Acute Caffeine Consumption and fall-related outcomes in older adults: A Narrative Systematic Review
Abstract
Introduction
Falls affect one third of adults aged over 65 annually and represent the leading cause of emergency hospital admissions in this age group in England. Caffeine is routinely consumed in clinical settings yet is not addressed in current falls prevention guidance. It exerts competing physiological effects relevant to fall risk, improving muscular strength and alertness whilst potentially disrupting postural control.
Methods
A systematic search of MEDLINE, EMBASE, and PubMed was conducted for all randomised, double-blind, placebo-controlled trials examining effects of acute caffeine ingestion on balance or fall-related functional outcomes in adults aged ≥65 years. Substantial heterogeneity in dose, form, abstinence protocol, and outcome measures precluded meta-analysis; findings were synthesised narratively.
Results
Six studies met inclusion criteria (n=188; mean age 67.5-74.7). Five studies reported an adverse effect of caffeine on at-least one measure of static postural control (postural sway/stability). Dynamic balance and functional performance were assessed across two studies using the Timed Up and Go, Four Square Step Test, Y-Balance, and Senior Fitness Test and were not adversely affected by caffeine, other than an improved sit-to-stand rate of force development in one study (p=0.01). Significant improvements in walking distance were observed in people with claudication (+26.6% maximal, +20.0% pain-free; p<0.05) . The only study using brewed coffee rather than capsules found no significant sway amplitude effect (p>0.05) when compared to another study with equivalent dose (3 mg/kg).
Conclusion
Acute caffeine ingestion consistently impairs static postural stability in older adults but does not adversely affect dynamic balance or functional performance: outcomes most closely associated with real-world falls risk. Caffeine form appears as an important moderator, with brewed coffee producing markedly attenuated effects compared to capsules. Future research should prioritise ecologically valid caffeine vehicles, dynamic outcomes, inpatients, and people with frailty to guide whether fall prevention programmes should consider caffeine exposure.