Cadernos Cajuína · Jun 17, 2026
Lifestyle modification strategies for fall prevention in community-dwelling older adults
By Viana RP, Costa AHBM, Gomes JPRR et al.
INTRODUCTION: Approximately one-third of community-dwelling older adults experience at least one fall per year, and half of these are recurrent fallers, with consequences including fractures, fear of falling, loss of functional independence, and costs of approximately 1% of health expenditures in developed countries. Modifiable risk factors, such as gait and balance disorders, polypharmacy, and environmental hazards, are priority targets for preventive interventions. OBJECTIVE: To critically synthesize the available evidence on lifestyle modification strategies—including physical exercise, nutritional interventions, health education, and environmental adaptations—for fall prevention in community-dwelling older adults. METHODS: A narrative literature review with a PubMed/MEDLINE search using a specific strategy. Initially, 971 articles were identified; applying filters (past 5 years, free full text, meta-analyses, systematic reviews, reviews, and randomized clinical trials) yielded 93 articles, of which 15 were selected based on alignment with the topic, methodological quality, and relevance. RESULTS: Physical exercise reduced the number of people who fell (RR 0.83; IC95% 0.77–0.89) and the fall rate (RR 0.79; IC95% 0.73–0.86). Postural control training was the most effective modality (RR 0.66–0.82). The modified Otago Exercise Program improved balance and functional capacity and reduced fear and the number of falls, with benefits sustained at 12 months. A Taekkyon-based program improved balance, lower limb strength, and gait parameters. Perturbation-based balance training showed short-term improvements in stepping reaction time (−49 ms; IC95% −80 to −18) and dual-task gait speed (0.05 m/s; IC95% 0.01 to 0.09), but these were not maintained at 6 and 12 months. Fall prevention education increased risk awareness and promoted behavioral changes, with a reduction in the number of people who fell (RR 0.90; IC95% 0.83–0.98) when integrated into broader programs. Combining yoga with a Mediterranean diet produced significant improvements in balance (Cohen's d = 0.41), gait (d = 0.44), and lower limb strength (d = 0.81). Multicomponent programs integrating exercise, nutrition, education, and environmental modification demonstrated superiority. Challenges include low adherence (only 9–13% of participants met weekly goals in digital programs) and the need for cultural adaptation. In older adults with cognitive impairment, the interventions reduced fear of falling (SMD −0.73) and improved balance (SMD 0.66) and functional mobility (SMD −0.56), but had no significant effect on fall incidence. CONCLUSIONS: Physical exercise, particularly multicomponent programs integrating balance, resistance, and functional training, constitutes the most effective intervention for fall prevention in community-dwelling older adults, with risk reductions of 17% to 34%. Education and nutritional interventions have synergistic potential when integrated into comprehensive programs. Cultural adaptation and personalization of interventions are fundamental to feasibility and sustainability. Gaps include the scarcity of studies on synergistic combinations, the isolated role of nutrition, long-term follow-up, and the underrepresentation of low-income populations.