Non-invasive neuromodulation in reducing the risk of falls and fear of falling in community-dwelling older adults: systematic review

Guilherme Augusto Santos Bueno; Arthur Dutra do Bomfim; Lorrane Freitas Campos; Anabela Correia Martins; Raquel Brito Elmescany; Marina Morato Stival; Silvana Schwerz Funghetto; Ruth Losada de Menezes

doi:10.3389/fnagi.2023.1301790

Non-invasive neuromodulation in reducing the risk of falls and fear of falling in community-dwelling older adults: systematic review

Front Aging Neurosci. 2024 Mar 5:15:1301790. doi: 10.3389/fnagi.2023.1301790. eCollection 2023.

Authors

Guilherme Augusto Santos Bueno^{1

2}, Arthur Dutra do Bomfim¹, Lorrane Freitas Campos², Anabela Correia Martins³, Raquel Brito Elmescany⁴, Marina Morato Stival², Silvana Schwerz Funghetto², Ruth Losada de Menezes^{2

4}

Affiliations

¹ Department of Medicine, Centro Universitário Euro Americano, Brasilia, Brazil.
² Postgraduate Program in Health Sciences and Technologies, University of Brasilía, Brasilia, Brazil.
³ LabinSaúde, Coimbra Health School Polytechnic of Coimbra, (ESTeSC-IPC), Coimbra, Portugal.
⁴ Postgraduate Program in Health Sciences, Federal University of Goiás, Goiânia, Brazil.

Abstract

Introduction: Neuromodulation is a non-invasive technique that allows for the modulation of cortical excitability and can produce changes in neuronal plasticity. Its application has recently been associated with the improvement of the motor pattern in older adults individuals with sequelae from neurological conditions.

Objective: To highlight the effects of non-invasive neuromodulation on the risk of falls and fear of falling in community-dwelling older adults.

Methods: Systematic review conducted in accordance with the items of the Cochrane Handbook for Systematic Reviews of Interventions. Searches were carried out in electronic databases: CENTRAL, Clinical Trials, LILACS, PEDro, PubMed, Web of Science, between 13/06/2020 and 20/09/2023, including all indexed texts without language and publication date restrictions, randomized controlled clinical trials, which presented as their main outcome non-invasive neuromodulation for reducing the fear of falling and risk of falls in the older adults, regardless of gender.

Results: An extensive search identified 9 eligible studies for qualitative synthesis from 8,168 potential articles. Rigorous filtering through automated tools, title/abstract screening, and full-text evaluation ensured a focused and relevant selection for further analysis. Most studies (80%) used transcranial direct current electrical stimulation as an intervention, over the motor cortex or cerebellum area, with anodal current and monopolar electrode placement. The intensity ranged from 1.2 mA to 2 mA, with a duration of 20 min (80%). The profile of the research participants was predominantly individuals over 65 years old (80%), with a high risk of falls (60%) and a minority reporting a fear of falling (40%). The outcomes were favorable for the use of neuromodulation for the risk of falls in the older adults, through improvements in static and dynamic balance.

Conclusion: The results may have limited applicability to direct outcomes related to the risk of falls, in addition to evidence regarding the difference or lack thereof in applicability between genders, fallers and non-fallers, as well as older adults individuals with low and high fear of falling.

Systematic review registration: The protocol for this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) to obtain the identification of ongoing research (ID: 222429).

Keywords: aging; fall accident; fear of falling; transcranial direct current stimulation; transcranial magnetic stimulation.

Publication types

Systematic Review

Grants and funding

Our sincere thanks to the University of Brasília, under the DPI/DPG/BCE N. 01/2024 Notice, and to the Research Support Foundation of the Federal District (FAPDF) for their financial support. This support was essential for the completion and publication of this study.