Interventions for falls among older adults in low- and middle-income countries: a systematic review

Falls among older adults represent a significant public health challenge in low- and middle-income countries (LMICs), yet evidence-based fall prevention interventions remain underexplored in these settings. This systematic review aimed to identify fall prevention interventions implemented in LMIC settings and to describe their reported outcomes. The systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) guidelines. Seven electronic databases (PubMed, Scopus, Embase, Web of Science, African Index Medicus, Global Health, and CINAHL) were searched from January 2003 to December 2023. Studies were included if they reported on fall prevention interventions among older adults (aged ≥ 60 years) in LMICs. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment, using RoB 2 for randomised trials and ROBINS-I for non-randomised studies. Data synthesis was performed using narrative analysis due to heterogeneity in study designs, populations, and interventions, and a descriptive sensitivity check excluded studies without a concurrent comparison group. The review was registered in the International Prospective Register for Systematic Reviews (PROSPERO) with the reference number CRD42023434079; amendments to the registered protocol are reported. A total of 4,063 records were retrieved from the database search and 17 studies from nine LMICs, including 2,030 participants, were included (12 RCTs). Using RoB 2, four of the 12 RCTs were at low risk of bias, five raised some concerns and three were at high risk; using ROBINS-I, two non-randomised studies were at moderate risk and three at serious risk. Exercise-based interventions were most prevalent, including balance training, yoga, culturally adapted dance programs, and multi-system physical exercise. All six studies that measured fear of falling reported improvements, whereas findings on falls were mixed: three of the eight studies reporting fall outcomes found fewer falls, one of which was uncontrolled. Exercise-based fall prevention interventions were associated with improvements in balance, mobility, and fear of falling in most of the studies that assessed them in LMIC settings, though evidence for actual fall reduction remains mixed. Culturally adapted interventions merit further evaluation in diverse LMIC contexts. CRD42023434079