Fall Prevention Interventions for Cognitively Impaired Older Adults: A Systematic Literature Review and Meta-Analysis

Abstract

Background: Older adults with cognitive impairment are at increased risk of falls due to impaired judgment, balance, and mobility. The effectiveness of fall prevention interventions in this population remains unclear. Objective: To investigate the effects of fall prevention interventions on fall incidence in older adults with cognitive impairment. Methods: A systematic review and meta-analysis were conducted and reported following PRISMA guidelines. Six databases (PubMed, CINAHL, PsycINFO, Embase, Cochrane CENTRAL, and PQDT) were searched for studies published from January 2014 to December 2023, with an updated search in May 2025. Eligible studies were randomized or quasi-experimental trials involving adults aged >= 60 years with cognitive impairment. Of 2342 records identified, 17 studies were included in the review and 10 studies (13 data sets) in the meta-analysis. Study quality was appraised using a modified Scottish Intercollegiate Guidelines Network checklist. A random-effects model was used to synthesize results. Results: Interventions included exercise programs (eg, Tai Chi, resistance training), technology-enhanced training, and environmental or cognitive strategies. They were delivered 1 to 4 times/week over 4 to 52 weeks. Meta-analysis showed a significant reduction in fall rates in intervention groups compared to controls (pooled incidence rate ratio = 0.82; 95% confidence interval: 0.69-0.98). Moderate heterogeneity was observed (I-2 = 73.7%; p < .001). Conclusions: Fall prevention interventions can effectively reduce fall rates among older adults with cognitive impairment. Implementing tailored, evidence-based strategies is essential to supporting this high-risk population.