Prevalence of fall risk and fear of falling among older adults in the Middle East and North Africa: a systematic review and meta-analysis

Background: Globally, falls are a major cause of morbidity and mortality in older adults (individuals aged ≥60 years). In the Middle East and North Africa (MENA) region, home to over 57 million older adults, data on key fall-related risk factors are limited, constraining targeted prevention efforts. We aimed to estimate the prevalence of fall risk and fear of falling among older adults in the 20 MENA countries. Methods: We searched PubMed, Web of Science, Google Scholar, and Google (up to November 2025). Two independent reviewers screened studies, extracted data, and assessed quality. We estimated pooled prevalence using random-effects meta-analysis and conducted meta-regression to explore heterogeneity. Results: We included 109 studies with 213,877 older adults. The mean age ranged from 63.1 (standard deviation (SD) = 2.5) to 77.2 (SD = 4.6) years across studies. The pooled prevalence of older adults at higher fall risk was 54.2% (95% confidence interval (CI) = 35.1, 72.8) based on the Missouri Alliance for Home Care Fall Risk Assessment and 33.4% (95% CI = 18.4, 53.8) based on the Morse Fall Scale. The pooled prevalence of older adults classified at higher fall risk was 41.7% (95% CI = 27.6, 57.2) based on balance performance using the Berg Balance Scale and 58.0% (95% CI = 39.4, 74.5) based on functional mobility using the Timed Up and Go Test. Studies reporting fear of falling mainly used validated tools assessing concern about falling and fall-related self-efficacy. The pooled prevalence of moderate to high concern about falling, measured by the Falls Efficacy Scale-International, was 82.7% (95% CI = 60.4, 93.8). The pooled prevalence of reduced fall-related self-efficacy, assessed by the Modified Falls Efficacy Scale, was 67.1% (95% CI = 44.9, 83.6). We observed substantial heterogeneity across studies, with no significant differences by population type, sex, or country-income level in meta-regression analyses. We detected no evidence of publication bias for fear of falling, while minor asymmetry was observed for fall risk; however, data were unavailable for ten MENA countries. Conclusions: This review shows a substantial prevalence of fall risk and fear of falling among older adults in the MENA countries represented in the available evidence, underscoring the need for region-specific fall prevention interventions. These findings support integrating routine fall-risk screening and standardised assessment tools into primary and geriatric care to address both physical and psychological risk factors and to inform targeted interventions across the region. Registration: Open Science Framework: https://osf.io/3cu4q/overview.