An evidence gap map of fall-related outcomes among older adults in the Middle East and North Africa region
Karima Chaabna, Anupama Jithesh, Salina Khawaja, Jasmine Aboughanem, Ravinder Mamtani, Sohaila CheemaIntroduction
Unintentional falls are a leading cause of injury and mortality among older adults, with a growing burden in rapidly ageing regions like the Middle East and North Africa. Despite this, the availability, scope and geographical distribution of epidemiological evidence on fall-related outcomes in the region remain poorly characterised, limiting policy and prevention efforts. This evidence gap map systematically identifies, categorises and maps existing observational research on fall-related outcomes among older adults in the Middle East and North Africa.
Methods
We searched PubMed, Web of Science, Google Scholar and Google (up to November 2025) without time restrictions to identify primary studies and systematic reviews reporting on fall prevalence, frequency, risk and fear of falling, self-reported perceived reasons for falling and postfall consequences in older adults (aged ≥60) in the Middle East and North Africa. Two reviewers independently conducted screening, data extraction and quality assessment.
Results
We included 203 primary studies, representing data from 424 112 older adults. Evidence from low-income countries was scarce (one national health survey from Sudan, one retrospective study from Yemen, no study for Syria). Upper-middle-income countries (Iraq, Jordan and Libya) contributed limited evidence (4.9%; 10/203). High-income countries contributed registry-based and national-level data. Most studies were conducted in lower-middle-income countries (113/203; 55.7%); in both genders (96.6%; 196/203) and in urban settings (157/203; 77.3%). The most frequently studied populations were the general population and outpatients (each 45/203; 22.6%). Under-researched outcomes were fear of falling and self-perceived reasons of fall.
Conclusion
This evidence gap map highlights substantial data gaps across several countries, with marked underrepresentation of rural, low-income and conflict-affected settings, and limited evidence on key fall-related outcomes across the Middle East and North Africa. Strengthened surveillance using validated context-adapted tools, hospital-based registries and integrated national survey fall indicators are essential to inform effective and equitable fall prevention strategies in the region.