Am I Just Getting Older, or Should I Be Worried About My Balance?
- Disease Control and Pr
Am I Just Getting Older, or Should I Be Worried About My Balance? A Physical Therapist Answers
By Nova Physical Therapy | North Hollywood, CA
Patient Question
“I’m getting older and I’ve noticed that I’m less steady than I used to be. I sometimes hold onto furniture, feel nervous on stairs, or lose my balance when I turn quickly. Is this just a normal part of aging? Can balance actually improve with physical therapy?”
The Short Answer
Some physical changes can occur with aging, but frequent loss of balance and falls should not simply be dismissed as “getting old.”
Balance depends on several interacting systems, including:
- Muscle strength
- Sensation
- Vision
- Vestibular function
- Joint mobility
- Walking ability
- Reaction speed
- Attention
- Medications and medical conditions
- Environmental demands
The CDC reports that more than 1 in 4 adults age 65 and older falls each year, representing more than 14 million older Americans.
But an important message from current fall-prevention guidance is:
Falls are not an inevitable consequence of aging.
The 2025 American Physical Therapy Association clinical practice guideline recommends that physical therapists screen adults 65+ for fall risk and use multicomponent exercise programs that include balance training and other appropriate exercise, with programs progressed according to the individual.
The goal is not simply:
“Be more careful.”
A better question is:
What factors are affecting your balance, and which of those factors can we improve?
What Does “Balance” Actually Mean?
Balance is your ability to control your body's position while:
- Sitting
- Standing
- Walking
- Turning
- Reaching
- Stepping over objects
- Changing surfaces
- Responding to unexpected movement
Good balance does not mean standing perfectly still.
In everyday life, balance is constantly changing.
Think about walking through a busy grocery store.
You may need to:
walk → look sideways → avoid another person → turn → reach for an item → continue walking.
Your nervous and musculoskeletal systems continuously coordinate these tasks.
That is why balance rehabilitation often involves more than simply standing on one leg.
Is Losing Balance a Normal Part of Aging?
Age-related changes can influence balance.
These may include changes involving:
- Muscle performance
- Reaction speed
- Vision
- Sensation
- Vestibular function
- Mobility
- Physical activity
But frequent falls or significant instability should not automatically be considered normal.
The CDC specifically emphasizes that falls can be prevented and that older adults can take steps to reduce their risk.
If someone begins:
- Holding furniture while walking
- Avoiding stairs
- Walking much more slowly
- Avoiding uneven ground
- Falling repeatedly
- Restricting activity because of fear
those changes deserve attention.
Why Am I Suddenly Holding Onto Furniture?
Some people gradually develop what is sometimes informally called furniture walking.
They move around the house while touching:
- Counters
- Walls
- Chairs
- Tables
for additional stability.
This may indicate reduced confidence, reduced balance capacity, weakness, sensory changes, or another contributing factor.
It does not establish a diagnosis.
But it is useful information during a physical therapy evaluation.
What Causes Balance Problems?
There is no single cause.
Balance difficulties may be influenced by:
Muscle performance
Lower-extremity weakness can make it harder to control standing, stairs, or unexpected movements.
Vision
Vision provides important information about the environment.
Vestibular function
The inner-ear vestibular system helps detect head movement and orientation.
Sensation
Sensation from the feet and joints helps the nervous system understand where the body is positioned.
Medications
Some medications may influence dizziness, blood pressure, alertness, or balance.
Medical conditions
Neurological, cardiovascular, vestibular, musculoskeletal, and other conditions may affect balance.
Environment
Poor lighting, loose rugs, clutter, stairs, and uneven surfaces can increase environmental demands.
This is why fall prevention is usually more effective when it considers the whole person rather than prescribing one generic balance exercise.
Does Weakness Increase Fall Risk?
Reduced lower-extremity strength can contribute to difficulty with:
- Rising from a chair
- Climbing stairs
- Recovering from a loss of balance
- Walking efficiently
Strength training is therefore often part of fall-prevention rehabilitation.
But strength alone is not balance.
Someone can have relatively strong legs and still have difficulty with:
- Rapid turning
- Narrow-base walking
- Uneven surfaces
- Reactive stepping
- Head movements
A comprehensive program may therefore combine:
strength + balance + walking + functional movement.
Why Is Getting Out of a Chair Important?
Standing from a chair is a common everyday task.
It requires coordinated force from the:
- Hips
- Knees
- Ankles
- Trunk
Difficulty rising from a chair may reflect reduced lower-extremity capacity or other functional limitations.
Physical therapists frequently assess sit-to-stand performance as part of functional mobility and fall-risk evaluation.
The goal is not simply to improve a test score.
The goal is to help someone safely:
get out of bed → stand from a chair → use the bathroom → walk through the home → participate in daily life.
Why Do I Lose Balance When I Turn?
Turning is more complex than straight-line walking.
You need to:
- Change direction
- Shift body weight
- Reposition the feet
- Coordinate the head and trunk
- Maintain visual orientation
Someone may walk reasonably well in a straight line but become unstable when turning quickly.
Physical therapy may therefore assess both walking and directional changes.
Why Is Walking in the Dark Harder?
Your balance system combines information from:
- Vision
- Vestibular system
- Sensation
When lighting is reduced, visual information becomes less available.
The nervous system must rely more heavily on other sensory information.
This is why someone may feel relatively stable during the day but less confident:
- Walking to the bathroom at night
- Entering a dark room
- Walking in a dim restaurant
Nighttime lighting and environmental safety can therefore be important considerations.
Why Are Uneven Surfaces Harder?
Grass, gravel, sand, curbs, and uneven sidewalks create changing demands under the feet.
The body must continuously adjust.
Someone who primarily walks on smooth indoor floors may notice much greater difficulty outside.
A rehabilitation program may progressively challenge different surfaces when appropriate and safe.
Is Fear of Falling a Problem?
Fear of falling is understandable, especially after a previous fall.
But fear can sometimes create a cycle:
fear of falling → less activity → reduced physical capacity → more difficulty with activity.
The CDC notes that people who fall may become afraid of falling and subsequently reduce everyday activities; reduced activity can contribute to weakness and increased fall risk.
This does not mean someone should ignore fear and attempt unsafe activities.
Instead, rehabilitation can progressively rebuild capacity and confidence in a controlled environment.
If I Have Fallen Once, Am I More Likely to Fall Again?
Yes, previous falls are important.
The CDC reports that falling once approximately doubles the chance of falling again.
That is one reason a previous fall should not simply be dismissed because:
“Nothing broke.”
A fall can provide useful information about future risk.
How Common Are Falls in Older Adults?
Very common.
Updated CDC data published in February 2026 report that:
more than 14 million U.S. adults age 65+—approximately 1 in 4—report falling each year.
The same CDC data indicate that approximately 37% of people who fall report an injury requiring medical treatment or restricting activity for at least one day.
Falls are also the leading cause of injury among adults age 65 and older.
These numbers explain why balance assessment and fall prevention deserve serious attention.
Does Everyone Who Falls Need a Walker?
No.
Assistive-device recommendations should be individualized.
Some people may benefit from:
- Cane
- Walker
- Other assistive device
because it improves safety and mobility.
Others may not require one.
The correct device depends on factors such as:
- Balance
- Strength
- Walking pattern
- Medical condition
- Environment
- Functional needs
A device should be properly selected and fitted.
Will Using a Cane Make Me Weaker?
Not necessarily.
A properly prescribed assistive device can help someone move more safely and remain active.
Avoiding all walking because of fear may be much more limiting than appropriately using a device.
The objective is not:
“Never use assistance.”
The objective is:
maximize safe, functional independence.
What Balance Tests Do Physical Therapists Use?
The exact assessment depends on the patient.
Possible measures may include:
- Timed Up and Go
- Five Times Sit-to-Stand
- 30-Second Chair Stand
- Gait-speed testing
- Balance tests
- Functional reach
- Walking with head movement
- Turning
- Single-leg or narrow-base balance when appropriate
- Dual-task walking
- Reactive balance assessment
The 2025 APTA guideline specifically recommends screening adults 65+ for fall risk and provides an evidence-based clinical reasoning algorithm for community-dwelling older adults.
No single test perfectly predicts whether someone will fall.
The complete clinical picture matters.
What Is the Timed Up and Go Test?
The Timed Up and Go—often called the TUG—assesses functional mobility.
The person typically:
stands from a chair → walks → turns → returns → sits.
This combines several important everyday skills.
A physical therapist considers the test result along with other findings rather than using one cutoff score as a diagnosis.
What Is Dual-Task Walking?
Dual-task walking means walking while simultaneously performing another task.
Examples might include:
- Walking while talking
- Walking while counting
- Walking while carrying something
- Walking while scanning the environment
Real life is full of dual tasks.
You rarely walk through a grocery store while focusing exclusively on your feet.
A systematic review and meta-analysis involving 44 studies and 2,782 older adults found that dual-task exercise improved dynamic balance and functional mobility and reduced fall frequency. Evidence quality across outcomes ranged from very low to moderate.
A 2026 scoping review of 31 studies similarly found favorable results for gait, dynamic balance, and cognitive function with dual-task interventions, although optimal protocols remain uncertain.
What Is Reactive Balance?
Reactive balance is your ability to respond when balance is unexpectedly disturbed.
Imagine:
- Tripping slightly
- Being bumped
- Missing a step
- Slipping
- Stepping unexpectedly onto an uneven surface
The body may need to rapidly take a step or make another corrective movement.
This ability can be specifically trained in appropriate patients.
What Is Perturbation-Based Balance Training?
Perturbation-based balance training intentionally exposes a person to controlled, unexpected balance disturbances in a safe rehabilitation environment.
The goal is to practice recovering balance.
A new systematic review published in the August 2026 issue of the Journal of the American Medical Directors Association found that perturbation-based balance training reduced:
overall fall rates by approximately 23%
and
injurious falls by approximately 24%
compared with control interventions.
The certainty for the fall-rate evidence was low, so these percentages should not be presented as a guaranteed individual outcome.
Interestingly, programs involving at least approximately six hours of perturbation training showed greater fall reduction in subgroup analysis.
This is an emerging area of fall-prevention rehabilitation.
Should I Practice Losing My Balance at Home?
Not without appropriate safety precautions.
Reactive-balance exercises can intentionally challenge stability.
Attempting difficult balance exercises:
- Without supervision
- Near stairs
- Without appropriate support
- On unsafe surfaces
can create unnecessary risk.
The difficulty of balance exercise should match the person's current ability.
Does Tai Chi Help Balance?
Tai Chi can be an appropriate form of physical activity for some older adults and incorporates controlled weight shifting, movement, and balance challenges.
Interestingly, this is also locally relevant today.
The Los Angeles Public Library has a Tai Chi program for adults over 50 scheduled today, September 15, in Mar Vista, with additional weekly sessions throughout the fall. The program specifically identifies balance as one of its goals.
Tai Chi may be one useful option, but someone with substantial fall risk may require a more individualized assessment and program.
What Is the FallProof Program?
FallProof is a structured balance and mobility program designed for older adults.
A 2026 systematic review and meta-analysis evaluated FallProof exercise programs and found improvements in:
- Balance
- Fear of falling
- Quality-of-life measures
among older adults.
This adds to the broader evidence supporting structured balance exercise.
Do I Need to Stand on a Foam Pad?
Not necessarily.
Foam surfaces are one tool therapists may use to alter sensory information and challenge balance.
But effective balance rehabilitation does not require circus-like exercises.
Exercise might instead involve:
- Standing with a narrower base
- Weight shifting
- Stepping
- Turning
- Walking
- Reaching
- Sit-to-stand
- Strengthening
- Head movement
The exercise should address the person's actual functional limitations.
Should I Practice Standing on One Leg?
Single-leg balance can be useful for selected patients.
But it is not appropriate for everyone.
Someone with substantial instability may need to begin with:
wider stance → narrower stance → stepping → more advanced balance challenges.
Progression matters.
Can Strength Training Reduce Fall Risk?
Strengthening is an important component of many fall-prevention programs.
But current APTA guidance recommends multicomponent exercise, not strength training alone, for many older adults at fall risk.
A comprehensive program may include:
balance + strength + walking + functional tasks.
Can Physical Therapy Help?
Yes, when balance impairment, walking limitations, weakness, or fall risk are appropriate for physical therapy.
Physical therapy may include:
- Fall-risk screening
- Balance assessment
- Strength assessment
- Walking assessment
- Assistive-device assessment
- Progressive strengthening
- Balance exercise
- Functional mobility training
- Reactive balance training when appropriate
- Dual-task training when appropriate
- Gait training
- Stair training
- Home exercise
- Education
- Environmental safety discussion
- Appropriate referral
The goal is not simply:
“Don't fall.”
A better rehabilitation goal may be:
stand safely → walk confidently → turn → use stairs → walk outdoors → shop → exercise → participate in life.
What Does Research Say?
Fall prevention is receiving substantial research attention in 2026.
August 2026 Perturbation-Based Balance Training Review
Sharma and colleagues published a systematic review in the Journal of the American Medical Directors Associationexamining perturbation-based balance training in community-dwelling adults age 65+.
The meta-analysis found approximately:
23% lower fall rates
and
24% fewer injurious falls
compared with control interventions.
Reactive balance improved, while effects on some other fall-risk factors such as gait were limited.
The authors concluded that perturbation training appears to reduce falls primarily by improving the ability to recover from balance disturbances.
2026 FallProof Meta-Analysis
Alghosi and colleagues published a systematic review and meta-analysis in BMC Geriatrics examining FallProof exercise programs.
The analysis found favorable effects on balance, fear of falling, and quality of life among older adults.
Dual-Task Exercise Meta-Analysis
A systematic review with meta-analysis and meta-regression included:
44 studies
and
2,782 older adults.
Dual-task exercise improved dynamic balance and functional mobility and reduced fall frequency.
This is particularly relevant because everyday walking frequently occurs while simultaneously:
- Talking
- Looking around
- Carrying objects
- Making decisions
August 2026 Cognitive Training Meta-Analysis
A newly published systematic review in JMIR Aging found that cognitive training alone did not clearly improve single-task balance or functional mobility, but did improve walking speed during cognitive-motor dual-task conditions in higher-quality studies.
This finding is useful because it demonstrates that different interventions affect different aspects of mobility.
APTA Clinical Practice Guideline
In April 2025, APTA Geriatrics published an updated evidence-based guideline for physical therapy management of fall risk in community-dwelling adults age 65+.
The guideline recommends:
- Screening for fall risk
- Multifactorial assessment when appropriate
- Multicomponent exercise
- Balance training
- Strength and other appropriate physical exercise
- Individualized progression
Taken together, the evidence supports an important message:
Balance can be trained, fall risk can often be modified, and getting older does not mean people should simply accept repeated falls.
Why Is This Topic Especially Relevant Right Now?
September is Falls Prevention Awareness Month.
The U.S. Administration for Community Living issued its 2026 Falls Prevention Awareness Month announcement on September 3, emphasizing evidence-based programs that help older adults build strength and confidence and reduce fall risk.
Next week—September 21–25, 2026—is national Falls Prevention Awareness Week, led by the National Council on Aging.
The campaign emphasizes a simple but important message:
Falls can often be prevented.
Local interest in healthy aging is also especially high this month.
The 8th Annual Statewide Village Conference for organizations supporting older adults will take place September 17–18 at the Los Angeles County Arboretum and Botanic Garden, and a senior health and aging expo is scheduled in Culver City for September 19.
For people in North Hollywood, Burbank, Studio City, Toluca Lake, Valley Village, Van Nuys, Sherman Oaks, and greater Los Angeles searching:
“Why am I losing my balance as I get older?”
“How can seniors improve balance?”
“What exercises help prevent falls?”
“Should I see a physical therapist after a fall?”
and
“Can physical therapy improve balance?”
this is an especially timely topic.
What Happens During a Physical Therapy Evaluation?
At Nova Physical Therapy, a balance or fall-risk evaluation may include, when appropriate:
- Fall history
- Near-fall history
- Medical history
- Medication-related concerns for appropriate referral
- Dizziness history
- Walking difficulties
- Assistive-device use
- Lower-extremity muscle performance
- Sit-to-stand ability
- Walking speed
- Turning
- Static balance
- Dynamic balance
- Functional mobility
- Dual-task mobility when appropriate
- Stair ability
- Sensory considerations
- Vestibular-related screening when relevant
- Patient goals
The physical therapist may ask:
Have you fallen in the past year?
Have you almost fallen?
Do you hold furniture while walking?
Do you feel unsteady outside?
Are you afraid of falling?
Do you avoid activities because of your balance?
The 2025 APTA guideline specifically recommends fall-risk screening for community-dwelling adults age 65 and older.
The Physical Therapy Board of California Practice Act includes physical therapy evaluation, treatment planning, instruction, rehabilitation, and active, passive, and resistive exercise within physical therapy practice. California law also states that a physical therapist license does not authorize diagnosis of disease.
If findings suggest a medical condition requiring additional evaluation, appropriate referral is made.
When Should You Seek Medical Attention?
A balance problem is not always simply a strength problem.
Seek appropriate medical evaluation for:
- A fall with significant injury
- A fall with head impact, particularly when taking blood-thinning medication
- Sudden new severe dizziness
- New facial weakness
- New arm or leg weakness
- New numbness
- New difficulty speaking
- New confusion
- Sudden severe headache
- New inability to stand or walk
- Loss of consciousness
- Chest pain
- Severe shortness of breath
- Repeated unexplained falls
- Rapidly worsening balance
- New neurological symptoms
The CDC specifically advises that an older adult who falls and hits their head should receive medical evaluation because head injuries can be serious, particularly when certain medications such as blood thinners are involved.
Persistent balance changes should not automatically be attributed to aging.
Why Patients Choose Nova Physical Therapy
At Nova Physical Therapy, our mission is simple:
We Care.
Balance problems can gradually make someone's world smaller.
A person may stop:
- Walking outside
- Shopping independently
- Using stairs
- Traveling
- Exercising
- Visiting friends
- Playing with grandchildren
because they are afraid of falling.
Our goal is not to make patients more afraid.
We want to understand:
What is making you less confident, and what can we appropriately improve?
Our rehabilitation philosophy emphasizes:
- Evidence-based care
- Individualized treatment
- Progressive strengthening
- Balance training
- Functional mobility
- Walking
- Appropriate fall-risk reduction
- Patient education
- Building physical capacity
- Maintaining independence
Instead of telling patients simply to “be careful,” we focus on building the abilities needed to participate safely and confidently in everyday life.
Frequently Asked Questions
Is losing balance a normal part of aging?
Some age-related changes can affect balance, but repeated falls or significant instability should not simply be dismissed as normal aging.
How common are falls after age 65?
More than 14 million—or approximately 1 in 4—U.S. adults age 65+ report falling each year.
If I have fallen once, am I more likely to fall again?
Yes. The CDC reports that one fall approximately doubles the chance of another fall.
Why am I holding onto furniture when I walk?
It may reflect reduced balance confidence, weakness, sensory changes, or another contributing factor. An evaluation can help determine relevant functional limitations.
Can weak legs affect balance?
Yes. Lower-extremity muscle performance contributes to standing, walking, stairs, and recovery from balance disturbances.
Does strength training alone improve balance?
Strengthening can be important, but APTA guidance supports multicomponent exercise including balance training for people at fall risk.
Can balance actually improve after age 70 or 80?
Older adults can improve physical abilities with appropriately selected training. Individual response depends on health, baseline function, exercise dosage, and other factors.
What is reactive balance training?
It trains the ability to recover from unexpected disturbances to balance. A 2026 systematic review found reductions in falls and injurious falls with perturbation-based training.
What is dual-task balance training?
It combines movement with another task, such as walking while talking or performing a cognitive task.
Does dual-task exercise help?
A meta-analysis of 44 studies involving 2,782 older adults found improvements in dynamic balance and functional mobility and reductions in fall frequency.
Is Tai Chi good for balance?
Tai Chi can be one appropriate exercise option for some older adults and includes controlled weight shifting and balance challenges.
Should I practice standing on one leg?
It may be appropriate for some people, but balance exercise should match the person's current ability and safety needs.
Do I need a walker because I fell?
Not automatically. Assistive-device recommendations should be individualized.
Will using a cane make me weaker?
Not necessarily. A properly prescribed device may improve safe mobility and help someone remain active.
Should I see a physical therapist after a fall even if I was not injured?
A fall may be an important reason to assess balance, strength, walking, mobility, and other modifiable risk factors, particularly after age 65.
Can physical therapy prevent every fall?
No intervention can guarantee that someone will never fall. Physical therapy can address modifiable factors and help reduce risk when appropriate.
Can physical therapy help balance problems?
Yes, when the balance or mobility limitation is appropriate for physical therapy. Rehabilitation may address strength, balance, walking, reactive control, functional movement, and confidence with activity.
Schedule an Evaluation
If balance problems, weakness, falls, near-falls, or fear of falling are making it difficult to walk, use stairs, exercise, shop, travel, or participate confidently in everyday activities, Nova Physical Therapy can help determine whether physical therapy is appropriate.
Our licensed physical therapists provide individualized evaluations and rehabilitation programs focused on:
- Balance
- Lower-extremity muscle performance
- Walking
- Functional mobility
- Progressive strengthening
- Fall-risk reduction
- Maintaining independence
Contact Nova Physical Therapy today to schedule a comprehensive physical therapy evaluation in North Hollywood.
Disclaimer
This article is intended for educational and informational purposes only and does not constitute medical advice, medical diagnosis, fall-risk clearance, or individualized physical therapy treatment.
Balance impairment, dizziness, falls, weakness, numbness, gait changes, and instability can have many causes. Symptoms alone do not establish a vestibular, neurological, cardiovascular, musculoskeletal, medication-related, or other diagnosis.
Physical therapists evaluate and treat movement and functional impairments within their regulated professional scope. California Business and Professions Code §2620 includes physical therapy evaluation, treatment planning, instruction, rehabilitation, and exercise within physical therapy practice and specifies that a physical therapist license does not authorize diagnosis of disease.
Balance training, strengthening, gait training, Tai Chi, assistive devices, perturbation training, dual-task exercise, or other interventions cannot guarantee prevention of falls, injuries, hospitalization, or a specific outcome.
The research discussed in this article reports group-level findings and should not be interpreted as an individualized exercise prescription.
Balance exercises that substantially challenge stability should not be attempted without appropriate safety precautions.
Seek appropriate medical care for significant injury after a fall, head impact, sudden neurological symptoms, severe dizziness, new inability to stand or walk, loss of consciousness, chest pain, severe shortness of breath, or other severe or rapidly worsening symptoms.
Individual results vary.
References
- Kirk-Sanchez N, McDonough C, Avin K, Blackwood J, Hanke T. Physical Therapy Management of Fall Risk in Community-Dwelling Older Adults: An Evidence-Based Clinical Practice Guideline From APTA Geriatrics.Published April 1, 2025.
- Sharma S, Szabo IZ, Danielsen MB, Andersen S, Nørgaard JE, Lord SR, Okubo Y, Jørgensen MG. Perturbation-Based Balance Training Reduces Falls and Fall Injuries in Older People: Insights on Mechanisms and Training Parameters From a Systematic Review. Journal of the American Medical Directors Association. August 2026;27(8):106316.
- Alghosi M, Khazanin H, Faraji S, et al. The Effect of FallProof Exercise Programs on Balance, Fear of Falling and Quality of Life in Older Adults: A Systematic Review With Meta-Analysis. BMC Geriatrics. 2026;26:491.
- Effectiveness of Dual-Task Exercise in Improving Balance and Preventing Falls Among Older Adults: Systematic Review With Meta-Analysis and Meta-Regression. European Geriatric Medicine. Forty-four studies involving 2,782 older adults.
- Thazhakkattu Vasu et al. Effects of Dual-Task and Single-Task Interventions on Physical and Cognitive Function in Older Adults: A Scoping Review. Journal of Aging Research. 2026. Thirty-one studies were included.
- Effects of Pure Cognitive Training on Gait and Balance in Older Adults: Systematic Review and Meta-Analysis.JMIR Aging. August 2026;9:e85070.
- Centers for Disease Control and Prevention. Older Adult Falls Data. Updated February 26, 2026.
- National Council on Aging. Falls Prevention Awareness Week 2026. September 21–25, 2026.
- Physical Therapy Board of California. California Physical Therapy Practice Act — Business and Professions Code §2620.
- Muscle strength