Risk Factors for Falls and Recurrent Falls in Older Stroke Survivors: A Systematic Review and Meta-Analysis of Prospective Studies

Background: Falls are a serious complication often associated with stroke in the older population. However, a comprehensive review of risk factors specific to falls in older stroke patients is currently lacking. Aims: To fill this gap by synthesising prospective studies and providing evidence-based insights into the risk factors for falls and recurrent falls in older stroke survivors. Design: Systematic review and meta-analysis following PRISMA statement. Methods: Two researchers independently screened eligible references and assessed their quality. Pooled summary effects, in the form of odds ratios with 95% confidence intervals, were calculated using a random-effects model. Data Sources: A systematic search of PubMed, Cochrane Library, Embase, Web of Science, Scopus, PsycINFO and CINAHL up to 4 January 2025. Results: Our systematic review and meta-analysis included 22 studies. We identified five key domains predicting falls: (1) balance and mobility, encompassing impaired mobility, impaired balance, motor impairment and disability in self-care; (2) environmental factors, particularly the use of walking aids; (3) psychological factors, notably depression status; (4) medication factors, including the use of medications; and (5) sociodemographic factors, such as a history of falls. Importantly, a history of falls significantly increases the risk of recurrent falls. Conclusions: Falls are a pressing concern in older stroke patients, with key risk factors including balance and mobility problems, use of walking aids, depression and medication. Future research should focus on mechanistic insights and tailored prevention strategies for this vulnerable group.