HealthRuby : Adulthood

Aging and Balance Changes- A Best Guide in Preventing Falls and 6 Exercises to Enhance Balance in the Elderly

Discover key strategies to prevent falls and improve balance in the elderly with our guide on aging-related changes, featuring medical insights and practical tips

We have all lost our body balance at some point in our lives. From falling over a pebble as a kid to stumbling over our own feet as adults, we’ve all been there. But these incidences become more frequent as people age, particularly in people over 50.

These balance issues may raise the possibility of falls among elders and can also lead to serious injuries such as fractures, head injuries, reduced mobility, and dependency on caregivers. These complications rise from 1 to 10 in the elderly.  For older people to maintain their health and quality of life, they need to know what causes balance problems and use effective fall prevention techniques. This is what our article will focus on. So let’s begin!

How Does Balance Work?

First, we need to understand how balance is maintained in a body. Achieving balance requires coordinated efforts from several parts of the body. Our eyes, muscles, joints, and the vestibular system in the inner ear all help us stay upright and on our toes, see clearly when in movement, and automatically modify our posture to keep us steady.

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As the brain interprets the data from every sense, it communicates with the muscles that move our eyes, neck, trunk, body, and legs. By responding to these signals, one can maintain balance. (1)

When Balance Deteriorates? 

Research suggests that the decline in balance typically begins in midlife, approximately 50 years of age. In 2022, a recent study found that individuals in their 30s and 40s can maintain balance on one foot for at least one minute. At age 50, however, this ability commenced to deteriorate, and by then, individuals could only sustain the position for 45 seconds. Participants aged 70 and above demonstrated the ability to maintain equilibrium for 28 seconds, while those aged 80 and above achieved the feat of standing on one foot for less than 12 seconds.

Causes of Balance and Falls in Elderly

Falls and balance problems become more common as people age because of musculoskeletal, neurological, and other physiological system changes. Some of the most common ones include the following:

1. Musculoskeletal Changes: Aging is associated with a decline in muscle mass and strength, a condition known as sarcopenia. This decline affects the lower extremities disproportionately, compromising the ability to maintain postural stability and perform weight-bearing activities.

Additionally, osteoarthritis and osteoporosis contribute to joint pain and bone fragility, respectively, further exacerbating the risk of falls and the severity of fall-related injuries.

2. Neurological Changes: Significantly contributing to the increased incidence of falls among the elderly is neurological decline. Peripheral neuropathies and neurodegenerative diseases, including Parkinson’s disease, substantially impair balance and locomotion, thereby elevating the risk of falling. It has been reported in research that people with epilepsy (57%), dementia (60%), Parkinson’s disease (77%), and stroke (89%) are at risk of falling.

3. Vestibular Impairment: Age-related changes in the visual, vestibular, and proprioceptive systems, including macular degeneration, glaucoma, and vestibular disorder, impact spatial orientation and increase the risk of falls.

One of the most common causes of loss of balance in the elderly is Meniere’s disease. It is an ear disorder that causes dizziness and a sense of fullness in the ears. It is a common cause of balance issues. Seniors who have this ailment may also endure vertigo and hearing loss, which can impair balance.

Another notable change is subtle, age-related hearing loss, known as presbycusis. Because of this, the person suffering from it might not realize that their hearing is changing, which can lead to changes in their bones, blood vessels, and tissues, all of which impact their balance. Learn more about age-related hearing loss in our dedicated article here.

Last but not least, another common condition that can increase the risk of falls in the elderly is benign paroxysmal positional vertigo (BPPV). Simply rotating the head, such as when you get out of bed or rollover from sitting, can induce BPPV. Mild to severe head injuries to the elderly are to blame for such conditions that increase the fall risk.

4. Visual Changes: Age-related vision changes, such as decreased depth perception and peripheral vision, as well as trouble recognizing colors or contrasts, can make it challenging to navigate and detect possible dangers. Uneven surfaces, slippery flooring, poor illumination, loose rugs or carpets, and congested walkways can all lead to falls among older individuals.

5. Proprioceptive Changes: Proprioception, sometimes known as body awareness, declines with age and immobility. An essential part of this process is transmitting information from nerve receptors in and around joints to the central nervous system and brain. Unfortunately, these nerve receptors begin to deteriorate with age and less physical exercise, which impacts balance and coordination and causes a loss in body awareness.

6. Cardiovascular Changes: Standing-related orthostatic hypotension, or a marked drop in blood pressure, is more common in the elderly and frequently occurs as a side effect of cardiac drugs. This can cause lightheadedness and fainting, increasing the likelihood of falling.

7. Infections in the Ear: One infection that might impact balance is labyrinthitis, which affects the inner ear. The inflammation is at fault because it interferes with the conduction of ear-to-brain signals. It is frequent among seniors because it is linked to the flu.

8. Medications Side effects: The inability to maintain one’s balance is a potential negative impact of several drugs used by the elderly, including those for blood pressure management. The effects of this medication may be similar to those of sedatives, antidepressants, anticancer medications, and some anxiety medications.

Roughly one-quarter of the elderly population falls each year. Injuries in seniors 65 and older are most commonly caused by falls. Traumatic brain injuries and hip fractures are most commonly caused by falls.

Symptoms of Balance Disorders

Various symptoms, such as nausea, dizziness, or unsteadiness, can manifest when people lose their balance. How one feels as one loses one’s balance varies widely from person to person. Some people feel like they are spinning around in their bodies, even when not moving. A few others reported that they were floating.

  • Feeling faint or lightheaded
  • Loss of balance or unsteadiness
  • Vertigo, or a sense that you are spinning
  • Falling or feeling like you might fall
  • Dizziness
  • Vision changes, like blurriness
  • Confusion

Nausea and vomiting, diarrhea, differences in heart rate and blood pressure, and emotions of fear, anxiety, or distress may also be present.

Depending on the severity of the symptoms, they may be temporary and go away quickly, or they can remain for a long time and cause emotional distress or physical exhaustion.

Accessing the Risk of Falls

It is essential to determine how likely one is to fall to avoid falls in the future. For an easy way to assess your own risk, the CDC suggests asking yourself these three questions:

  1. Have you fallen in the past year?
  2. Do you feel unsteady when standing or walking?
  3. Do you worry about falling?

A greater risk of falling may be associated with the answer being yes.

Another method doctors use for assessing the risk of falls is testing a person’s strength, balance, and gait. It includes a series of tests, such as,

  • Timed Up-and-Go Test: This test checks the gait. The person to be accessed will be seated in a chair and then asked to stand and walk for 10 feet at their normal pace. Then, he or she is asked to sit again. A healthcare professional will evaluate the duration required for an individual to complete a designated mission. A duration exceeding 12 seconds may signify an elevated risk of falling for the afflicted individual.
  • 30-second Chair Stand Test: In the 30-second chair stand test, the person sits cross-armed in a chair, stands up at the “go” signal, and sits down 30 times in a row. The doctor keeps track of the repetitions. A lower count indicates a higher risk of falls, depending on age.
  • The 4-Stage Balance Test: In this 4-stage balance test, an individual’s ability to maintain balance is assessed by standing for 10 seconds in four progressively more challenging positions. The following are the positions:
  1. Standing with feet side-by-side.
  2. Moving one foot halfway forward so the instep touches the other foot’s big toe.
  3. Placing one foot fully in front of the other, with toes touching the heel of the other foot,.
  4. Standing on one foot.

Many other tests are used to assess balance and risk of falls and must be advised and performed at the doctor’s recommendation.

Managing Balance Disorders for the Elderly

Neglecting balance issues is dangerous for the elderly. Instead, they should consult their physician regarding their abilities and ways to lessen the likelihood of falls while exercising, using the restroom, walking the stairs, and other everyday tasks.

Neglecting problems with balance is a bad idea for people over the age of 60.

1. Consulting the Healthcare Provider

Individuals should schedule a visit with their doctor to discuss fall prevention measures and get their risk of falling evaluated. It should include an evaluation of:

  • Report Previous Falls: Make sure to record the specifics of any falls, even if they were close calls. The professionals can use this data to target preventative measures better.
  • Discuss Medications: One measure is to write down all the medications one is currently taking or the medical records. The doctor can look for any interactions or side effects that could make people more likely to fall, and if needed, they can change the prescription.
  • Share Symptoms: In particular, make sure to mention any issues with the eyes or ears, as well as any symptoms that may be experienced, such as vertigo or joint discomfort that affects the capacity to walk. The healthcare professional may check the patient’s muscular strength, balance, and gait as part of the evaluation.

2. Medication Management

The CDC recommends reviewing and adjusting medications contributing to fall risk, such as those causing dizziness or hypotension, as essential. This involves a careful balance of managing underlying conditions while minimizing side effects.

3. Increase Physical Activity

As people get older, one of the main reasons they lose strength and balance is that they don’t do as much physical exercise.

A myth goes around that says it’s okay to do less and less exercise as you age. The truth is the exact opposite! It’s more important than ever to work out daily as you get older, and this has been proven too. The Journal of the American Geriatrics Society also reports that physical activity, including exercise, reduces falls by 13 to 40% among senior adults residing in the community.

The World Health Organization recommends that older adults engage in moderate-intensity physical activity thrice weekly to protect themselves from falls and improve their functional capacity.

4. Exercises for Fall Prevention

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Physical therapists can help their patients improve their balance by using variety of exercises. In addition to keeping someone from falling, these exercises are perfect for maintaining agility, flexibility, and muscle power.

  • Balance Exercises: The capacity to perceive one’s position in space, or proprioception, can be enhanced through balance training. A detailed investigation of over 8,000 older adults found that balance and functional workouts cut the risk of falls by 24%.
  • Flexibility Training: Older individuals can enhance their mobility and reduce the risk of falls by increasing their range of motion. It entails stretching the muscles and joints to increase mobility and decrease stiffness.
  • Tai Chi: The gentle martial art of Tai Chi promotes weight shifting and calm, controlled motions. Studies have shown that it can help the elderly with flexibility, strength, and balance. According to multiple meta-analyses of 2023, falls are 20% less common among tai chi practitioners.
  • Yoga: Some yoga positions that could aid with balance are tree, warrior, and mountain postures. The best is to consult a yoga instructor who can modify the poses according to each person’s needs.
  • Muscle Training Exercises: Strength training exercises include lifting weights or utilizing resistance bands to build muscle and improve strength and power. Stability and balance can be enhanced for older people by training their legs, hips, and core muscles. Research has indicated that strength training can strengthen walking speed and reduce the chance of falling.

5. Use Sensible shoes

For those who have trouble maintaining their balance, it is essential to prioritize comfort and practicality while selecting footwear to promote stable footing and enhance overall safety. Slips and stumbles are less likely to occur while wearing shoes that offer adequate support and reduce joint pains!

6. Use Walking Aids or Assistive devices.senior woman traveler summer

For people who have trouble navigating, using mobility aids is an absolute must while trying to avoid falls. Research studies testing canes and walkers used by elderly people show that these devices can improve balance and movement.  Select devices that cater to personal interests and requirements.  Other assistive devices can help, too. For example:

  • Grab bars for the toilet or shower
  • A durable plastic seat and a handheld shower nozzle for use in the tub or shower while seated.
  • Stairway handrails on both sides
  • Slip-resistant treads for bare wood steps

As long as these aids are used correctly, they make the world safer, improving people’s health by lowering the likelihood of falls and giving them more confidence to go about their everyday lives. If you need further ideas for preventing falls, an occupational therapist is a good resource.

7. Use the Proper Illumination

Make your home more secure and comfortable with proper lighting. Ensure enough illumination throughout the room, particularly on the stairs and hallways. Light up essential places with higher-wattage bulbs and think about installing motion detectors. A well-lit home not only makes you feel safer against falls but also makes you feel more at ease and secure in your skin.

8. Environmental Modifications

Check the surroundings for possible fall hazards. Adjusting the following can be very beneficial.

  • Avoid moving around tight spaces and uneven surfaces
  • Use double-sided tape, tacks, or slip-resistant lining to secure or remove rugs.
  • Install nonslip mats in the shower and bathtub. Utilize a bath mount to facilitate sitting during your shower.
  • Immediately repair any loose wooden floorboards or carpeting.
  • Food, dishes, clothing, and other essentials should be easily accessible.
  • Clean up leaking liquids, grease, or food immediately.
  • Boxes, newspapers, electrical, and phone cords should be removed from walkways.

At-Home Exercises To Improve Balance and Reduce Falls

Strength training for the hips, knees, and ankles is a beneficial method for maintaining balance, often prescribed by home healthcare providers and physical therapists. The most common yet beneficial exercise types include the following:

  1. Walking Heel-to-ToeLeg standing exercise

Take 10 steps forward by placing one foot’s heel against the other’s toe.

2. Standing on One Leg 

Stand and elevate one leg, knee bent at a 45-degree angle. Hold this position for ten seconds. Repeat ten times, then move to the opposite leg.

As this becomes less of a challenge, increase the difficulty by performing additional activities while standing on one leg, such as doing the dishes, brushing your teeth, or talking on the phone.

3. Side steps

Image of side step and front step exercise

Move your left foot to the side, then bring your right foot up to meet your left.  Cross-step by putting your left foot on top of your right foot and then your right foot on top of your left.

4. Ankle Pumpsdownload 3

Getting out of bed can make you feel dizzy or disoriented. If this happens, sit on the edge of the bed and pump your ankles by pulling your toes up to the sky and then pointing them down.

5. Sit-to-Stand ExerciseScreenshot 2024 03 01 180136

Another classic and well-documented way to improve balance and prevent falls is to perform Sit-to-Stand Exercise

To perform this exercise, sit on a chair with a support surface. Now, shift your body weight forward and slowly rise to a stable position. Sit back down and repeat 10 times. If needed, place your hands on the chair’s arms or seat to help you stand and sit, aiming to avoid using your hands at all.

6. Standing March Screenshot 2024 03 01 175347

Starting near stable support, perform a slow march in position for 20 to 30 seconds. As this becomes more manageable, your physical therapist may increase the difficulty of the exercise by varying the tempo and surface of your marching, such as from hardwood to carpet, foam pad, grass, and so forth.

A lot of these exercises are quick and easy, and one can do them while watching TV. But remember, everyone must consult a doctor or certified physical therapist to determine which exercises will work best for them before beginning an exercise program.

In some cases, finding a permanent solution to a balance issue may be impossible, so learning to adapt and cope may be necessary. A vestibular rehabilitation therapist can help people create a unique therapy program based on their symptoms and conditions.


A key component of good aging is maintaining your sense of balance. You may continue dancing through life safely and cheerfully if you know what causes your balance to shift and what you can do to maintain it. Let’s make our homes safer places to live, do enjoyable activities, and stay active. So, are you ready to game up your balance?

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Dr Aimen

Being a Doctor by profession, Aimen is passionate about helping people get better health in their lives. Aimen enjoys her research on Prime With Time subjects and strives to create better awareness of the problems and changes related to women's health.
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