A missed step on the stairs. A trip over a rug that's been there for years. A moment of unsteadiness getting out of a chair.
Why do older adults fall? According to the CDC, about one in four adults age 65 and older falls each year - usually from a combination of factors like leg weakness, balance, vision, medications, and home hazards.
Falling isn't something you simply have to accept as part of getting older. These risk factors can be identified and addressed, helping older adults stay safer and more independent.
Strong legs are the foundation of safe movement, independence, and fewer falls.
Quick Answer: What Causes Falls in Older Adults?
The most common causes of falls in older adults include:
- Muscle weakness, especially in the legs and trunk
- Poor balance
- Fear of falling
- Inner ear (vestibular) disorders
- Vision changes
- Hearing loss
- Medication side effects
- Low blood pressure when standing
- Home and environmental hazards
Here's what many people miss: fall risk is influenced by multiple factors, but leg strength is one of the most important - and most overlooked - pieces of the equation.
Signs You May Be at High Risk of Falling
Many people begin showing warning signs long before their first fall.
You may be at increased risk if you:
- Have difficulty standing from a chair without using your hands, or feel unsteady while walking
- Walk slower, shuffle your feet, or tire more easily than you used to
- Frequently hold onto furniture while walking, or avoid stairs altogether
- Have fallen within the past year or been hospitalized recently
- Have become more dependent on a walker or cane
If several of these sound familiar, now is the time to begin addressing the underlying causes before a fall occurs.
1. Leg Weakness: One of the Biggest Contributors to Falls
The most common cause of falls is loss of leg and trunk strength.
Falling isn't just about losing your balance - it's also about whether your legs are strong enough to respond when your balance is challenged. If you trip, your legs need to quickly generate enough force to take a corrective step. If you begin to lose your balance while standing, your muscles need to help you reposition your body. And if you end up on the floor, you need enough strength to get back up - or at least move safely until help arrives.
Balance tells your body what to do. Strength helps your body do it.
Common signs of weakness include:
- Bent knees or hips while walking
- Difficulty lifting the feet
- Short, shuffling steps
- Poor coordination
- Feeling unsteady
- Difficulty getting out of chairs or bed
When leg strength declines, everyday activities become increasingly difficult. Strong legs are responsible for almost every movement you perform throughout the day. They allow you to:
- Stand up from a chair or the toilet
- Climb stairs and step over curbs
- Walk safely and recover after a trip
- Maintain good posture
- Move confidently throughout your home
Some loss of muscle mass is a natural part of aging - but left unaddressed, it accelerates quickly, especially during illness, surgery, hospitalization, or inactivity.
Even short stretches of bed rest or reduced activity can cause a surprising amount of strength loss. For someone already near their physical limit, that loss can be the difference between walking independently and needing assistance. (Read more about how quickly muscle loss happens →)
Common Misconceptions
"It's too late to rebuild strength." Not true - research shows strength can be rebuilt at any age, even among frail adults in their late 80s and 90s who took part in supervised resistance training programs.
"Walking is enough exercise." Walking is great for your heart, but it doesn't provide enough resistance to build the leg strength you need to stand safely, climb stairs, or catch yourself after a stumble - that takes progressive resistance training.
What helps:
- Progressive resistance training targeting the functional muscle groups in the legs and trunk, at least twice a week
- Working with a physical therapist or other healthcare professional who understands and values the relationship between strength, balance, and mobility to build a program suited to your ability
- Sticking with it consistently for 2-5 months, since that's typically how long meaningful gains take to show up - and continuing afterward, even after formal therapy ends, is what keeps you steady on your feet and lowers your risk of falling
2. Poor Balance
Balance is a skill - not something we simply lose because we grow older.
It also depends heavily on leg strength. Standing on one leg, catching yourself mid-stumble, or simply staying steady while reaching for something all require a certain amount of strength in the legs. Without it, people often compensate by holding onto furniture, walls, a walker, or a cane just to feel secure - a habit the CDC itself flags as a warning sign of increased fall risk.
Everyone can improve balance, regardless of age or diagnosis. Better balance begins with stronger legs, but it requires more than balance practice alone - leg strength, coordination, sensory input, and the ability to respond quickly when balance is challenged all play a role. That's why effective fall-prevention programs combine strength, balance, gait, and functional training.
What helps:
- Building stronger legs through progressive resistance training
- Ongoing practice with progressive weight shifting, larger, more confident movements, and challenging balance safely in different positions
- Many people can't safely do this alone - ongoing work with a physical therapist or other healthcare professional to retrain ankle and knee reactions
- Balance challenges done safely, with support nearby
3. Fear of Falling
Fear of falling can become one of the greatest contributors to future falls.
A 2025 study of over 75,000 older adults found that high concern about falling raised the risk of a future fall by as much as 60%.
Fear often causes people to:
- Shortening their stride to a cautious shuffle
- Reaching for furniture before they even feel unsteady
- Becoming reluctant to move, or moving far less than they used to
- Leaning on a walker or cane they didn't need before
- Skipping walks, errands, or visits rather than risk a fall
This creates a cycle:
Fear → Less movement → More weakness → Greater fall risk
Breaking that cycle takes time - fear is often the slowest piece to resolve. But the stronger the legs and the more practice with safe movement, the faster confidence tends to follow.
What helps:
- Starting a supervised strength and balance program, at least twice a week, and practicing movements in that safe, supported setting until confidence returns
- Talking openly with a doctor or therapist about your specific concerns
- Staying active rather than avoiding movement altogether
4. Inner Ear (Vestibular) Disorders
Your inner ear plays an essential role in maintaining balance.
Vestibular disorders are conditions that disrupt the inner ear's ability to send accurate balance signals to the brain. One common one is called BPPV (short for Benign Paroxysmal Positional Vertigo) - it happens when tiny calcium crystals in your inner ear get out of place.
Symptoms may include:
- Spinning sensations
- Dizziness when rolling over in bed, or when lying flat and turning your head
- Feeling off balance
- Symptoms when bending over or looking upward
What helps:
- An evaluation from an ENT physician or vestibular specialist
- Vestibular rehabilitation therapy, if recommended
- Moving slowly when changing positions - sitting up, standing, or turning over in bed
- Reporting new or worsening dizziness to your doctor promptly
5. Vision Changes
Vision helps the brain determine where your body is in space. Outdated prescriptions, and bifocals or trifocals in particular, can distort depth perception - making it harder to judge exactly where the floor, a step, or a curb actually is. Poor vision can also make it hard to spot uneven surfaces, see clearly in low light, or maintain steady, upright posture. Older adults with cataracts or glaucoma are at even greater risk.
What helps:
- Regular eye examinations
- Updated eyeglass prescriptions
- Keeping glasses within reach at night
- Nightlights throughout the home
- Improved lighting in hallways, bathrooms, and stairways
6. Hearing Loss
Hearing contributes more to balance than many people realize.
Hearing loss may also be associated with increased fall risk. Hearing provides additional sensory information that helps people understand what is happening around them, and hearing loss can occur alongside other conditions that affect balance and mobility. Tinnitus (ringing in the ears) can also play a role.
What helps:
- Regular hearing evaluations
- Properly fitted, functioning hearing aids
- Routine ear cleanings to clear wax buildup that can affect hearing
- Addressing tinnitus with your doctor if it's affecting balance or sleep
7. Medications
Many medications increase the risk of falling by causing:
- Dizziness
- Drowsiness
- Lightheadedness
- Slower reaction times
- Confusion
The risk increases when taking multiple medications, particularly:
- Blood pressure medications
- Diabetes medications
- Pain medications
- Sleep aids
- Antidepressants
- Anti-anxiety medications
- Seizure medications
What helps:
- An annual review of all medications, including over-the-counter products, with your physician or pharmacist
- Asking specifically about fall-risk side effects when starting anything new
- Reporting new dizziness or drowsiness after a medication change
8. Blood Pressure Changes
Some older adults experience a drop in blood pressure when standing up, called orthostatic hypotension.
Symptoms include:
- Lightheadedness
- Blurry vision
- Feeling faint
- Loss of balance
What helps:
- Stand up slowly.
- Pause before walking.
- Stay hydrated.
- Ask your healthcare provider to check your blood pressure while lying down, sitting, and standing.
9. Home and Environmental Hazards
Many falls occur because of hazards that can be corrected - things like loose rugs, cluttered walkways, poor lighting, and low or unstable furniture.
Furniture height also matters.
The ideal chair or bed height allows the knees to sit slightly lower than the hips, making standing much easier. Chairs with sturdy armrests allow people to push themselves up safely rather than pulling with their arms.
Don't make the home safer by making the person weaker. Removing hazards is important, but avoiding movement altogether is not a long-term fall-prevention strategy. Older adults also need opportunities to maintain the strength, balance, and mobility required to move safely through their environment.
What helps:
- A room-by-room walkthrough to spot and remove hazards like loose rugs and cords
- Adding grab bars in bathrooms and railings on both sides of stairs
- Improving lighting throughout the home, especially hallways and stairways
- Choosing chair and bed heights that make standing up easier
Frequently Asked Questions
Does walking count as exercise for reducing fall risk?
It helps your heart, but it doesn't provide enough resistance to build the leg strength you need for daily activities. Progressive strength training is necessary for that.
How often should older adults strength train?
Most experts recommend at least two days per week, with meaningful gains typically taking several months of consistent training.
Why does physical therapy sometimes end before strength fully returns?
Traditional physical therapy often focuses on restoring safe function after an injury or illness. Because meaningful strength gains typically take several months, many people benefit from continuing a structured strength program after therapy concludes.
Key Takeaways
✔ Weak leg muscles are one of the leading causes of falls - and strength can be rebuilt at any age.
✔ Walking alone does not build enough strength to significantly reduce fall risk.
✔ Fear of falling raises your risk of falling again.
✔ Vision, hearing, medications, and home safety all play a role in fall risk.
✔ Meaningful strength gains take 2-5 months, and maintaining them requires training at least twice per week - ideally continuing even after formal therapy ends.
Stay Strong. Stay Independent.
Falls should never be accepted as an unavoidable part of aging. If you or someone you love has fallen - or is showing early warning signs - it's worth finding out why, rather than assuming it's just part of getting older.
At Tandem Strength & Balance®, we've spent more than 25 years helping older adults build the strength, balance, and confidence to live safely and independently - whether they're recovering from a hospitalization, managing Parkinson's disease, living with arthritis, or simply noticing everyday activities have become harder.
If any of this sounds familiar, the first step is simple: reach out to schedule an evaluation with our team. We'll assess your strength, balance, and specific risk factors, then build a plan around them.
Sources
- Centers for Disease Control and Prevention (CDC), Older Adult Falls
- Kortebein P, Ferrando A, Lombeida J, et al. "Effect of 10 Days of Bed Rest on Skeletal Muscle in Healthy Older Adults." JAMA, 2007.
- Fiatarone MA, O'Neill EF, Ryan ND, et al. "Exercise Training and Nutritional Supplementation for Physical Frailty in Very Elderly People." New England Journal of Medicine, 1994.
- Delbaere K, et al. Systematic review and meta-analysis on concerns about falling and future fall risk. Age and Ageing, 2025.
- CDC STEADI Initiative, "Stay Independent" Fall Risk Screening Brochure.