Breaking the Vicious Cycle? A Systematic Review of Interventions Targeting Both Falls and Fear of Falling in Older Adults.

Abstract

Background: Falls and fall-related injuries are common in older adults and are frequently accompanied by fear of falling (FoF), which may lead to activity avoidance and functional decline. Because many interventions target falls or FoF in isolation, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to identify, describe, and evaluate interventions reporting both falls and FoF outcomes in older adults.

Methods: This systematic review and meta-analysis were registered in PROSPERO (CRD420251113137) and conducted in accordance with PRISMA guidelines. PubMed, Embase, and Web of Science were searched from inception to 4 November 2025. Eligible studies were English-language RCTs that included adults aged ≥60 years, evaluated nonpharmacological interventions, and reported both FoF and falls. Methodological quality was assessed using the PEDro scale. Random-effects meta-analyses were performed for FoF (Hedges g), and Bayesian random-effects binomial meta-analyses were conducted for falls.

Results: Ten RCTs published between 1998 and 2018 (sample sizes per trial: n = 27-540) were included. Interventions included cognitive-behavioral therapy-based programs, Tai Chi, physiotherapist-led strength and balance training, computerized visual feedback, and video-guided home exercise. PEDro scores ranged from 6 to 9 (mean, 7.7). Pooled analyses showed no significant effect on FoF at the end of intervention (g = -0.20, 95% CI -1.45 to 1.05; p = 0.68; high heterogeneity) or at follow-up (g = -0.14, 95% CI -0.60 to 0.33; p = 0.50). For falls, postintervention evidence favored the null (BF₁₀ = 0.16; pooled estimate -0.01, 95% credible interval [CrI] -0.30 to 0.14). Follow-up results were inconclusive (BF₁₀ = 2.07; pooled CrI -0.56 to 0.00), with substantial uncertainty.

Conclusions: Across RCTs that measured both outcomes, interventions did not consistently improve both FoF and falls outcomes. These findings may suggest a partial dissociation between psychological and physical fall-related outcomes, highlighting the need for integrated, adequately powered trials that utilize standardized measures and longer follow-up periods.