Balance Problems With Age: Why They Happen

By Nova Physical Therapy, an outpatient physical therapy clinic in North Hollywood, CA | Published October 2026

Maybe you've started reaching for the wall when you turn around in the kitchen. Stepping off a curb feels less certain than it used to, or you've had a close call on the stairs. Some people quietly start doing less because they're worried about falling.

Balance can change as we get older, but declining balance isn't something you just have to accept. This article explains why balance changes, what raises the risk of falling, how balance can improve at any age, and when dizziness or unsteadiness needs a doctor.

The short answer

Balance depends on your eyes, your inner ear, the sensation in your feet and legs, your muscle strength, and how quickly your body reacts. Changes in any of these, along with certain health conditions and medications, can make balance worse with age. Falls are common: the CDC reports that more than one in four older adults falls each year, but fewer than half tell their doctor (CDC). The good news is that exercise works. A large Cochrane review found, with high-certainty evidence, that exercise reduces the rate of falls in older adults by about 23% (Sherrington et al., Cochrane). In California, you can see a physical therapist without a referral.

Why is my balance getting worse?

Staying upright is a team effort. Your brain constantly combines information from several systems:

• Your eyes, which tell you where you are in space
• Your inner ear, which senses head movement and position
• Sensation in your feet and joints, which tells you where your body is and what you're standing on
• Your muscles, especially in the hips, legs, and ankles, which make quick corrections
• Your reflexes and reaction time, which help you catch yourself

With age, several of these can change at once. The National Institute on Aging notes that eyesight, hearing, and reflexes may not be as sharp as they once were, and that age-related loss of muscle mass and strength, called sarcopenia, can affect standing and walking (NIA). Health conditions such as diabetes, heart disease, and problems with the nerves, feet, or blood vessels can also affect balance.

What raises my risk of falling?

Common risk factors include (NIA):

• Leg weakness and balance or walking problems
• Vision or hearing changes
• Medications that cause dizziness or sleepiness, or taking several medications
• A drop in blood pressure when standing up
• Foot pain or unsafe shoes, like backless slippers or high heels
• Home hazards, such as loose rugs, clutter, poor lighting, or no stair railings
• Rushing, for example to answer the phone or get to the bathroom
• Alcohol, which can affect balance
• A previous fall or a fear of falling that leads to doing less

Fear of falling matters too. The CDC notes that many people who fall, even if they aren't hurt, become afraid of falling (CDC). That fear can lead to less activity, which weakens muscles and makes balance worse, a cycle that the right plan can help break.

Simple steps that help many people (NIA):

• Stand up slowly, especially after lying down or sitting
• Wear supportive, nonskid, low-heeled shoes, and avoid walking on smooth floors in socks
• Get your eyes and hearing checked
• Ask your doctor or pharmacist whether any of your medicines affect balance
• Remove tripping hazards, add lighting, and use railings and grab bars
• Tell your doctor about any fall, even if you weren't hurt

Can balance improve at any age?

Yes. Balance is a skill, and like strength, it responds to practice. The Cochrane review of exercise for older adults living in the community found that (Sherrington et al., Cochrane):

• Exercise overall reduced the rate of falls by about 23% and the number of people who fell by about 15% (high-certainty evidence)
• Balance and functional exercises reduced the rate of falls by about 24% (high-certainty evidence)
• Programs combining several types of exercise, such as balance plus strength training, probably reduced the rate of falls by about 34% (moderate-certainty evidence)

The key is the right kind of exercise, done regularly and made gradually more challenging, safely.

How can physical therapy help?

A physical therapy evaluation may include:

• Your history of falls or near-falls, and what you want to be able to do
• Standardized balance and walking tests
• Leg, hip, and ankle strength
• How you get up from a chair, turn, climb stairs, and step over objects
• Foot sensation and footwear
• Screening for signs that need a physician's evaluation, such as dizziness or blood pressure changes

A typical plan may include:

• Balance exercises that safely challenge you, progressed over time
• Strength training for the hips, legs, and ankles
• Practice with everyday tasks like getting up, turning, stairs, and curbs
• Walking training, including whether a cane or walker would help and how to use it
• Guidance on home safety and how to get up after a fall
• A home program you can keep doing on your own

Physical therapy doesn't guarantee that you won't fall, but a structured, progressive program can make a real difference in strength, balance, and confidence.

At Nova Physical Therapy in North Hollywood, we work with balance problems and fall risk, and every plan starts with an evaluation so treatment fits what we find. Nova works with Medicare and many insurance plans; see our insurance page or call to confirm.

When should I see a doctor about dizziness?

Call 911 right away if balance problems or dizziness come on suddenly with any of these, which can be signs of a stroke:

• Face drooping, arm or leg weakness or numbness, especially on one side
• Trouble speaking or understanding speech
• Sudden trouble seeing, a severe headache, or confusion
• Sudden, severe loss of balance or trouble walking

Also get emergency care for a fall with a head injury, especially if you take blood thinners, or a fall after which you can't get up or put weight on a leg.

See a physician promptly if you have:

• New or ongoing dizziness, lightheadedness, or a spinning feeling
• Feeling faint or lightheaded when you stand up
• A fall, even without injury
• Balance that's getting worse over weeks or months
• New numbness or tingling in your feet
• Hearing loss or ringing in the ears along with dizziness

Dizziness has many causes, from inner ear problems to blood pressure, heart conditions, and medications, so it needs a physician's evaluation. We screen for these signs during every evaluation and refer you to a physician when findings call for medical assessment.

Do I need a referral for physical therapy in California?

Not to get started. California allows direct access to physical therapy. A physical therapist can evaluate and treat you without a referral for up to 45 calendar days or 12 visits, whichever comes first. After that, a physician or podiatrist needs to sign the plan of care for treatment to continue. Your insurance plan may have its own referral rules, so check your coverage.

Frequently asked questions

Is it normal for balance to get worse with age?
Balance often changes with age, but significant decline isn't something you just have to accept. Strength and balance training can help at any age.

What are good balance exercises for seniors?
Exercises that safely challenge balance, combined with strength training for the legs and hips, have the strongest support. A physical therapist can choose exercises that are safe and challenging enough for you.

Does tai chi help balance?
Research suggests tai chi can reduce falls in older adults. It can be a good option alongside, or as part of, a balance program.

Should I use a cane or walker?
A properly fitted cane or walker can help some people stay safe and active. A physical therapist can help you decide whether one would help and teach you how to use it.

Why do I feel dizzy when I stand up?
Feeling lightheaded when standing can be caused by a drop in blood pressure, dehydration, or some medications. Stand up slowly and talk with your physician, especially if it happens often.

I fell but wasn't hurt. Should I tell my doctor?
Yes. The CDC notes that fewer than half of older adults who fall tell their doctor, but a fall can be a sign of a problem that can be treated.

Do I need a referral to see a physical therapist?
No, not to start. California allows direct access within the limits described above. Medicare and some plans have their own rules, so check your coverage.

About Nova Physical Therapy

Nova Physical Therapy is an outpatient physical therapy clinic in North Hollywood, California, led by a Doctor of Physical Therapy. We help people recover from back and neck pain, sports injuries, work injuries, auto accident injuries, knee pain, and shoulder problems, and we also work with balance problems and rehab after surgery. Patients come to us from North Hollywood, Burbank, Studio City, Toluca Lake, Valley Village, and across the San Fernando Valley. Learn more about Nova or see our services.

Schedule an evaluation

If you have been feeling unsteady, have had a fall or a close call, or want to stay active and confident on your feet, an evaluation can help you build a plan.

Nova Physical Therapy
4795 Vineland Ave #E, North Hollywood, CA 91602
Call (818) 639-3402 | Book an appointment online

Disclaimer

This article is for general education only. It is not medical advice, a diagnosis, or a treatment recommendation for any individual. Dizziness and balance problems have many causes, and only an in-person evaluation can determine what is right for you. No treatment guarantees symptom resolution, and results vary. Physical therapists evaluate movement and function within their scope of practice and refer to physicians when findings warrant. Physical therapy in California is regulated by the Physical Therapy Board of California.

References

1. Centers for Disease Control and Prevention. Older Adult Falls Data. Updated September 2026. Link
2. Sherrington C, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019. Link
3. National Institute on Aging. Falls and Fractures in Older Adults: Causes and Prevention. Link