Why Balance May Get Harder With Age—even If You Have Strong Bones

Key Takeaways

• Balance may change with age because the eyes, inner ear, muscles, nerves, and brain may not work together as well.
• Balance exercises, such as heel-to-toe walking and standing up from a chair, can help lower fall risk.
• Ask your healthcare provider to review any medications that may cause dizziness, drowsiness, or impaired coordination.

Even with strong bones, balance may shift with age as changes impact how your eyes, inner ears, muscles, nerves, and brain work together. Regular exercise, balance training, and other preventive measures can help improve stability, reduce fall risk, and help you feel more confident on your feet. 

Balance Goes Beyond Strong Bones

Maintaining balance functions via a constant conversation between three body systems:

1. Your eyes tell you where you are relative to your environment.
2. Your inner ear tells you how your head and body are moving through space.
3. Your muscles, joints, and skin provide sensory information about the position of your body and limbs.

The nervous system then integrates input from all three sources by sending it to your brain, where it is processed.

Instructions are then sent back to your muscles to control your body to stay upright.

What Body Changes Occur With Age?

As the body ages, these three body systems can undergo changes that affect how efficiently they function.

1. Vision Changes

It is common for eyesight to worsen with age. This may affect the ability to focus on the environment, especially during movement and changes in direction, thereby impairing balance.

2. Inner Ear Changes

Deep inside your inner ear is the vestibular system, a group of structures that detects changes in head movement and position. Your brain uses these signals to help determine whether you are standing still, turning, or losing your balance. 

With aging, vestibular function can become less effective. The changes may be subtle rather than dramatic. Instead of experiencing obvious vertigo, you might notice that turning quickly feels less secure or that walking in darkness is more challenging.

3. Muscle Changes

Strong bones are important, but strong muscles matter too.

When your balance is momentarily disrupted, staying upright requires your leg and trunk muscles to make rapid adjustments.

As people age, muscle mass, strength, reaction time, and movement coordination may decline. This may make it more challenging to recover from a small disturbance in balance, depending on different factors.

The difference can show up in ordinary moments, including standing up from a chair, taking large steps, walking while carrying groceries, turning around quickly, or regaining balance after tripping.

This is one reason fall-prevention programs emphasize functional movements.

International falls-prevention guidelines recommend exercises such as the following:

• Sit-to-stand movements
• Stepping in different directions
• Reaching while standing
• Squats
• Walking at different speeds and under different conditions

The Brain-Body Connection Changes Too

Perhaps the most overlooked part of balance is your brain’s role.

Your brain has to combine information from several sensory systems and decide how your body should respond. With age, processing speed and the ability to divide attention can change.

Other conditions, like neurological disorders, cognitive impairment, diabetes-related nerve problems, vision problems, and medication side effects, can further complicate the process.

This helps explain why dual-task situations can sometimes reveal balance problems that aren’t obvious when someone is simply standing still.

For example, the following all require the brain to manage movement and another task simultaneously, and can make balance more challenging:

• Walking while talking to someone
• Carrying an object
• Navigating a crowded room
• Looking for something

Everyday Balance Changes Can Be Easy to Overlook

Balance decline often happens gradually. That’s why you may not recognize it until a fall or a close call occurs.

Some early clues include:

• Holding onto furniture when walking around the house
• Feeling less steady when getting out of bed at night
• Avoiding stairs
• Taking shorter or more cautious steps
• Feeling uncertain on grass, gravel, or uneven sidewalks
• Needing a handrail more often
• Feeling less confident carrying objects while walking
• Having more difficulty walking in dim lighting

These changes don’t necessarily mean that you have a serious balance disorder. However, take note of persistent dizziness, vertigo, repeated falls, or a noticeable change in walking. These symptoms deserve medical attention.

Balance problems can sometimes result from treatable conditions, medications, blood pressure changes, vision problems, or inner ear disorders.

Strategies to Prevent Falls

The good news about balance is that it can be trained. The CDC recommends that adults 65 and older include balance activities along with aerobic and muscle-strengthening exercise.

Examples include heel-to-toe walking and repeated standing up from a chair. A study from the U.S. Preventive Services Task Force notes that exercise was associated with approximately a 15% reduction in the rate of falls.

Other forms of exercise, like tai chi, can also help improve balance. Tai chi combines slow, controlled movements with shifting weight, postural control, coordination, and concentration.

A 2024 meta-analysis found that tai chi improved several measures of balance and physical function in older adults and reduced the fear of falling.

It may also be beneficial to review your medications. Some medications can contribute to dizziness, drowsiness, low blood pressure, or impaired coordination. The CDC’s STEADI program specifically recommends medication review as part of fall-risk assessment.

Ask your healthcare provider whether any prescription drugs, over-the-counter medications, or supplements could be affecting your balance.

Balance becomes more difficult when the brain receives less reliable information from the senses. Regular vision and hearing checks are, therefore, part of fall prevention. The National Institute on Aging specifically recommends checking vision and hearing and addressing problems that could contribute to falls.