Why Am I Losing My Balance More Often as I Get Older?

Why Am I Losing My Balance More Often as I Get Older? A Physical Therapist Answers

By Nova Physical Therapy | North Hollywood, CA

Patient Question

“I feel less steady than I used to, especially when walking, turning, using stairs, or getting up at night. Is this just a normal part of aging, and can physical therapy help?”

The Short Answer

Some changes in strength, reaction time, vision, sensation, mobility, and balance can occur as we age, but frequent loss of balance or repeated falls should not simply be dismissed as an unavoidable part of getting older.

Falls are common among older adults, but they are also often preventable.

CDC data updated in 2026 report that more than 1 in 4 adults age 65 and older falls each year, and falling once increases the likelihood of falling again. 

Balance problems can be influenced by multiple factors, including:

• Lower-extremity weakness
• Reduced balance reactions
• Gait changes
• Reduced physical activity
• Vision changes
• Foot or ankle problems
• Vestibular problems
• Medication effects
• Environmental hazards
• Neurological conditions
• Fear of falling

A licensed physical therapist can evaluate movement, strength, gait, balance, functional mobility, and fall-related limitations and determine whether physical therapy is appropriate.

Is Losing Balance a Normal Part of Aging?

Aging can influence many systems that contribute to balance, but repeated instability is not something that should automatically be accepted without evaluation.

Maintaining balance requires coordination between the:

• Muscles
• Joints
• Nervous system
• Eyes
• Inner-ear vestibular system
• Sensory system
• Brain

These systems continuously provide information about where your body is and how it is moving.

When one or more systems becomes less efficient—or when physical demands exceed current capacity—an individual may feel less stable.

The important question is not simply:

“How old are you?”

It is:

“What specific factors are affecting your ability to stay balanced and move safely?”

What Are Common Signs of Balance Problems?

Balance limitations may show up in different ways.

Some people notice:

• Feeling unsteady while walking
• Holding onto furniture
• Difficulty turning quickly
• Trouble walking in the dark
• Difficulty stepping over obstacles
• Hesitation on stairs
• Difficulty getting up from a low chair
• Feeling unstable on uneven surfaces
• Needing more support when showering
• Repeated trips or near-falls
• Fear of walking outside alone

Even a “near fall” can provide useful information.

A person does not need to hit the ground before balance should be evaluated.

Why Do I Feel More Unsteady at Night?

Walking in a dark environment reduces visual information.

Your body must then rely more heavily on other balance systems, including:

• Sensation from the feet and joints
• Vestibular input
• Strength
• Balance reactions

If one of these systems is impaired, walking in low-light environments may become more difficult.

This is also why nighttime trips to the bathroom can be challenging for some older adults.

Environmental modifications—such as adequate lighting and reducing tripping hazards—may be useful parts of a broader fall-risk strategy.

CDC fall-prevention guidance specifically recommends improving home lighting and removing common tripping hazards. 

Why Does My Balance Feel Worse When I Turn?

Turning requires rapid coordination.

Your body must:

• Shift weight
• Reposition the feet
• Control the trunk
• Maintain visual orientation
• Adjust to changing momentum

Some individuals who walk adequately in a straight line may become less stable during:

• Quick turns
• Direction changes
• Pivoting
• Walking around furniture
• Turning while carrying something

This is one reason a physical therapy balance evaluation includes more than simply observing straight-line walking.

Does Weakness Affect Balance?

Yes.

Strength is one important contributor to functional balance.

Lower-extremity muscles help control movements such as:

• Standing from a chair
• Climbing stairs
• Stepping over obstacles
• Recovering after a small loss of balance
• Walking uphill
• Controlling a step down

However, strengthening alone is not enough if the goal is specifically to reduce fall risk.

APTA's current clinical practice guideline recommends multicomponent exercise that includes progressive, sufficiently challenging balance training. It specifically advises against using resistance training alone as the sole intervention for fall-risk reduction. 

What Is Balance Training?

Balance training involves progressively challenging the systems responsible for maintaining stability.

Depending on the individual's abilities, exercises may involve:

• Narrowing the base of support
• Changing foot position
• Reaching
• Weight shifting
• Turning
• Stepping
• Walking around obstacles
• Changing walking speed
• Reducing hand support
• Practicing direction changes
• Functional stepping activities

The key word is progressive.

Simply standing with both feet together while holding onto a counter indefinitely may not provide enough challenge to meaningfully improve balance.

APTA's fall-risk guideline strongly recommends that balance training be sufficiently challenging and include changes in the base of support, movement of the body in multiple directions, and reduced upper-extremity support when safe and appropriate. 

Why Is Stepping Practice Important?

When people begin to lose balance, they often need to take a quick corrective step.

This ability is sometimes called a balance recovery response.

If the step is too slow, too small, or poorly controlled, the person may be more likely to fall.

Current APTA recommendations specifically include volitional stepping and gait-adaptability training as important components of fall-risk rehabilitation. 

That means rehabilitation may involve practicing how to:

• Step quickly
• Change direction
• Avoid obstacles
• Adjust stride
• Respond to changing walking demands

rather than relying only on stationary exercises.

Can Walking Alone Improve My Balance?

Walking is excellent physical activity and may support general health, endurance, and mobility.

However, walking alone may not challenge balance sufficiently for someone who has identified fall risk.

A person can walk the same flat route every day without necessarily practicing:

• Narrow-base balance
• Direction changes
• Obstacle negotiation
• Reactive stepping
• Single-leg control
• Variable surfaces

For this reason, a physical therapist may combine walking with individualized balance and strengthening exercises.

Can Physical Therapy Help Reduce Fall Risk?

Yes.

Physical therapists have a significant role in evaluating and managing fall risk.

APTA's 2025 clinical practice guideline strongly recommends that physical therapists participate in multifactorial fall-risk management and provide multicomponent exercise programs that include progressive balance training. 

Depending on examination findings, physical therapy may include:

• Balance training
• Gait training
• Lower-extremity strengthening
• Functional strengthening
• Sit-to-stand training
• Stair training
• Step training
• Gait-adaptability exercises
• Mobility exercises
• Endurance exercise
• Assistive-device assessment when appropriate
• Fall-recovery education
• Home-safety education
• Individualized home exercise programs

Physical therapists may also recommend referral to another healthcare professional when a risk factor falls outside physical therapy scope.

What Does Research Say?

The current evidence strongly supports exercise-based fall-risk management.

The 2025 APTA Geriatrics Clinical Practice Guideline concludes that:

• Multicomponent exercise reduces fall risk and fall rate.
• Balance training should be progressive and sufficiently challenging.
• Balance exercises should include whole-body movement, varying the base of support, and reducing hand support when appropriate.
• Volitional stepping and gait-adaptability training should be included.
• Strength training may be useful but should not be used alone when the goal is reducing falls.
• Education alone is also not sufficient as a stand-alone fall-prevention intervention.

The guideline also recommends combining exercise with individualized education and addressing environmental hazards and other modifiable risk factors.

CDC likewise emphasizes strength and balance exercise, medication review, vision care, and making the home environment safer as important fall-prevention strategies. 

Why Is This Topic Especially Important Right Now?

Falls Prevention Awareness Week is September 21–25, 2026.

The National Council on Aging is using this nationwide observance to promote awareness that falls are preventable and to help older adults remain safe, active, and independent. 

This year's observance is also being promoted by healthy-aging organizations in California, including events and resources connected with older-adult communities in the Los Angeles area. 

The timing provides a useful reminder:

You do not need to wait until after a serious fall to address balance.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, an evaluation for balance or fall-risk concerns may include:

• Medical history review
• Fall and near-fall history
• Balance assessment
• Walking assessment
• Lower-extremity strength assessment
• Functional mobility testing
• Sit-to-stand assessment
• Stair assessment when appropriate
• Turning assessment
• Gait-speed assessment
• Sensory screening when appropriate
• Vestibular screening when appropriate
• Assistive-device assessment when relevant
• Review of home and community mobility
• Review of activity limitations
• Goal setting

APTA's current guideline identifies mobility, balance, gait, activities of daily living, physical activity, lower-extremity strength, footwear, and environmental hazards as relevant components of fall-risk examination. 

The Physical Therapy Board of California describes physical therapy evaluations as including health history, observation of posture and movement, assessment of limitations, and development of an individualized treatment plan and goals. 

Do I Need a Cane or Walker?

Not everyone with balance concerns requires an assistive device.

For some individuals, however, a cane, walker, or other device may improve safety and mobility.

A physical therapist may evaluate:

• Walking stability
• Strength
• Balance
• Endurance
• Home environment
• Community mobility
• Ability to correctly use the device

If an assistive device is appropriate, correct height, technique, and usage are important.

The goal is to support safe function while continuing to address modifiable impairments when appropriate.

What About Fear of Falling?

Fear after a fall or near-fall is understandable.

However, fear can sometimes lead people to dramatically reduce activity.

Reduced activity may then contribute to:

• Deconditioning
• Muscle weakness
• Lower endurance
• Reduced confidence
• Less community participation

This can create a difficult cycle.

Physical therapy may help by progressively exposing the patient to appropriate movements and functional tasks in a structured environment.

The goal is not to force someone into activities they do not feel ready for.

It is to build capacity and confidence progressively.

Can Tai Chi Help With Fall Prevention?

Yes, Tai Chi is one evidence-supported option for some older adults.

The current APTA guideline strongly recommends Tai Chi as an intervention that can reduce fall risk and fall rate in community-dwelling older adults. 

However, Tai Chi is not necessarily the only exercise someone needs.

Individualized physical therapy may identify additional deficits in strength, gait, stepping, mobility, or functional performance that should also be addressed.

When Should You Seek Medical Attention?

Balance problems can sometimes be associated with medical conditions that require evaluation outside routine physical therapy.

Seek prompt or emergency medical attention for symptoms such as:

• Sudden new weakness
• Facial drooping
• New difficulty speaking
• Sudden severe dizziness
• Loss of consciousness
• New chest pain
• Severe shortness of breath
• Sudden significant vision changes
• New severe headache
• Significant head injury after a fall
• Inability to bear weight after a fall
• Suspected fracture
• Rapidly worsening neurological symptoms

Falls associated with loss of consciousness should receive appropriate medical evaluation.

A new balance problem should also not automatically be attributed to aging.

Why Patients Choose Nova Physical Therapy

At Nova Physical Therapy, our mission is simple:

We Care.

We believe maintaining independence is an important rehabilitation goal.

For one patient, that may mean walking confidently around the house.

For another, it may mean:

• Shopping independently
• Walking outside
• Traveling
• Using stairs
• Playing with grandchildren
• Exercising
• Returning to community activities

Our treatment philosophy emphasizes:

• Evidence-based care
• Individualized treatment plans
• Progressive balance training
• Strengthening
• Gait and functional training
• Patient education
• Fall-risk reduction
• Confidence with movement
• Healthy aging
• Long-term independence

Our goal is not simply to tell patients to “be careful.”

We work to identify modifiable limitations and progressively improve the physical abilities needed for everyday life.

Frequently Asked Questions

Is losing balance just a normal part of aging?

Some age-related changes can affect balance, but repeated instability or falls should not automatically be dismissed as normal aging. An evaluation may identify modifiable factors.

How common are falls in older adults?

CDC reports that more than 14 million adults age 65 and older—approximately 1 in 4—report falling each year. 

Can physical therapy help improve balance?

Yes. Current APTA guidelines strongly support progressive, challenging balance training as part of multicomponent exercise for older adults at risk of falling. 

Is strength training enough to prevent falls?

Strengthening may be valuable, but APTA specifically recommends against resistance training alone when the goal is reducing fall risk. Balance and functional training should also be considered. 

Should I stop walking because I am afraid of falling?

Not automatically. The appropriate level of activity depends on your safety and clinical presentation. A physical therapist can help determine safer ways to maintain and progressively improve mobility.

Do I need a walker if I lose my balance?

Not everyone needs one. Assistive-device recommendations should be individualized based on walking stability, function, environment, and examination findings.

Can Tai Chi help balance?

Yes. APTA's current clinical practice guideline strongly recommends Tai Chi as one evidence-supported intervention for reducing fall risk in older adults. 

Should I get my medications reviewed if I have fallen?

Yes. Certain medications may contribute to dizziness, sedation, or other fall-related risks. CDC recommends discussing medications with a physician or pharmacist. 

Does one fall mean I will fall again?

Not necessarily, but CDC reports that falling once increases the likelihood of another fall. 

Can I work on balance before I have ever fallen?

Yes. You do not need to wait for a serious fall. Balance limitations, near-falls, reduced confidence, or changes in walking can justify appropriate evaluation.

Schedule an Evaluation

If balance problems, weakness, unsteadiness, or fear of falling are affecting your ability to walk, use stairs, exercise, leave the house, or participate independently in everyday activities, Nova Physical Therapy can help determine whether physical therapy is appropriate.

Our licensed physical therapists provide comprehensive evaluations and individualized rehabilitation programs focused on improving balance, strength, walking, functional mobility, and confidence.

Contact Nova Physical Therapy today to schedule your comprehensive physical therapy evaluation in North Hollywood.

Disclaimer

The information provided in this article is intended for educational and informational purposes only and should not be considered medical advice, diagnosis, or treatment. Reading this article does not establish a physical therapist-patient relationship with Nova Physical Therapy or any of its providers.

Balance problems and falls can have multiple causes. Unsteadiness, weakness, dizziness, or a history of falling does not establish a specific diagnosis.

Treatment recommendations should be individualized based on a licensed physical therapist's evaluation, clinical judgment, medical history, functional presentation, current evidence, and applicable California laws and regulations.

Physical therapists evaluate and treat movement and functional impairments within their scope of practice and refer patients to physicians or other appropriate healthcare professionals when findings require additional medical evaluation.

If you experience sudden neurological symptoms, loss of consciousness, severe dizziness, chest pain, significant injury after a fall, suspected fracture, or other concerning symptoms, seek appropriate medical attention.

Individual results may vary. Nova Physical Therapy does not guarantee that physical therapy, exercise, balance training, assistive devices, or any other intervention will prevent every fall or produce a specific outcome.

References

1. Kirk-Sanchez N, McDonough C, Avin KG, Blackwood J, Hanke T. Physical Therapy Management of Fall Risk in Community-Dwelling Older Adults: An Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association – Geriatrics. Journal of Geriatric Physical Therapy. 2025. 
2. American Physical Therapy Association. Physical Therapy Management of Fall Risk in Community-Dwelling Older Adults (CPG+). April 1, 2025. 
3. Centers for Disease Control and Prevention. Older Adult Falls Data. Updated February 26, 2026. 
4. Centers for Disease Control and Prevention. Preventing Falls and Hip Fractures. Updated January 27, 2026. 
5. Centers for Disease Control and Prevention. Facts About Falls. Updated January 27, 2026. 
6. Physical Therapy Board of California. Consumer FAQ—Physical Therapy Evaluation and Treatment.
7. National Council on Aging. Falls Prevention Awareness Week 2026. September 21–25, 2026. 

Current resources: APTA Fall-Risk Clinical Practice Guideline · CDC Older Adult Fall Prevention · 2026 Falls Prevention Awareness Week resources · Physical Therapy Board of California consumer guidance

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