Background Functional near-infrared spectroscopy (fNIRS) is a method to measure cerebral hemodynamics. Determining the changes in prefrontal cortex (PFC) hemodynamics during dual-task paradigms is essential in explaining alterations in physical activities, especially in older adults. Aims To systematically review and meta-analyze the effects of dual-task paradigms on PFC hemodynamics in older adults. Methods The search was conducted in PubMed, Scopus, and Web of Science from inception until March 2023 to identify studies on the effects of dual-task paradigms on PFC hemodynamics. The meta-analysis included variables of cerebral hemodynamics, such as oxygenated hemoglobin (HbO2) and deoxygenated hemoglobin (HbR). The heterogeneity of the included studies was determined using the I2 statistic. Additionally, subgroup analysis was conducted to compare the effects of different types of cognitive tasks. Results A total of 37 studies were included in the systematic review, 25 studies comprising 2224 older adults were included in the meta-analysis. Our findings showed that inhibitory control and working memory tasks significantly increased HbO2 in the PFC by 0.53 (p textless 0.01, 95% CI = 0.37 to 0.70) and 0.13 (p textless 0.01, 95% CI = 0.08 to 0.18) μmol/L, respectively. Overall, HbO2 was significantly increased during dual-task paradigms by 0.36 μmol/L (P textless 0.01, 95% CI = 0.27 to 0.45). Moreover, dual-task paradigms also decreased HbR in the PFC by 0.04 (P textless 0.01, 95% CI = −0.07 to −0.01). Specifically, HbR decreased by 0.08 during inhibitory control tasks (p textless 0.01, 95% CI = −0.13 to −0.02), but did not change during working memory tasks. Conclusion Cognitive tasks related to inhibitory control required greater cognitive demands, indicating higher pfc activation during dual-task paradigms in older adults. for clinical implications, the increase in pfc oxygenated hemoglobin and decrease in pfc deoxygenated hemoglobin may help explain why older adults are more likely to fall during daily activities.