical activity, social activities, accessing healthcare, and work.