Effectiveness of fall prevention interventions for community-dwelling adults aged 60 years and above in low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND: Falls are a major cause of disability and mortality in older age. There is clear evidence of effective fall prevention interventions that have informed global guidelines, however much of the evidence comes from high-income countries. The objective of this study was to identify and assess the effectiveness of fall prevention interventions for community-dwelling older people living in low- and middle-income countries (LMICs). METHODS: Studies published up to March 2025, in Medline, Embase, the Cochrane Library, Scopus, CINAHL and references of previous reviews were searched. A study was included if an intervention was used to prevent falls or to improve fall-related outcomes among community-dwelling older adults in LMICs. Titles, abstracts, full texts and study quality were screened by two independent reviewers and conflicts were resolved by a third reviewer. Data were extracted by two independent reviewers and studies which had sufficient data were included for meta-analysis. RESULTS: Among the retrieved 2013 studies, 30 relevant studies with 9817 participants (65% female) from 12 LMICs were included. The participants' ages ranged from 60 to 94 years. Nine studies were eligible for meta-analysis and only two to four studies were able to be pooled for each outcome. According to the meta-analysis, exercise significantly improved balance (standardised mean difference (SMD) = 1.18, [0.30,2.06], p = 0.008), while it had no effect on falls (SMD=-0.4, [-1.08,0.29], p = 0.18) and fall-related outcomes such as mobility (SMD=-0.50, [-1.13,0.12], p = 0.11), and fear of falling (SMD=-0.04, [-0.69,0.61], p = 0.90). According to the narrative synthesis interventions such as exercise, dance, and education programs may reduce falls and fall-related outcomes. CONCLUSION: Exercise, a senior dance program, Thai traditional dance, and education programs were among the interventions identified in the included studies. Exercises could improve balance in community-dwelling older adults living in the LMICs. However, the effectiveness of these interventions in reducing falls or other fall-related outcomes is uncertain due to the limited number of studies with small samples available from LMICs. TRIAL REGISTRATION: CRD42022335448, 07th June, 2022.