The Efficacy of “Pre-habilitation” in Primary Care for Geriatric Fall Prevention: A Narrative Review

Falls represent a major public health concern among older adults, contributing to significant morbidity, mortality, and healthcare costs. Community-dwelling geriatric populations experience falls at rates of 20-30% annually, with higher risks in those with frailty, impaired balance, or prior falls. Traditional fall prevention strategies in primary care have emphasized reactive approaches following incidents, but emerging concepts such as “pre-habilitation”—proactive interventions aimed at enhancing physiological reserve before adverse events—offer a preventive paradigm. Originally developed in surgical contexts to optimize outcomes in frail patients, pre-habilitation is increasingly explored in non-surgical settings to mitigate fall risk through targeted exercise, neuromodulation, and multifactorial risk reduction. This narrative review synthesizes recent evidence on the efficacy of pre-habilitation-inspired interventions delivered in primary care for geriatric fall prevention. Key themes include exercise-based programs, home-based self-delivered protocols combining motor imagery and neuromodulation, and multifactorial individualized approaches. High-quality systematic reviews and randomized trials demonstrate moderate benefits from exercise interventions in reducing fall rates and injurious falls, particularly among at-risk individuals. Multifactorial strategies show smaller but consistent effects on falls when tailored appropriately. Emerging pre-habilitation protocols, such as home-based neuromodulation-assisted motor imagery, show promise for feasibility and acceptability in proactive fall risk reduction, though large-scale efficacy data remain limited. Primary care delivery facilitates accessibility, but implementation barriers include resource constraints and patient adherence. This review highlights the potential of pre-habilitation to shift from reactive to proactive fall prevention in primary care, while underscoring the need for further research in community settings.