Challenges and Opportunities in the Development of Assistive and Rehabilitation Exoskeletons for Older Adults

Population aging has contributed to an increased prevalence of conditions that impair lower-limb mobility in older adults, resulting in reduced functional independence and a greater risk of falls. In this context, assistive and rehabilitation exoskeletons have emerged as a technological approach to maintaining and restoring mobility. This study reviews 135 publications from 2016 to 2026 on lower-limb exoskeletons for older adults. The studies were classified according to design, actuation method, assisted joint, application, and evaluation evidence. The results of this analysis show that, within the reviewed literature, multi-joint and ankle exoskeletons are the most frequently represented systems. Among the studies reporting the actuation method, active electric systems and passive unpowered mechanisms are the most common, whereas pneumatic and hybrid solutions are reported less frequently. The reviewed developments also emphasize lightweight design and portability, together with control strategies intended to adapt assistance to the user’s needs. Gait assistance and motor rehabilitation account for the largest body of evidence, whereas sit-to-stand transitions, stair locomotion, and fall prevention remain underexplored. The reported evaluations employ functional, metabolic, spatiotemporal, and electromyographic metrics, with several studies reporting improvements in mobility-related outcomes. However, further clinical validation and more standardized assessments of safety, stability, and long-term performance are needed. Additional progress in regulatory guidance may also facilitate the clinical and everyday use of these technologies.