Objective To systematically evaluate the effect of tai chi exercise on balance function and fall prevention in the elderly. Methods Randomized controlled trials (RCTs) on the balance function and fall prevention of Tai Chi exercise in the elderly were searched by computer for PubMed, Web of Science, The Cochrane Library (Issue 8, 2012), EMbase, CBM, CNKI, VIP and WanFang Data, and the search time limit was 2000~2012. and retrospectively included reference lists of studies. After screening studies according to inclusion and exclusion criteria, extracting data and assessing the methodological quality of the included studies, meta-analysis was performed using RevMan 5.1 software. Results A total of 6 RCTs with a total of 2 796 patients were included. Meta-analysis showed that the tai chi group reduced the incidence of falls in the elderly [RR=0.82, 95%CI (0.73, 0.92), P=0.000 6], reduced standing walking time [MD=0.71, 95%CI(0.29, 1.12), P=0.000 9], increased functional stretching distance [MD=0.78, 95%CI (0.33, 1.23), P=0.000 7] and Berg balance scale scores [MD= 2.45, 95% CI (1.47, 3.43), P lt; 0.000 01] were significantly better than the control group, and the differences were statistically significant. Conclusion Tai Chi exercise can reduce the occurrence of falls and improve balance function in the elderly.