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Balance Problems & Fall Prevention

Feeling unsteady, dizzy or as if you might fall. Balance problems are common, especially as we get older, and more than one in four adults 65 and over falls each year — but many falls can be prevented once the cause is found.

Call 911 right away if dizziness or loss of balance comes on suddenly with any sign of a stroke. Sudden trouble walking, dizziness, loss of balance or poor coordination can be a stroke, especially with numbness or weakness on one side, confusion, trouble speaking or a sudden severe headache with no known cause (CDC). The CDC uses B.E. F.A.S.T.:

  • B — Balance: is the person suddenly off-balance or dizzy?
  • E — Eyes: any sudden trouble seeing?
  • F — Face: ask them to smile. Does one side droop?
  • A — Arms: ask them to raise both arms. Does one drift down?
  • S — Speech: is their speech slurred or strange?
  • T — Time: call 911 now and note when the symptoms started. Don’t drive to the hospital — an ambulance crew can start treatment on the way (CDC).

If the symptoms go away after a few minutes, it may have been a “mini-stroke” (TIA), which still needs medical help right away (CDC).

Also call 911 or go to the emergency room if you are dizzy and have chest pain, a skipping or irregular heartbeat, shortness of breath, weakness, can’t move an arm or leg, have a change in vision or speech, a head injury, a seizure, or faint and stay less alert for more than a few minutes (MedlinePlus). An older person who falls and hits their head should see a doctor right away, especially if they take a blood thinner (CDC).

What is a balance problem?

A balance disorder makes you feel unsteady or dizzy. You might feel as if you are moving, spinning or floating when you are still, or as if you are tipping over when you walk. Other signs include staggering, lightheadedness or feeling faint, blurred vision and confusion (NIDCD). “Dizziness” means different things to different people: doctors separate lightheadedness (feeling you might faint) from vertigo (feeling that you or the room is spinning) (MedlinePlus). Most causes of dizziness aren’t serious and either get better on their own or are easy to treat (MedlinePlus).

Good balance depends on signals from your eyes, your inner ears and the muscles and touch sensors in your legs, all working together in the brain. When any of these signals goes wrong, you can feel dizzy or off-balance — and if you also have weakness, slowness or stiffness, it is harder to catch yourself, which raises the risk of falling (NIDCD).

How common is it?

In 2008 about 15 percent of American adults — 33 million people — had a balance or dizziness problem, and the risk rises with age (NIDCD). Balance problems are one cause of falls and fall injuries such as a broken hip (MedlinePlus).

Falls in older adults

  • More than one in four people aged 65 and older falls each year, but fewer than half tell their doctor. Falling once doubles the chance of falling again (CDC).
  • Falls caused over 43,000 deaths among adults 65 and older in 2024 — the leading cause of injury death in that age group — and about 4.5 million emergency room visits (CDC).
  • Falls cause the large majority of hip fractures that end in an emergency visit or hospital stay, and are the most common cause of traumatic brain injury in older adults (CDC).
  • Many people who fall become afraid of falling and cut back on activity. Being less active makes you weaker, which raises the chance of falling again (CDC).

The good news: falls are not an inevitable part of aging, and there are proven ways to prevent them (CDC). Most falls come from a combination of risk factors, and many of those can be changed (CDC).

Common causes

  • Inner-ear (vestibular) problems. The most common is benign paroxysmal positional vertigo (BPPV): brief, intense spinning set off by certain head movements, such as rolling over in bed or looking up. It happens when tiny calcium crystals in the inner ear drift into the balance canals, and it can follow a head injury or simply come with age (NIDCD). Others include inner-ear infection or inflammation (labyrinthitis), vestibular neuritis and Ménière’s disease (NIDCD). A separate MBHA guide to vertigo is on the way.
  • Medicines. Some medicines cause dizziness or confusion, and the more medicines you take, the more likely you are to fall (NIA). Three out of four older adults take at least one medicine commonly linked to falls or car crashes (CDC).
  • Blood pressure that drops when you stand up (postural or orthostatic hypotension) can make you dizzy or faint and more likely to fall (CDC STEADI). Older adults are more likely to have this, sometimes as a side effect of blood pressure medicines (NHLBI).
  • Nerve damage in the feet and legs (peripheral neuropathy), for example from diabetes, can cause loss of balance and more frequent falls (NIDDK).
  • Vision and hearing. Even small changes in sight and hearing are linked to a higher risk of falling (NIA); conditions such as glaucoma or cataracts can limit vision (CDC STEADI).
  • Muscle weakness and other conditions. Age-related muscle loss, problems with walking, foot pain, unsafe footwear, low vitamin D, heart disease, thyroid problems, incontinence and some types of dementia all raise the risk (NIA, CDC).
  • Home hazards such as throw rugs, clutter and poor lighting (CDC).

Many balance disorders start suddenly with no obvious cause (NIDCD), and balance problems can be a sign of something else, such as an ear infection or a stroke — so it is important to see a doctor (MedlinePlus).

How it’s diagnosed

Finding the cause can take some detective work. Your doctor may refer you to an ear, nose and throat specialist (otolaryngologist) and an audiologist (NIDCD). Depending on your symptoms, checks may include:

It helps to arrive ready to describe your dizziness — spinning or faint, what sets it off, how long it lasts, any hearing changes — and any falls, with a full list of your medicines and supplements (NIDCD). Always tell your doctor if you have fallen, even if you weren’t hurt (NIA).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Find and treat the cause: a medication review, repositioning maneuvers (such as the Epley maneuver) for BPPV done by a clinician, vestibular rehabilitation with a physical therapist, managing blood pressure drops, eye and hearing checks, a walking aid if needed, and making the home safer. Physical therapy about $50–$350+ a session without insurance or a $10–$75 copay with it. Medicare Part B covers needed outpatient physical therapy and prescribed walkers (20% after the deductible); the yearly Wellness visit costs nothing if your provider accepts assignment. Most people with BPPV improve after one or two repositioning treatments. Vestibular rehabilitation is safe and effective for many inner-ear balance problems. Some people can’t fully get rid of dizziness and learn to manage it.
Chiropractic Hands-on treatment of the upper neck for dizziness thought to come from the neck (“cervicogenic dizziness”), often with exercises. About $50–$200 a visit without insurance ($15–$75 with); first evaluations $100–$250. Reviews find low to moderate quality evidence that manual therapy may ease neck-related dizziness. It does not treat inner-ear, blood-pressure or medicine causes. Neck manipulation carries a rare risk of artery tears and stroke, so sudden new dizziness needs a medical check first.
Acupuncture Fine needles at points on the body; studied mainly for “cervical vertigo” (dizziness linked to the neck). About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. One review found it promising for neck-related vertigo, but the evidence was low to very low quality. We found no good evidence that it prevents falls.
Herbal medicine Ginkgo is the herb most often tried for vertigo and dizziness. Cost estimate being researched. Only a small amount of evidence suggests ginkgo helps vertigo, and it isn’t conclusive. Dizziness is one of its common side effects, it raises bleeding risk with blood thinners, and calming herbs can add to drowsiness — a fall risk.
Massage therapy General relaxation and muscle work; not a treatment for the causes of balance problems. Private therapists about $60–$120 for 45–60 minutes; massage-school clinics about $30–$40 an hour. We found no good evidence that massage improves balance or prevents falls. Rare serious injuries have been reported, more often with vigorous massage in older people.
MBHA Wellness Coach Strength and balance exercise (including tai chi), a home hazard check, good footwear, yearly eye checks, getting up slowly, and finding a community falls program such as A Matter of Balance or Stepping On. Many community falls-prevention classes are free or low cost — for example, free A Matter of Balance classes have been offered locally. MBHA coaching cost estimate being researched. Strong evidence: in older adults living at home, exercise programs lower the rate of falls by about 23%, and tai chi lowers the number of people who fall by about 20%.

Approach 1 of 6

Conventional medicine (AMA)

The first step is to find out what is causing the problem. A specialist will check whether another health condition or a medicine is to blame, and treat that condition, change the medicine or refer you on (NIDCD).

1. Reviewing your medicines

Some medicines, or combinations of medicines, can make you sleepy or dizzy and cause a fall, and the way your body handles medicines changes with age. Ask your doctor or pharmacist to review everything you take, including over-the-counter medicines (CDC STEADI). Medicine groups the CDC links to falls include sleeping pills, anti-anxiety medicines (benzodiazepines), some antidepressants, opioid pain medicines, anti-seizure medicines, antipsychotics, muscle relaxants, antihistamines and other “anticholinergic” medicines, and medicines that affect blood pressure (CDC STEADI). Over-the-counter sleep aids and allergy and motion-sickness tablets are on the list too (CDC). Clinicians are advised to stop, switch or reduce risky medicines where they can (CDC STEADI). Don’t stop a medicine on your own — talk with your provider first (CDC).

2. BPPV: repositioning maneuvers

For BPPV, a doctor, audiologist or physical therapist guides your head and body through a series of positions — such as the Epley maneuver — that move the loose crystals back where they cause no trouble. One session often works; some people need it again (NIDCD). The American Academy of Otolaryngology–Head and Neck Surgery describes these office procedures as taking only minutes, with very high success rates (AAO-HNS ENT Health). Its guideline recommends treating BPPV with repositioning, advises against routinely using “vestibular suppressant” medicines such as antihistamines or benzodiazepines for it, and asks clinicians to check people with BPPV for fall risk and to follow up within a month (AAO-HNS guideline, 2017). BPPV can come back, so ask what to do if it returns (AAO-HNS guideline).

3. Vestibular rehabilitation

Vestibular rehabilitation is a program of eye, head and balance exercises, usually taught by a physical therapist, that helps the brain adjust to an inner-ear problem. A Cochrane review of 39 trials (2,441 people) found moderate to strong evidence that it is safe and effective for problems affecting one inner ear, and that it reduces dizziness and improves daily function (Cochrane review, 2015). For BPPV specifically, repositioning maneuvers work better in the short term (Cochrane review). The U.S. physical therapy guideline says, based on strong evidence, that clinicians should offer vestibular rehabilitation, preferably supervised, along with home exercises (APTA guideline, 2022). For people who can’t fully get rid of their dizziness, a vestibular therapist can build a plan to cope with it (NIDCD).

4. Blood pressure drops when standing

If your blood pressure falls when you stand, your provider may adjust medicines that lower it, suggest drinking more fluids, or recommend changes in how you sit and stand (NHLBI, CDC STEADI). Everyday tips are under MBHA Wellness Coach below.

5. Eyes, ears and feet

  • See an eye doctor at least once a year and update your glasses if needed. Bifocals or progressive lenses can make steps look closer or farther than they are, so a pair with just your distance prescription may be safer for walking outdoors (CDC).
  • Have your hearing tested, and if you have a hearing aid, make sure it fits and wear it (NIA).
  • Have your feet checked once a year and ask about proper footwear (CDC STEADI).
  • Ask about vitamin D and get screened for osteoporosis, which makes a fall more likely to break a bone (CDC).

6. Walking aids and home safety

A cane or walker can help if you feel unsteady, but it needs to be the right size and used correctly; a physical or occupational therapist can help you choose one and teach you to use it (NIA). Handrails and other changes at home and work lower the risk of injury (NIDCD). Ask your doctor whether it is safe for you to drive (NIDCD).

7. After a fall

Seek medical attention after any fall. A full check of balance, muscles and joints, the inner ear, medicines, glasses and hearing aids can find what went wrong, and physical or vestibular therapy can help recovery (AAO-HNS ENT Health). If you fall and are hurt or can’t get up, call for help or 911 (NIA).

What it costs

  • Physical and vestibular therapy: about $50–$350 or more a session without insurance, depending on the provider and setting; with insurance, typically a $10–$75 copay or 10–50% coinsurance (CostHelper, a consumer cost guide). Medicare Part B covers medically necessary outpatient physical therapy when your provider certifies you need it, with no yearly cap; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • Medicare check-ups: the yearly “Wellness” visit costs nothing if your provider accepts assignment. It includes measuring blood pressure and reviewing your prescriptions. It focuses on prevention, so Medicare suggests booking a separate appointment for a specific concern such as dizziness (Medicare.gov). The one-time “Welcome to Medicare” visit includes a simple vision test (Medicare.gov).
  • Walkers: Medicare Part B covers walkers, including rollators, when your provider prescribes one for use at home; you pay 20% of the approved amount after the deductible if the supplier accepts assignment (Medicare.gov).
  • Specialist visits and balance testing vary widely; MBHA cost estimate being researched.

How well it works — what to expect

Results depend on the cause. BPPV usually responds quickly to repositioning: most people are better after one or two treatments, though some need more (AAO-HNS ENT Health). Vestibular rehabilitation eases symptoms and improves day-to-day function for many people with inner-ear balance problems (Cochrane review). Some people with a balance disorder can’t fully relieve their dizziness and learn ways to cope and stay safe (NIDCD).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractors and other manual therapists sometimes treat dizziness they believe comes from the neck — called cervicogenic dizziness — with mobilization or manipulation of the upper neck, often with exercises. This is only one possible cause of unsteadiness; it doesn’t address inner-ear problems, medicines or blood pressure drops.

What the research says

In short: hands-on neck treatment may help some people whose dizziness truly comes from the neck, but the evidence is limited. We found no good evidence that it prevents falls.

Safety

Mild aches, stiffness or headache are common after spinal manipulation and usually pass within a day. Serious problems are very rare, but manipulation of the neck has been linked to small tears in the neck arteries that can lead to a stroke, and serious side effects may be more likely in people with underlying health problems (NCCIH). Because sudden dizziness or loss of balance can itself be a sign of stroke (CDC), MBHA suggests seeing a medical doctor first for any new or sudden dizziness, and telling your chiropractor about osteoporosis, blood thinners or other health conditions.

What it costs

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

The acupuncture research we found looks at “cervical vertigo” — dizziness linked to problems in the neck — rather than at balance problems or falls in general.

What the research says

A 2017 review of 10 studies (914 people) found acupuncture worked better than the comparison drug treatments for cervical vertigo, but the quality of the evidence was low to very low, its long-term safety for this use was uncertain, and the authors said larger, high-quality trials are needed (systematic review, PubMed). We found no good evidence that acupuncture prevents falls or treats BPPV. If you choose to try it, use it alongside — not instead of — a medical check, exercise and the other steps in this guide.

Safety

Relatively few complications have been reported, but problems have come from non-sterile needles and poor technique. Needles must be sterile and single-use, and most states license acupuncturists (NCCIH).

What it costs

Private sessions run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb has been shown to fix a balance problem or prevent falls, and some herbal products can make falls more likely.

Ginkgo

Ginkgo is sometimes taken for vertigo. The U.S. National Institutes of Health says only a small amount of evidence suggests a benefit for vertigo, and the overall evidence is not conclusive (NCCIH); elsewhere it notes there is no conclusive evidence that ginkgo helps any health condition (NCCIH). Dizziness is also one of ginkgo’s most common side effects, and it may increase bleeding in people taking blood thinners such as warfarin (NCCIH) — a real concern for anyone at risk of falling and hitting their head.

Supplements can add to fall risk

Prescription medicines, over-the-counter medicines, dietary supplements and some herbal products can all cause side effects that raise the risk of a fall (CDC). Doctors are asked to review herbal supplements too, because some cause dizziness, drowsiness, confusion, blurred vision or a drop in blood pressure on standing (CDC STEADI). Calming herbs are a particular worry: valerian should not be combined with alcohol or sedatives (NCCIH), and kava should not be used with sedating substances such as benzodiazepines or alcohol (NCCIH).

Before you try any herbal product, bring every supplement you take to your medication review (NIDCD), and check with your doctor or pharmacist — especially if you take a blood thinner, sleep or anxiety medicine, or blood pressure medicine (NCCIH). We don’t list doses here.

Approach 5 of 6

Massage therapy

Massage may help you relax and ease sore muscles, but it does not treat the causes of balance problems — inner-ear disorders, medicines, blood pressure drops or nerve damage. We found no good research showing that massage improves balance or prevents falls in older adults.

Safety

The risk of harm from massage appears to be low, but rare serious problems — a blood clot, nerve injury or broken bone — have been reported, some with vigorous deep-tissue massage or in people at higher risk, such as older adults (NCCIH). If you are unsteady, MBHA suggests asking for gentle pressure, taking your time getting on and off the table, and sitting for a moment before you stand up.

What it costs

Private massage therapists charge about $60–$120 for 45–60 minutes; massage-school clinics about $30–$40 an hour (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Most fall prevention happens in daily life, and much of it is simple. The CDC sums it up in four steps: have your medicines reviewed, exercise to improve balance and strength, have your eyes and feet checked, and make your home safer (CDC STEADI). An MBHA Wellness Coach can help you turn these into habits.

Strength and balance exercise

Exercises that strengthen your legs and improve balance lower your chances of falling and help you feel more confident; lack of exercise leads to weakness and more falls (CDC STEADI). The strongest evidence comes from a Cochrane review of 108 trials: exercise lowered the rate of falls by 23% and the number of people who fell by 15% in older adults living at home (high-certainty evidence) (Cochrane review, 2019). Balance and functional exercises — movements like rising from a chair or stepping up — lowered the rate of falls by 24% (NCCIH).

  • Balance: aim for about three sessions a week — for example tai chi, yoga, standing on one foot, heel-to-toe walking or practicing standing up from a chair. Go slowly, steady yourself if you feel unsteady, and ask your doctor or physical therapist if you’re unsure about a movement (NIA).
  • Strength: work the major muscle groups at least two days a week, with weights, resistance bands or your own body weight (NIA).
  • Pilates can also improve balance and strength (NIA).
  • Ask your doctor which exercise program suits you, especially if you are dizzy now (CDC STEADI).

Check your home for hazards

The CDC’s Check for Safety checklist walks you room by room (CDC STEADI):

  • Floors: clear paths of furniture, papers, shoes and cords; remove throw rugs or secure them with double-sided tape or non-slip backing.
  • Stairs: keep them clear, fix loose steps and carpet, and have sturdy handrails on both sides and lights with switches at the top and bottom.
  • Kitchen: keep everyday things on lower shelves; if you must use a step stool, get one with a bar to hold — never stand on a chair.
  • Bedroom: put a lamp within reach of the bed and a nightlight on the way to the bathroom.
  • Bathroom: non-slip mats or strips in the tub or shower, and grab bars inside and next to the tub and next to the toilet.

Brighter bulbs help too, because we need more light to see well as we age (CDC STEADI).

Shoes and getting around

Getting up slowly

Getting up too quickly can make your blood pressure drop and leave you wobbly (NIA). The CDC suggests sitting up first, then sitting on the side of the bed before you stand; moving your feet and hands before getting up; having something to hold when you stand; not walking while you feel dizzy; and avoiding very hot baths and showers (CDC STEADI).

Everyday health habits

Community falls-prevention programs

  • A Matter of Balance is a small-group program for older adults who have started limiting their activity because they worry about falling. It runs as eight two-hour classes led by trained coaches and covers viewing falls as controllable, setting activity goals, home safety and strength and balance exercise (NCOA). Locally, the Volunteer Center of Santa Cruz County has run it and announced free classes for seniors in San Benito County (BenitoLink, 2024).
  • Stepping On is a seven-week workshop covering balance and strength exercises, medication review, vision and home changes. NCOA reports that research found it reduced falls by 31% (NCOA).
  • Tai Ji Quan: Moving for Better Balance is a tai chi–based falls program of two one-hour sessions a week for 24 weeks (NCOA) — see the tai chi section below.

Your local community or senior center can tell you about exercise and falls-prevention programs near you (CDC STEADI). Costs vary by provider; MBHA coaching cost estimate being researched.

Another approach

Tai chi

Tai chi is a gentle practice of slow, flowing movements and deep breathing. Of all the complementary approaches in this guide, it has the strongest evidence for preventing falls, and the CDC names it as a good example of the strength and balance exercise that lowers fall risk (CDC).

What the research says

  • Older adults: in the 2019 Cochrane review, tai chi lowered the number of people who fell by about 20% (high-certainty evidence, 8 studies, 2,677 people) and may lower the overall rate of falls by about 19% (low-certainty evidence) (NCCIH, Cochrane review).
  • Parkinson’s disease: tai chi may improve balance and reduce falls, though the certainty of the evidence is lower (NCCIH).
  • Other conditions: it is not known whether tai chi reduces falls after a stroke or in people with osteoarthritis or heart failure (NCCIH).

Safety

Tai chi appears to be safe: in a review of 24 studies, side effects were no more common than with other activities or no activity, and those reported were minor aches and pains (NCCIH). Don’t use it to put off seeing a doctor about a medical problem (NCCIH). If you are unsteady now, start with a class designed for falls prevention and keep a chair or wall within reach.

Finding a class

Tai chi instructors don’t need a license and there is no national certification standard, so ask about a teacher’s training and experience (NCCIH). Programs built for falls prevention, such as Tai Ji Quan: Moving for Better Balance, are taught by trainers who have completed the program’s own training (NCOA). Senior and community centers are a good place to look (CDC STEADI). Cost estimate being researched.

Member stories

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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