Falls as a Predictor of Future Dementia in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

To systematically review and quantitatively synthesize evidence on the predictive role of falls for future dementia in middle-aged and older adults.

Systematic review and meta-analysis.

Middle-aged and older adults without dementia (aged ≥40 years).

Systematically retrieved literature from 4 English-language databases-PubMed, Embase, Web of Science, and the Cochrane Library-from inception to July 1, 2025. Prospective and retrospective cohort studies investigating the association between falls and future development of dementia were included. Study quality was assessed using the Newcastle-Ottawa Scale. A random-effects model was applied using Stata 17.0 software to conduct a pooled analysis of the incidence of dementia in middle-aged and older adults (≥40 years) with a history of falls, as well as the strength of the association between falls and future dementia [adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs)].

A total of 7 studies were included, of which 5 were included in the meta-analysis, comprising a total of 2,922,624 participants. Results indicate that among 1,246,410 middle-aged and older adults with a history of falls, the pooled incidence of future dementia was 11.6% (95% CI, 4.2%-19.0%; I² = 99.8%). Among older adults (≥60 years), the pooled incidence was 12.3% (95% CI, 4.7%-20.0%; I² = 99.8%). Both single falls (aHR, 1.20; 95% CI, 1.07-1.36) and multiple falls (aHR, 1.74; 95% CI, 1.53-1.98) increased the risk of future all-cause dementia, and multiple falls were a more robust predictor of future dementia. Collectively, the results indicate that the frequency of falls exhibits a dose-response relationship with dementia risk.

This study demonstrates that multiple falls are a significant predictor of future dementia and highlights the importance of fall frequency. Recurrent falls may serve as a potential clinical marker for identifying individuals at higher risk. Clinicians should maintain heightened vigilance for cognitive decline in middle-aged and older adults with a history of recurrent falls to facilitate early detection of dementia. Given the limited evidence base and high heterogeneity, further high-quality research is warranted to clarify this association and support preventive strategies in aging populations.