Comparative efficacy of Nine Non-Pharmacological Interventions for Fall Prevention in Older Adults: A Systematic Review and Network Meta-Analysis

Background: Non-pharmacological interventions (NPIs), due to their high safety profile, cost-effectiveness, and ease of implementation, have become a research focus for preventing falls among older persons. This study aims to systematically evaluate the differential preventive effects of various NPI strategies, providing evidence-based guidance to optimize clinical practice and public health policy. Methods: A systematic search was conducted in PubMed, Web of Science, Embase, and the Cochrane Library for English-language randomized controlled trials (RCTs) published up to March 10, 2025. Bayesian network meta-analysis was performed using a random-effects model with R version 4.4.3 and Stata 16.0 software. Heterogeneity was assessed using the I² statistic. Publication bias was evaluated through funnel plots combined with Begg’s and Egger’s tests. The effect sizes were reported as odds ratios (OR) with 95% confidence intervals (CIs). Model consistency was verified using node-splitting analysis. Results: A total of 45 RCTs (n = 17,671) were included. Between-study heterogeneity was low (I² = 17%). Network meta-analysis showed that compared to Usual, Exer+Cog (OR = 0.64, 95% CI: 0.34–0.84), MBE (OR = 0.64, 95% CI: 0.47–0.87), and Education (OR = 0.65, 95% CI: 0.45–0.90) demonstrated superior fall prevention effects. Subgroup analyses revealed: 1) Temporal effects: within intervention periods ≤4 months, Exer+Cog showed the best effect (OR = 0.34, 95% CI: 0.09–0.81), while MBE was significantly effective during the 4–8 month period (OR = 0.41, 95% CI: 0.23–0.73); 2) Gender specificity: in populations with 50–80% female participants, Exer+Cog (OR = 0.50, 95% CI: 0.27–0.81) and Education (OR = 0.62, 95% CI: 0.38–0.97) showed more pronounced effects. Conclusion: Exer+Cog may represent the optimal strategy for preventing falls in older adults, while MBE and Education can serve as effective alternative interventions. It is recommended that individualized fall prevention programs be developed based on the availability of resources and the characteristics of the population. Future research should focus on optimizing intervention dosage and long-term benefits.