Occupational Therapy Interventions for Fall Prevention in Older Adults: A Systematic Review of Multimodal Strategies

Background: Falls are a leading cause of morbidity and loss of independence among older adults, and occupational therapy (OT) offers a unique, multidimensional approach to fall prevention. This systematic review evaluates the effectiveness of OT-based interventions for improving balance, mobility, functional performance, and psychological outcomes related to fall risk in older adults. Methods: This review followed PRISMA (2020) guidelines. A comprehensive search of PubMed, Scopus, Dialnet, and OTseeker was conducted from March to May 2025. The inclusion criteria targeted studies involving non-pharmacological, OT-led interventions in adults aged ≥65. Seventeen studies were selected, including randomized controlled trials, pilot studies, and quasi-experimental designs. The data extraction and quality appraisal were performed independently by two reviewers. Results: The included interventions varied among exercise-based programs (e.g., Tai Chi, Pilates), virtual reality training, home safety modifications, cognitive–behavioral therapy, and wearable technologies. Most of the studies reported significant improvements in postural balance, fear of falling, and functional independence. Environmental adaptations and educational strategies also yielded positive outcomes. However, a real-world fall incidence reduction was inconsistently reported, and the methodological heterogeneity limited the meta-analytic synthesis. Conclusions: Occupational therapy contributes significantly to fall prevention through multimodal, person-centered strategies that integrate physical, cognitive, and environmental components. Future research should aim to standardize the outcome measures, include high-risk populations, and assess the long-term efficacy and cost-effectiveness of OT-led programs.