Effects of Cognitive Behavioral Therapy on Fall Prevention for Older Adults: A Meta-Analysis

Falls among older adults are a major public health issue and the leading cause of injury-related deaths. They affect older adults' physical, social, and psychological well-being. Although CBT-based interventions show promise for fall prevention, they have not yet been specifically applied to this population.

To evaluate and synthesize the effects of cognitive behavioral therapy (CBT) on older adults' fear of falling, perceived consequences of falls, physical performance, and balance: METHODS: A systematic search of Academic Search Complete, CINAHL Plus with Full Text, Cochrane Library, Embase, Medline, PubMed, and Web of Science was performed, from database inception to March 8, 2025, to find randomized trials applying CBT to prevent falls among older adults. The Cochrane risk-of-bias tool for randomized trials was used to assess the risk of bias of the studies included. A random-effects DerSimonian-Laird model with a 95% confidence interval was used to estimate the pooled standardized mean differences (SMDs) of outcomes.

Seventeen studies were included in the final analysis. CBT in combination with exercise was found to reduce fear of falling (pooled SMD = -0.25; 95% CI = -0.41 to -0.09; I² = 22.22%) and improve balance (pooled SMD = 0.79; 95% CI = 0.56-1.01; I² = 0.00%; p < 0.001) in older adults. The findings of this study can guide future research on developing CBT-based interventions to maximize the benefits of this modality for preventing falls among older adults. This study suggests that CBT in combination with exercise is effective for preventing falls among older adults. CBT also appears to benefit older adults by reducing their fear of falling and improving balance. The intervention duration should be considered to achieve a meaningful effect on fall prevention for this population.