The epidemiology of unintentional falls among older people in the Middle East and North Africa: a systematic review and meta-analysis

Background: Falls epidemiology in the Middle East and North Africa (MENA) remains underexplored despite being a major cause of morbidity and mortality. We synthesised the data on unintentional falls among older adults in MENA countries. Methods: We conducted a systematic review, meta-analysis, and meta-regression, searching MEDLINE/PubMed, Web of Science, and Google Scholar up to 5 May 2024, without language or time restriction. We included records on fall prevalence, frequency, location, self-reported reasons, consequences, and health care utilisation. Two reviewers independently conducted multi-stage screening, data extraction, and quality assessment. We estimated the pooled-average prevalence using random-effect models and calculated MENA population-size weighted-averages. Results: We identified 7392 records, finding 90 eligible studies covering 99 588 older adults from 14 countries. The MENA population-size weighted-average prevalence of older adults with ≥1 fall was 17.6% (95% confidence interval (CI) = 9.8-36.3), with higher prevalence in older age (P = 0.001). Among fallers, 59.0% (95% CI = 40.0-76.0) reported ≥2 falls. The pooled prevalence of fallers was 60.1% (95% CI = 42.2-75.7) among older trauma unit patients, while 49.3% (95% CI = 33.9-64.8) of older outpatients reported falling in the past year. Falls occurred primarily at home (pooled-average proportion of fallers = 66.1%; 95% CI = 46.6-81.3), with fewer at work (10.1%; 95% CI = 1.6-44.2), and in hospitals (6.0%; 95% CI = 2.5-13.8). On average, post-fall, 45.6% (95% CI = 37.8-53.5) sought medical care, 36.8% (95% CI = 21.9-54.8) had fractures, and 17.3% (95% CI = 8.0-33.2) experienced anxiety or depression. The in-hospital death rate following a fall was 7.5% (95% CI = 1.5-29.8). Self-reported reasons for falls included medical conditions, balance problems, and environmental factors. We observed substantial heterogeneity and some publication bias (LFK index = 7.34). Conclusions: The prevalence of older adults in MENA reporting ≥1 fall is lower than global estimates. However, substantial fracture proportions, mental health issues, and in-hospital deaths following a fall underscore the need for region-specific fall prevention strategies. Registration: This review is registered on the Open Science Framework (https://osf.io/3cu4q; https://doi.org/10.17605/OSF.IO/3CU4Q).