Why Am I Losing My Balance as I Get Older, and Can Physical Therapy Help Prevent Falls?

Why Am I Losing My Balance as I Get Older, and Can Physical Therapy Help Prevent Falls? A Physical Therapist Answers

By Nova Physical Therapy | North Hollywood, CA

Patient Question

“I’ve noticed that I feel less steady when I walk, especially when I turn quickly, get up from a chair, walk in the dark, or step off a curb. I haven’t had a serious fall, but I’m worried that my balance is getting worse. Is losing balance just part of getting older, and can physical therapy actually help?”

The Short Answer

Changes in balance can become more common with age, but frequent unsteadiness and falls should not simply be accepted as an inevitable part of aging.

Balance is a complex function involving several systems working together, including:

• Vision
• Vestibular function
• Sensation from the feet and joints
• Muscle strength
• Coordination
• Reaction ability
• Walking ability
• Joint mobility
• Cognitive attention

Medications, blood-pressure changes, vision problems, neurological or medical conditions, footwear, environmental hazards, and previous falls can also influence fall risk.

The encouraging part is that many fall-risk factors are potentially modifiable.

Current evidence supports exercise programs incorporating balance, gait, and strengthening activities for appropriate older adults. A major 2026 systematic review and network meta-analysis of 69 randomized controlled studies found particularly useful results when gait and balance training were combined with strength and resistance exercise. 

Physical therapy can evaluate the movement-related factors that may contribute to unsteadiness and develop an individualized program to improve balance, strength, walking, and functional mobility when appropriate.

Is Losing Balance a Normal Part of Aging?

Some physical abilities can change with age.

Muscle performance, reaction speed, vision, sensation, and other systems involved in balance may change over time.

But that does not mean:

“You’re getting older, so falling is unavoidable.”

The Centers for Disease Control and Prevention emphasizes that falls are preventable and should not be considered an inevitable consequence of aging. 

If someone begins feeling increasingly unsteady, the more useful question is:

What factors are contributing to the balance problem, and which of them can be addressed?

How Does Your Body Maintain Balance?

Balance is not controlled by one muscle or one organ.

Your nervous system continuously receives information from several sources.

Vision

Your eyes provide information about where you are relative to your surroundings.

This becomes obvious when walking through an unfamiliar dark room.

Without normal visual information, your other balance systems must do more work.

Vestibular System

Structures within the inner ear provide information about head position and movement.

Vestibular problems can contribute to symptoms such as:

• Vertigo
• Dizziness
• Unsteadiness
• Difficulty walking while moving the head

However, dizziness can have many causes and should not automatically be assumed to represent an inner-ear condition.

Somatosensory Information

Your brain also receives information from the feet, ankles, joints, muscles, and other tissues about where your body is positioned.

Muscular Response

Once the nervous system identifies a change in balance, your body must respond.

Adequate lower-extremity muscle performance can help you:

• Control your body
• Change direction
• Step
• Recover from small disturbances
• Rise from a chair
• Navigate stairs

Balance therefore depends on both sensing what is happening and physically responding to it.

Why Do I Feel Unsteady When I First Stand Up?

Several factors can contribute.

For some people, simply transitioning from sitting to standing challenges:

• Leg strength
• Balance
• Coordination

Others may experience dizziness or lightheadedness associated with changes in blood pressure or other medical factors.

That distinction matters.

If someone repeatedly becomes lightheaded after standing, the symptom should not automatically be treated as a leg-strength problem.

Medical evaluation may be appropriate, particularly when symptoms are new, significant, or associated with fainting.

Why Is My Balance Worse in the Dark?

When lighting is reduced, your visual system provides less information.

Your body must rely more heavily on the vestibular and somatosensory systems.

Someone who functions relatively well in a brightly lit room may therefore notice more difficulty:

• Walking to the bathroom at night
• Navigating a dark hallway
• Walking outside after sunset
• Entering a movie theater

Difficulty in darkness does not establish a specific diagnosis, but it can provide useful information during a balance evaluation.

Why Do I Lose My Balance When I Turn?

Turning is more complicated than simply walking straight ahead.

The body must:

• Slow down
• Reposition the feet
• Rotate
• Control momentum
• Reorient visually
• Continue walking

Fast or narrow turns may therefore expose balance limitations that are less noticeable during straight-line walking.

Physical therapists may assess turning as part of functional mobility.

Why Do I Feel Unsteady on Uneven Ground?

Walking across:

• Grass
• Gravel
• Sand
• Uneven sidewalks
• Sloped surfaces

requires continual adjustments.

The surface underneath the foot is less predictable than a flat indoor floor.

This can increase demands on ankle control, lower-extremity strength, sensation, vision, and balance.

For patients who want to return to outdoor walking, rehabilitation may eventually include appropriately progressed functional challenges rather than practicing only on perfectly flat surfaces.

Does Leg Weakness Affect Balance?

It can.

Lower-extremity muscles help control everyday activities including:

• Standing up
• Walking
• Stepping onto curbs
• Climbing stairs
• Controlling descent into a chair
• Recovering balance

Reduced physical activity can also contribute to decreased physical capacity over time.

This is one reason strengthening is frequently combined with balance and gait training rather than treating balance as an isolated skill.

Can Fear of Falling Actually Make Mobility Worse?

Fear of falling deserves attention.

Someone who becomes afraid of falling may begin avoiding:

• Walking outside
• Stairs
• Shopping
• Exercise
• Social activities

Reduced activity can then contribute to reduced strength and physical capacity.

This does not mean fear is “all in your head.”

A previous fall can be frightening, and caution may be reasonable.

The rehabilitation goal is not to tell someone:

“Just be confident.”

Instead, the goal may be to progressively improve physical ability and safely practice meaningful activities so confidence can develop alongside function.

A 2026 systematic review and meta-analysis of FallProof exercise programs found improvements in balance and fear of falling among older adults, supporting the role of structured exercise in this area. 

Does Having One Fall Mean I Will Fall Again?

Not necessarily, but a previous fall is an important risk factor.

The California Department of Public Health notes that falling once doubles the risk of falling again. 

That is why even a fall that did not cause a serious injury is worth discussing with a healthcare professional.

The goal is not to predict with certainty whether another fall will happen.

It is to identify potentially modifiable risk factors.

Are Falls Really That Common?

Yes.

The CDC reports that more than 1 in 4 adults age 65 and older falls each year. 

The most recent CDC older-adult falls data report more than 14 million older adults falling annually. 

Falls are also the leading cause of injury among adults age 65 and older. 

In California specifically, falls among people 65+ resulted in:

2,521 deaths

114,427 hospitalizations

317,582 emergency-department visits

in 2023. 

These numbers demonstrate why balance and fall prevention deserve attention before a serious injury occurs.

Should I Wait Until I Fall Before Getting My Balance Checked?

No.

You do not necessarily need to experience a serious fall before discussing balance concerns.

Possible reasons to seek evaluation include:

• Feeling increasingly unsteady
• Frequently grabbing furniture
• Difficulty turning
• Difficulty getting out of a chair
• Trouble walking on uneven surfaces
• Reduced walking confidence
• Near-falls
• Previous falls
• Difficulty with stairs
• Reduced ability to participate in normal activities

Early evaluation may identify modifiable limitations before they become more significant.

What Is a Near-Fall?

A near-fall occurs when someone begins losing balance but manages to recover before reaching the ground.

For example:

“I tripped and had to grab the counter.”

or

“I almost fell stepping off the curb but caught myself.”

Near-falls can provide useful information.

Someone does not have to wait for a serious fall before reporting increasing instability.

Can Physical Therapy Help?

Yes, physical therapy can address movement and functional factors associated with balance and mobility when the presentation is appropriate for physical therapy.

Treatment may include:

• Balance training
• Lower-extremity strengthening
• Gait training
• Functional mobility training
• Sit-to-stand practice
• Stepping exercises
• Turning practice
• Coordination activities
• Appropriate vestibular exercises when indicated
• Flexibility or mobility exercise when relevant
• Home exercise
• Patient and caregiver education

The program should reflect the individual's actual limitations.

Someone who has difficulty getting out of a chair may require a different emphasis from someone who is strong but becomes unstable when turning their head while walking.

What Does Balance Training Actually Look Like?

Balance exercise does not simply mean standing on one leg.

Depending on the patient's abilities, rehabilitation may progressively challenge:

• Base of support
• Surface
• Vision
• Head movement
• Reaching
• Stepping
• Direction changes
• Walking
• Dual-task activities

The challenge should be appropriate for the patient's abilities and safety.

Balance training should not consist of placing a patient in unnecessarily dangerous situations simply to make an exercise harder.

Does Strength Training Help Prevent Falls?

Current research supports incorporating strengthening into comprehensive fall-prevention exercise programs.

A 2026 systematic review and component network meta-analysis examined 69 randomized controlled studies of multifactorial and exercise-based fall-prevention programs.

The analysis found that programs combining gait and balance training with strength and resistance exercise reduced fall and fall-related injury risk, while gait and balance training showed benefit for recurrent fall risk. 

This supports a central physical therapy principle:

Balance and strength often need to be addressed together.

Is Walking Enough to Improve Balance?

Walking is valuable physical activity.

But walking alone may not address every balance limitation.

Someone may walk regularly but still have difficulty with:

• Turning
• Stepping backward
• Narrow-base activities
• Uneven surfaces
• Rapid changes in direction
• Recovering from a disturbance

An individualized program may therefore combine walking with strength and balance exercises.

What About Tai Chi?

The CDC identifies Tai Chi as an example of an activity that can help improve strength and balance. 

Tai Chi may be appropriate for some older adults, particularly as part of an overall activity program.

However, a person with significant balance limitations or a recent unexplained fall may benefit from individualized assessment before relying solely on a group exercise program.

Do I Need a Cane or Walker?

Not everyone with balance problems needs an assistive device.

For some individuals, however, an appropriately selected and properly fitted device may improve mobility or safety.

A physical therapist may evaluate:

• Walking pattern
• Balance
• Strength
• Functional needs
• Home and community mobility

when considering whether an assistive device is appropriate.

Using a cane or walker should not be viewed as failure.

For some patients, the right device can help support continued activity and independence.

Can Medications Affect Balance?

Yes.

Certain medications can contribute to:

• Dizziness
• Drowsiness
• Blood-pressure changes
• Other effects that may influence fall risk

The CDC recommends that older adults discuss medications with their physician or pharmacist, including prescription and over-the-counter medications. 

Medication management is outside the role of a physical therapist unless the therapist is appropriately communicating observations to the patient's medical team.

A physical therapist should not independently tell a patient to stop or alter medication.

Does Vision Matter?

Yes.

Vision contributes substantially to balance.

The CDC recommends regular eye examinations as part of fall-prevention strategies and notes that vision impairment can increase fall risk. 

This illustrates why fall prevention is often multifactorial.

Exercise can be important, but so can vision, medication review, medical management, footwear, and the home environment.

Should I Remove Rugs and Other Tripping Hazards?

Home modifications may help reduce environmental fall risks.

The CDC recommends strategies such as:

• Removing tripping hazards
• Improving lighting
• Adding grab bars when appropriate
• Installing railings on stairs

The newest 2026 meta-analysis also found that environmental modification contributed to fall-prevention outcomes within multifactorial programs. 

The goal is not to make a home completely obstacle-free.

It is to identify unnecessary hazards while simultaneously helping the person maintain physical capacity.

What Does Research Say?

The current evidence supports a multifactorial approach to fall prevention.

A major systematic review and component network meta-analysis published in 2026 analyzed 69 randomized controlled studies.

Researchers found that gait and balance training could reduce recurrent fall risk and that programs combining gait and balance with strength and resistance exercise reduced falls and fall-related injuries. 

Another 2026 systematic review and meta-analysis evaluated FallProof exercise programs and reported improvements in balance, fear of falling, and quality-of-life-related outcomes in older adults. 

The CDC's updated 2026 STEADI resources use a structured approach:

Screen. Assess. Intervene.

Healthcare providers are encouraged to screen adults age 65+ for fall risk, assess modifiable factors, and intervene using effective strategies. 

The CDC also recommends strength and balance exercise, medication review with the appropriate healthcare professional, vision care, and home-safety strategies. 

Importantly, fall prevention should not be reduced to one exercise.

The available evidence supports addressing the combination of factors relevant to the individual.

Why Is This Topic Especially Relevant Right Now?

September 2026 is Falls Prevention Awareness Month.

The Administration for Community Living formally launched this year's campaign on September 3, 2026, emphasizing evidence-based strategies that can help older adults maintain strength, confidence, health, and independence. 

The National Council on Aging is also leading Falls Prevention Awareness Week from September 21–25, 2026. 

The topic is particularly relevant locally.

California's older population continues to grow. Approximately 17% of California's population was age 65 or older in 2024, and that proportion is projected to reach 22% by 2040. 

Los Angeles County also offers evidence-based healthy-aging and fall-reduction programs for qualifying older adults, demonstrating the local public-health emphasis on maintaining independence and mobility. 

For patients searching:

“Why am I losing my balance?”

“How can I prevent falls as I get older?”

“Can physical therapy improve balance?”

or

“What exercises improve balance in older adults?”

this is an especially timely topic.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, a balance and mobility evaluation may include, when appropriate:

• Medical and fall history
• Near-fall history
• Symptom review
• Walking assessment
• Balance testing
• Lower-extremity muscle-performance testing
• Functional mobility testing
• Sit-to-stand ability
• Turning
• Stepping
• Coordination
• Joint mobility
• Vestibular screening when indicated
• Discussion of assistive-device use
• Home and community mobility
• Functional goals

Physical therapists may also use standardized functional tests when appropriate to help establish a baseline and track progress.

The purpose is not to predict with certainty whether someone will fall.

Instead, testing helps identify functional limitations that may be addressed through rehabilitation and findings that may require referral to another healthcare professional.

The APTA Geriatrics specifically trains physical therapists in evidence-based fall-risk screening, objective balance and gait measures, individualized prevention and rehabilitation strategies, and interprofessional referral. 

When Should You Seek Medical Attention?

Balance problems can have many causes, some of which require medical evaluation.

Seek urgent medical attention for sudden balance difficulty associated with symptoms such as:

• New facial weakness
• Difficulty speaking
• Sudden significant weakness or numbness
• Sudden severe headache
• Loss of consciousness
• New severe confusion
• Chest pain
• Significant head trauma
• Other sudden neurological or medical symptoms

Medical evaluation may also be appropriate for:

• Repeated unexplained falls
• Fainting
• New or worsening dizziness
• Rapidly progressive balance changes
• Significant neurological symptoms
• New medication-related symptoms
• Significant injuries following a fall

Physical therapists screen for findings that may indicate the need for referral rather than assuming all balance problems are musculoskeletal.

Why Patients Choose Nova Physical Therapy

At Nova Physical Therapy, our mission is simple:

We Care.

Balance problems can affect much more than walking.

They can make someone hesitant to:

• Leave home
• Walk independently
• Shop
• Exercise
• Use stairs
• Travel
• Attend family activities
• Participate in the community

Our goal is not to make older adults afraid of falling.

Our goal is to help patients maintain and improve the physical abilities that support an active, independent life.

Our treatment philosophy emphasizes:

• Evidence-based care
• Individualized rehabilitation
• Balance training
• Progressive strengthening
• Gait and mobility training
• Functional exercise
• Patient education
• Appropriate referral when necessary
• Long-term physical activity and independence

Aging does not mean that meaningful physical improvement is impossible.

When physical therapy is appropriate, we work with each patient to identify meaningful goals and progressively build the abilities required to pursue them.

Frequently Asked Questions

Is losing balance a normal part of getting older?

Some physical systems involved in balance can change with age, but frequent falls should not be considered an inevitable part of aging. The CDC emphasizes that many falls can be prevented. 

Can physical therapy improve balance?

Physical therapy can address modifiable movement and functional factors such as balance, strength, gait, coordination, and functional mobility when appropriate.

Can physical therapy prevent every fall?

No. No exercise or physical therapy program can guarantee that someone will never fall. Fall risk is multifactorial.

What exercises are best for fall prevention?

The appropriate program depends on the individual. Current research supports programs combining gait and balance training with strength and resistance exercise. 

Why am I more unsteady in the dark?

Reduced lighting removes some visual information used for balance, requiring greater reliance on other sensory systems.

Why do I lose balance when turning?

Turning requires deceleration, foot repositioning, rotation, visual reorientation, and balance control simultaneously.

Does leg weakness increase fall risk?

Reduced lower-extremity muscle performance can influence functional tasks involved in maintaining mobility and recovering balance.

Is walking enough for balance?

Walking is valuable physical activity but may not challenge all aspects of balance. Some patients benefit from additional strength, stepping, turning, and balance exercises.

Does Tai Chi help balance?

The CDC identifies Tai Chi as one example of exercise that can improve strength and balance. 

Should I tell my doctor if I fell but wasn't injured?

Yes. The CDC recommends telling a healthcare provider about falls, unsteadiness, or fear of falling. 

Should I be concerned about near-falls?

Repeated near-falls may provide useful information about balance and mobility and are worth discussing with an appropriate healthcare professional.

Can medication affect balance?

Some medications can contribute to dizziness, drowsiness, or other effects influencing fall risk. Medication review should be performed with a physician or pharmacist. 

Does vision affect balance?

Yes. Vision is one of the sensory systems used to maintain balance, and the CDC includes vision care among fall-prevention strategies. 

Do I need a cane or walker?

Not everyone does. Assistive-device recommendations should be individualized based on mobility, balance, functional needs, and safety.

Should I wait until I fall before seeing a physical therapist?

Not necessarily. Increasing unsteadiness, near-falls, reduced walking confidence, or difficulty with functional mobility may justify evaluation before a serious fall occurs.

Schedule an Evaluation

If you or a family member is experiencing increasing unsteadiness, difficulty walking, reduced balance confidence, near-falls, or changes in functional mobility, Nova Physical Therapy can help determine whether physical therapy is appropriate.

Our licensed physical therapists provide individualized evaluations and rehabilitation programs focused on:

• Balance
• Strength
• Walking
• Functional mobility
• Physical capacity
• 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 should not be considered medical advice, diagnosis, fall-risk prediction, or individualized treatment. Reading this article does not establish a physical therapist-patient relationship with Nova Physical Therapy or its providers.

Balance problems and falls can have many causes, including musculoskeletal, neurological, cardiovascular, vestibular, visual, medication-related, environmental, and other factors. Feeling unsteady does not by itself establish a specific diagnosis.

Physical therapists evaluate and treat movement and functional impairments within the scope of physical therapy. They may screen for findings requiring referral to a physician or another appropriate healthcare professional.

Balance exercises, strengthening, gait training, assistive devices, home modifications, and other interventions cannot guarantee that a fall will be prevented.

Patients should not discontinue or modify prescription or over-the-counter medications based on this article. Medication questions should be discussed with an appropriate physician or pharmacist.

Seek appropriate medical care for sudden balance changes, neurological symptoms, fainting, significant head injury, significant trauma, rapidly worsening symptoms, or other concerning findings.

Individual results vary. Nova Physical Therapy does not guarantee prevention of falls, elimination of symptoms, maintenance of independence, specific recovery times, or particular outcomes from physical therapy or any intervention discussed in this article.

References

1. Centers for Disease Control and Prevention. About Older Adult Fall Prevention. Updated January 27, 2026. 
2. Centers for Disease Control and Prevention. Older Adult Falls Data. Updated February 26, 2026. 
3. Centers for Disease Control and Prevention. Preventing Falls and Hip Fractures. Updated January 27, 2026. 
4. Centers for Disease Control and Prevention. STEADI: Provider Training and Continuing Education. Updated February 6, 2026. 
5. California Department of Public Health. Falls Prevention: Older Adult Falls Data.
6. Luo et al. Effectiveness of Multifactorial and Exercise Programs in Preventing Falls Among Older Adults: A Systematic Review and Component Network Meta-Analysis. Worldviews on Evidence-Based Nursing. 2026. 
7. 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. 
8. Administration for Community Living. Falls Prevention Awareness Month Is Here. September 3, 2026. 
9. National Council on Aging. Falls Prevention Awareness Week 2026. September 1, 2026. 
10. California Department of Public Health. California State of Public Health Report 2026. February 2026. 
11. APTA Geriatrics. Balance and Fall Prevention in Community-Dwelling Older Adults. 2026. 

Current resources: CDC Older Adult Fall Prevention · CDC 2026 Older Adult Falls Data · California Department of Public Health Falls Prevention · 2026 fall-prevention systematic review and network meta-analysis · 2026 FallProof systematic review and meta-analysis · 2026 Falls Prevention Awareness Month