Background <p>Older adults with dementia or cognitive impairment have a two- to three-fold higher fall risk than cognitively intact peers. Multifactorial fall-prevention interventions often require understanding, memory, and sustained adherence, which may be difficult in this population. This review synthesized recent evidence on barriers and facilitators affecting implementation and mapped determinants using CFIR 2.0, with ERIC-informed recommendations for future implementation design.</p> Methods <p>We searched PubMed, Web of Science, Embase, CINAHL, PsycINFO, the Cochrane Library, CNKI, Wanfang, VIP, and CBM/SinoMed for empirical studies published from January 2021 to March 2026. Eligible studies reported implementation outcomes, barriers, or facilitators related to fall prevention, fall-risk management, safe mobility, assistive-device use, or fall-related monitoring for older adults with dementia or cognitive impairment. Methodological quality was assessed using MMAT. Determinants were synthesized narratively and thematically, then mapped to CFIR 2.0 domains.</p> Results <p>Twenty-seven studies were included. The synthesis identified 49 barriers and 40 facilitators. Key barriers were intervention complexity, cognitive and neuropsychiatric symptoms, resistance to care or devices, limited dementia-specific fall-prevention knowledge among caregivers or staff, staffing constraints, workflow barriers, digital-access problems, caregiver burden, and limited follow-up after recommendations. Key facilitators included low-burden or passive technologies, simplified and familiar delivery formats, caregiver involvement, staff training, multidisciplinary collaboration, environmental adaptation, standardized communication, and dementia-sensitive instruction. Determinants varied by setting, with home/community studies emphasizing caregiver, transport, and digital-access barriers, and institutional studies emphasizing staffing, handover, workflow, and organizational culture.</p> Conclusions <p>Fall-prevention implementation for older adults with dementia or cognitive impairment is shaped by patient, caregiver, organizational, environmental, and process-level factors. Current evidence suggests that interventions requiring active memory and sustained independent adherence may be difficult to implement without cognitive adaptation, caregiver support, environmental modification, and workflow alignment. The ERIC-informed recommendations generated in this review are author-derived options for future implementation design and evaluation, not strategies proven by this review to improve implementation or clinical outcomes.</p> Trial registration <p>PROSPERO CRD420261296956.</p>