Falls and Balance: Why We Become Less Steady as We Get Older – and What We Can Do About It
Have you noticed that you feel a little less steady on your feet than you used to? Perhaps you find yourself holding onto furniture when walking around the house, feel less confident stepping off a kerb, or are more cautious when turning or reaching for something. You may even have had a fall or a near miss that has knocked your confidence.
Balance is something many of us take for granted until it starts to become more difficult. It is essential for everyday activities such as walking, getting dressed, climbing stairs, getting in and out of a chair and moving around safely at home. When our balance deteriorates, even simple tasks can become more challenging, and the fear of falling can sometimes lead us to become less active.
The good news is that balance can be improved. With appropriate exercises, regular practice and a little patience, it is possible to build strength, improve coordination and regain confidence when moving around.
Why does our balance get worse as we get older?
Balance is actually quite a complicated process. It relies on several different systems in the body working together to tell us where we are, how we are moving and what adjustments we need to make to stay upright.
Our brain constantly receives information from our eyes, inner ears, muscles and joints. It processes this information and sends instructions to our muscles to make small adjustments to our posture and position. Most of this happens automatically, without us even thinking about it.
As we get older, some of these systems can become less efficient.
1. Changes in muscle strength and power
As we age, we naturally lose some muscle mass and strength. This can particularly affect the muscles around our hips, thighs, ankles and trunk, which are important for maintaining an upright posture and controlling our movements.
Leg strength is particularly important when recovering from a stumble or loss of balance. If you catch your foot on a rug or lose your footing, your muscles need to react quickly to help you regain your balance. If those muscles are weaker, it can become harder to correct yourself.
Muscle power can also decline. Power is the ability to produce force quickly, and it is particularly important when making rapid movements to prevent a fall.
2. Changes in sensation from our feet and joints
Our feet and joints provide important information about our position and movement. Special sensory receptors tell the brain where our limbs are without us needing to look at them. This is known as proprioception.
For example, when standing on an uneven surface, the muscles and joints in our feet and ankles detect changes in position and help the body make small adjustments to remain upright.
As we get older, this sensory information can become less reliable. Conditions such as diabetes, peripheral neuropathy and arthritis can also affect sensation and joint movement, making it harder to judge where our feet are and how much weight we are putting through them.
3. Changes in vision
Our eyesight plays an important role in balance. We use visual information to judge distances, recognise obstacles and understand our surroundings.
Age-related changes in vision can make it more difficult to judge steps, uneven surfaces and changes in floor levels. Reduced vision in poor lighting can also make it harder to move around safely, particularly at night.
Regular eye tests and making sure glasses are suitable for the activities being undertaken are important.
4. Changes in the inner ear
The vestibular system, located in our inner ear, helps us understand the position and movement of our head. It plays an important role in keeping us balanced, particularly when turning, moving our head or walking.
Changes or disorders affecting this system can cause dizziness, unsteadiness or a sensation that the surroundings are moving.
5. Slower reactions and coordination
As we get older, our reactions can become slower. When we stumble or begin to lose our balance, the body needs to respond quickly by adjusting our posture, moving our feet or reaching for support.
If these reactions are slower, we may have less time to correct ourselves before a fall occurs.
6. Other health and lifestyle factors
Ageing is not the only reason balance can deteriorate. Arthritis, Parkinson's disease, stroke, previous injuries and periods of inactivity can all affect strength, coordination and mobility.
Some medications can cause dizziness, drowsiness or a drop in blood pressure when standing.
Dehydration, poor nutrition and low blood pressure can also contribute to feeling unsteady.
It is often a combination of several factors rather than one single problem that increases someone's risk of falling.
Why is it important to work on our balance?
Balance exercises are not just about standing on one leg or trying to avoid falling. They help improve the physical abilities we rely on every day.
Regular practice can help maintain leg strength, improve coordination, develop control when shifting our weight and make everyday movements feel more comfortable. It can also help improve confidence, particularly for people who have become nervous about walking or moving around following a fall.
Think about the movements involved in everyday life. Walking requires us to transfer our weight from one leg to the other. Turning requires us to adjust our position and coordinate several movements. Reaching into a cupboard requires us to move our upper body while maintaining control through our legs and trunk.
Balance exercises aim to practise these movements in a safe and controlled way, gradually challenging the body to become more capable.
Balance exercises you can practise at home
The following exercises are taken from our Balance Rehabilitation exercise programme. They are designed to gradually challenge your balance, coordination and strength.
You do not need to complete every exercise straight away. Start with exercises that feel manageable and progress as your confidence and ability improve.
Important: These exercises deliberately challenge your balance. Always have a solid, stable worktop directly in front of you so that you can hold on if needed. Do not practise unsupported balance exercises if you are at risk of falling without someone supervising you.
1. Standing with feet hip-width apart
Stand with your feet approximately hip-width apart, facing a stable worktop. Hold the worktop initially, then slowly release your hand while keeping it close to the surface in case you need support. Try to maintain your balance for 30–60 seconds. Repeat 2–3 times.
This is a good starting point for balance rehabilitation. It encourages you to maintain an upright position without relying entirely on your hands for support. It also helps you become more aware of how your body distributes weight through both feet.
To make it slightly more challenging, try slowly turning your head from side to side while maintaining your balance.
2. Standing with feet together
Once standing with your feet hip-width apart becomes comfortable, try bringing your feet together while holding the worktop for support. Slowly release your hands, keeping them close to the surface, and aim to maintain your balance for 30–60 seconds. Repeat 3–5 times.
Bringing your feet together reduces the size of your base of support. This means your body has less room to make adjustments before you become unsteady, so your balance system has to work harder.
This exercise helps improve postural control and confidence when standing in a narrower position.
3. Tandem standing
This is a further progression once you can maintain feet-together standing for 30 seconds without holding on.
Stand facing the worktop and place one foot slightly in front of the other, leaving a small gap between your feet. Slowly release your hand while keeping it close to the worktop. Aim to hold the position for 30–60 seconds, then swap feet so the opposite foot is in front. Repeat 3–5 times.
Tandem standing further narrows your base of support and challenges your ability to control your body from side to side. It is particularly relevant to walking, as walking involves repeatedly placing one foot in front of the other.
Try not to rush this exercise. It is normal for it to feel challenging initially.
4. Heel-to-toe standing
Stand next to the worktop and place one foot directly in front of the other, so the heel of your front foot touches the toes of your back foot. Keep a hand close to the worktop for support and aim to hold the position for 30–60 seconds. Swap your feet around and repeat. Complete 3–5 times.
This is a more challenging balance exercise because the feet are positioned in a straight line, making it harder to maintain stability from side to side.
It helps develop control through the ankles, hips and trunk and challenges the coordination needed for walking and negotiating narrow spaces.
5. Side stepping
Stand sideways next to a stable worktop and hold on for support. Take slow, controlled steps sideways, keeping your toes pointing forwards. Continue along the worktop, then return to your starting position. Repeat for 3–4 lengths.
Side stepping works the muscles around the hips, particularly those that help stabilise the pelvis when standing on one leg. These muscles are important when walking, stepping sideways and maintaining control when changing direction.
6. Heel-toe raises
Stand facing the worktop and hold on for support. Slowly rise up onto your tiptoes, then rock backwards onto your heels, lifting your toes from the floor. Repeat with slow, controlled movements for 10–15 repetitions.
This exercise strengthens the muscles around your ankles and lower legs. The calf muscles help control forward movement of the body, while the muscles at the front of the shin help lift the toes and control the foot.
These muscles are important when walking, negotiating uneven ground and making small adjustments to maintain balance.
7. Marching on the spot
Stand facing the worktop and hold on for support. Slowly lift one knee, then the other, as though marching on the spot. Lift each knee as high as is comfortable while maintaining an upright posture. Repeat 10–20 times on each leg.
Marching challenges your ability to stand on one leg while moving the other. This is particularly relevant to walking, where we repeatedly transfer our weight from one leg to the other.
It also works the muscles around the hips and thighs and helps improve coordination between the legs and trunk.
As your balance improves, you can gradually reduce the amount of support you use, keeping your hands close to the worktop.
8. Sit to stand
Sit towards the front of a sturdy chair with your feet hip-width apart and positioned slightly behind your knees. Lean forwards, bringing your nose over your toes, and push through your feet to stand up. Use your arms for assistance if needed. As you become stronger, try to stand without using your hands. Repeat 3–5 times.
Although this is primarily a strengthening exercise, it is also very important for everyday mobility and falls prevention.
Standing up requires strength through the thighs, hips and buttocks, as well as good coordination between the upper and lower body. Improving this movement can make getting out of chairs, rising from the toilet and getting out of bed easier.
9. Reaching in standing
Stand facing the worktop with your feet hip-width apart. Lightly rest one hand on the worktop for support. Reach forwards with your other arm as far as is comfortable, then return to the starting position. Repeat by reaching to the side and across your body while maintaining an upright posture. Complete 10 reaches in each direction.
This exercise challenges your ability to maintain balance while moving your upper body and shifting your weight.
In everyday life, we regularly reach for objects, open cupboards, get dressed and perform tasks that involve moving our arms away from our body. Practising these movements in a controlled environment helps improve confidence and control when reaching.
As your balance improves, gradually reduce the amount of support you use from the worktop.
10. Turning
Stand facing a stable worktop with one hand lightly resting on the surface for support. Slowly turn around in a full circle using small, controlled steps. Pause if needed, then return to your starting position by turning in the opposite direction. Keep your posture upright and avoid crossing your feet. Repeat 3–5 turns in each direction.
Turning can be particularly difficult for people with reduced balance. It requires coordination between the eyes, head, trunk and legs, as well as the ability to transfer weight between the feet.
Practising turning in a controlled way can help improve confidence when changing direction, moving around furniture and navigating confined spaces at home.
How often should you practise?
Balance is a skill that benefits from regular practice. Like strengthening exercises, improvements do not happen overnight. Consistency is more important than trying to do too much in one session.
Start with exercises that you can perform safely and comfortably. As they become easier, gradually progress to more challenging positions or reduce the amount of support you use, provided you can do so safely.
You should not feel that you have to complete the entire programme every day. A physiotherapist can help select the most appropriate exercises, decide how challenging they should be and review your progress.
The aim is to gradually improve your ability to control your body, rather than simply trying to stand without holding on.
Other ways to reduce your risk of falling
Exercise is an important part of falls prevention, but it is not the only consideration. There are several practical things you can do to make everyday activities safer.
Look after your eyesight: Have regular eye tests and make sure your glasses are appropriate and up to date.
Wear suitable footwear: Choose shoes that fit well, support your feet and have a good grip. Avoid loose slippers or walking around in socks.
Keep your home clear: Remove loose rugs, trailing wires and unnecessary clutter. Make sure hallways and stairs are well lit.
Stay active: Regular walking and physical activity help maintain strength, mobility and coordination.
Eat and drink well: Poor nutrition and dehydration can contribute to weakness, dizziness and light-headedness.
Review your medication: Speak to your GP or pharmacist if you experience dizziness, drowsiness or unsteadiness, as some medications can increase the risk of falling.
Use walking aids when needed: A walking stick or frame can provide additional stability and confidence. Make sure it is suitable and correctly adjusted.
If you have fallen, particularly more than once, or have noticed a significant change in your balance, it is worth seeking a professional assessment. A fall can sometimes be the result of an underlying medical problem that needs investigating.
Regaining confidence after a fall
One of the biggest difficulties following a fall is often the loss of confidence that comes afterwards.
People can become frightened of falling again and start avoiding activities they previously managed without thinking. They may walk less, spend more time sitting and rely increasingly on furniture or other people for support.
Unfortunately, becoming less active can lead to further muscle weakness, reduced mobility and worsening balance. This can create a cycle in which the fear of falling contributes to the very physical changes that increase the risk.
A gradual rehabilitation programme can help break this cycle. Starting with manageable exercises, practising everyday movements and building up activity over time can help restore confidence.
It is important to remember that progress does not have to be dramatic. Being able to stand for longer, turn more comfortably or walk around the home with greater confidence are all worthwhile improvements.
How can physiotherapy help?
At Physio at Home, we provide personalised physiotherapy and rehabilitation in people's own homes across Mid Cornwall, including Falmouth, Penryn and Truro.
Following a fall, illness or period of reduced mobility, it can be difficult to know where to start. A physiotherapy assessment can help identify the factors affecting your balance, strength and confidence.
We can assess how you stand, walk, turn and transfer, identify areas of weakness or reduced coordination, and develop an individual programme of exercises to help improve your mobility and reduce your risk of further falls.
Importantly, rehabilitation takes place in your own home, allowing us to work on the activities and challenges that matter most to you.
You don't have to accept becoming less steady as you get older. With the right support and regular practice, there is plenty you can do to improve your balance, maintain your independence and feel more confident on your feet.
If you or a family member are experiencing difficulties with balance or recovering following a fall, contact Physio at Home to discuss how we can help. More information here https://www.physioathome.uk/
Important safety information
Not all exercises are suitable for everyone. Always follow the advice of your doctor or healthcare professional, particularly following surgery or injury. Exercises should be selected and progressed according to your individual abilities and risks. If you have concerns about falling, seek guidance from a physiotherapist before attempting challenging balance exercises.
Stop exercising and seek medical advice if you experience chest pain, dizziness or severe shortness of breath.
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