Objective This study aims to systematically evaluate the application of the Trans-Theoretical Model (TTM) in preventing falls among the older adults, particularly focusing on the effectiveness of exercise interventions, and to propose practical recommendations.

Methods A systematic review was conducted, incorporating 18 relevant studies published between 2000 and 2024, to analyze the effectiveness of TTM in fall prevention among older adults.

Results The included studies focused on different core components of TTM (stages of change, processes of change, self-efficacy, and decisional balance) or applied TTM comprehensively. The findings indicate that TTM significantly improved exercise adherence and facilitated health behavior change in older adults. Most studies reported a 15% to 40% reduction in fall incidence and over a 20% increase in exercise adherence. Additionally, TTM effectively enhanced self-efficacy and decisional balance, supporting the long-term maintenance of healthy behaviors.

Conclusion TTM, through staged assessments and intervention strategies, effectively promotes health behavior changes in older adults and significantly reduces fall risk. However, research on the application of TTM in fall prevention among older adults is still limited, and there is also a lack of systematic evaluation of long-term effects. Future research should focus on developing more comprehensive intervention strategies that address the diversity of older adults and the complexity of fall risks.