Balance training and fall prevention for older adults

Falls are the leading cause of injury death for adults 65 and older, and the rate is rising. CDC reports that falls in this age group caused over 43,000 deaths in 2024, and emergency departments recorded about 4.5 million visits for older adult falls that year. Over 14 million older adults, about 1 in 4, report falling every year. The age-adjusted fall death rate rose 21%, from 64.7 to 78.4 per 100,000 older adults between 2018 and 2024.

Why falls happen (CDC)

Among the conditions CDC lists as making a fall more likely are lower body weakness, difficulties with walking and balance, and home hazards such as broken or uneven steps. Two points stand out:

• Falling once doubles your chances of falling again.
• Many people who fall, even without injury, become afraid of falling and cut down on everyday activities; when a person is less active, they become weaker, which increases the chances of falling.

Nearly 319,000 older people are hospitalized for hip fractures each year (CDC).

What the guidelines ask for

The Physical Activity Guidelines for Americans say that, as part of their weekly activity, older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities. The guidelines connect better physical function to a lower risk of falls and fall-related injuries, and to everyday tasks such as climbing stairs or carrying groceries. Japan's guideline for older adults also asks for multicomponent exercise; see U.S. and Japanese guidelines side by side.

Balance exercises (NIA)

The National Institute on Aging says that, as with muscle-strengthening exercises, balance exercises help prevent falls and fall-related injuries, and suggests aiming for about three sessions a week. Its examples include:

• Tai chi or yoga
• Standing on one foot
• The heel-to-toe walk
• Walking backward or sideways
• Practicing standing from a sitting position

For safety, NIA says to have a sturdy chair, person or wall nearby to hold onto. Its falls page adds that yoga, Pilates and tai chi can all improve balance and muscle strength.

Planning for emergencies

Ready.gov's advice for older adults focuses on planning: arrange transportation if you need help evacuating, and plan how you'll keep assistive devices with you. Our additions, which are suggestions rather than official guidance:

• Keep a flashlight or motion-sensor light by the bed and on the stairs, so a night-time power outage doesn't leave you moving in the dark.
• Practice the route out of your home, including stairs, with the shoes you would wear.
• Pack a spare cane or walker tips and any glasses in your emergency kit.
• Older relatives in an evacuation shelter should keep moving; long stretches of lying down weaken the legs quickly.

Check with a doctor or physical therapist before starting a new exercise program, especially after a fall.