Introduction

Fear of Falling (FOF), refers to the avoidance of daily activities due to the fear of falling, such as cleaning, which can lead to symptoms such as anxiety and palpitations if these activities are undertaken [1]. FOF is prevalent among older adults, ** countries and disease groups [30]. Their results indicated that FOF is a risk factor for falls in older adults, and that OEP can reduce FOF. Differences in outcome measurement tools might also contribute to heterogeneity, suggesting that future studies should use standardized measurement tools. Methodological heterogeneity, differences in intervention duration, and differences in intervention frequency among studies might also lead to varied outcomes. All included studies had a single intervention duration of more than 30 min, corroborated by Chiu et al. [31], whose results demonstrated that training sessions longer than 30 min are most effective for improving balance in older adults, as recommended in the OEP manual. Additionally, we conducted subgroup analyses based on the intervention period and frequency. The results indicate that interventions lasting longer than 16 weeks, with more than two sessions per week yielded better outcomes, aligning with the OEP manual’s recommendation of at least three sessions per week for 24 weeks. Our study included six interventions lasting more than 16 weeks, two for 16 weeks, and four for 24 weeks. Subgroup analysis revealed that 24-week outcomes surpassed 16-week outcomes; hence, we believe that training should last for at least 24 weeks, as suggested by the OEP manual. The OEP is a progressive training regimen, with a direct relationship between the intervention duration and its effectiveness. Generally, a longer intervention period allows for extended phases at each stage, enabling older adults to adapt well to the current training intensity before moving to the next phase. Shorter intervention periods often result in the study ending before the expected training intensity is reached, or older adults may be subjected to higher intensity training before they have adequately adapted. In the publication bias tests, Begg’s test showed no publication bias, but Egger’s test indicated some bias, suggesting that our results might be unstable due to publication bias. Thus, we used the trim-and-fill method to further verify the stability. The effect size remained significant and greater than zero after including seven hypothetical studies in the trim-and-fill analysis, with no reversal of the results, indicating the stability of our findings.

Our study also has limitations. The included studies did not blind participants, potentially affecting the quality and outcomes of the research and leading to results that might not align with reality. Additionally, due to the subjective nature of outcome measures derived from questionnaires and the lack of blinding among intervention subjects, measurement bias could lead to skewed results. Another limitation is the use of different measurement tools, a potential source of heterogeneity. Sensitivity analyses excluding studies by Qiao and Pei showed significant changes in effect size, identifying a source of heterogeneity. Furthermore, since follow-up durations varied, this study did not explore the long-term effects of OEP on older adults, which future research could investigate.

Conclusion

Current evidence suggests that OEP can alleviate psychological FOF in older adults, with interventions lasting more than 24 weeks, occurring more than twice a week, and has demonstrated high effectiveness when applied among older adults in community settings or elder care institutions. Currently, a variety of assessment tools are used in studies; future research is recommended to employ uniform measurement tools. The psychological issues related to falling in older adults are as important as the falls themselves. Future efforts should focus more on the psychological aspects of falls among older adults, and more high-quality, large-sample studies should be conducted to provide stronger evidence-based support.