The Balance We Stop Noticing

Last week, getting off a boat at the Temple of Philae in Egypt, our guide said, “Watch your step.” I didn’t hear him.

I was one missed sentence away from a twisted ankle, a fall, and potentially the start of an injury cascade in another country. 

It was that simple. 

The very steps I almost tripped on at the Temple of Philae in Egypt!

This week is Falls Prevention Awareness Week. Every year the National Council on Aging uses it to say one quiet, hopeful thing to millions of us: there are things we can do to reduce our risk of falling.

I want to start somewhere small. Think about the last time you reached for a railing you did not used to need or paused at the top of a dark staircase a few seconds longer than you once did. Most of us have had moments like that. And most of us file it under clumsiness, distraction, or a bad night's sleep, and move right along.

I would like you to file it somewhere else. Staying upright isn't a skill we either have or lose. It is the result of several systems working together: our eyes, inner ear, muscles, and blood pressure, each one of them shifting a little with age. Often, those changes are gradual and almost imperceptible. 

A fall is an indicator of how ridiculously fast our bodies have to solve a problem. 

What Is Actually Happening When You Lose Your Footing

Think about what happens when your foot catches the edge of a rug. Before you have time to think, I’m losing my balance, your brain is already taking in information from your eyes, inner ear, feet, and joints, figuring out where your body is in space, and asking your muscles to make a correction.

Most of the time, they do. What usually happens is we take that funny little recovery step, straighten ourselves up, and keep walking as though nothing happened.

That little save is balance

Balance is not one system. It is several systems working together, very quickly. All of our systems drift a little with age, and each drift is normal on its own. No single change is usually enough to make us fall. What matters is what happens when several small changes begin to overlap.

• Vision: Depth perception softens, contrast fades, and the eyes adjust to dark more slowly. The Falls Free materials are blunt about it: your eyes and ears are key to keeping you on your feet.

• Hearing and the inner ear: Hearing and balance are closely connected, although not quite as simple as “hearing declines, and therefore balance declines.” The vestibular system in the inner ear helps tell the brain where the head is in space and whether it is moving. Hearing loss can also mean missing information from the environment. Remember, I learned that firsthand when I didn’t hear the guide say, “Watch your step.” 

• Muscle and flexibility: This is where we have enormous leverage. Strength, balance, mobility, and flexibility are the holdings you can add to at any age. That is why the first of NCOA’s six steps is a balance and exercise program. 

• Blood pressure: Stand up too fast and pressure can drop. It's a shift called postural hypotension. It is a common, documented reason why falls tend to cluster in the early morning.

• Medications: This is the line-item most of us miss. A drug that helps one system can pull margin from another, and side effects that increase fall risk are common enough that reviewing your prescriptions with a doctor or pharmacist is its own step. Never stop or change a medication without talking with your clinician first.

The Instinct to be Careful

If you have felt a little less sure on the stairs, or reached for the wall in a dark hallway, that is useful information. These shifts can be gradual, and gradual changes are easy to accommodate without giving them much thought.

You take the elevator instead of the stairs. You shorten the walk. You choose the smoother path instead of the uneven one. Each decision makes sense on its own. We are trying to be careful.

But here is where psychology gets interesting.

When we ask less of our balance, strength and coordination, those systems get less practice. Muscles can lose strength. Reactions can become slower. Balance gets fewer opportunities to do exactly what we need it to do: recognize that we are off course and make a correction. What begins as reasonable caution can quietly become an activity-restriction spiral.

More than one in four adults 65 and older reports a fall every year, and a first fall doubles the risk of a second. 

Read that again. 

The single biggest predictor of a fall is a fall you already had.

That is not a reason to do less. It is a reason to pay attention sooner.

A stumble, a wobble, or a fall gives us information about where the system may need support. The goal is not simply to become more careful. It is to keep our bodies as capable as possible of catching us when being “careful” isn’t enough.

We Are Already There

I understand why a piece about falls can feel premature. If I saw the title, I might think, Not for me. I’m not there yet.

The truth is, we are already there.

Falls prevention does not begin when we become unsteady. It begins much earlier, while we are building and maintaining the systems that will one day help keep us on our feet.

That means some of what you are reading here belongs just as much to the twenty-somethings in our lives as it does to us. Strength built now matters later. Balance challenged now matters later. Vision and hearing protected now matter later. The habits that preserve capacity compound too.

So, I am not going to hand you a to-do list here. Where your specific number is, and the exact order to rebuild in, belongs in the practical piece in this series. What happens when concern about falling begins to change how much we move deserves its own piece too.

This one has a single job: to change what you think a fall is.

A fall is a drawdown across systems you may not have been watching.

And the good news lives in that same sentence, because many of those systems are not fixed in place. They respond. You can add to them. You can protect them. And you do not have to wait for a fall to start.

We will age. That part is not up for negotiation.

Whether we age with margin or without it is the part we still hold the pen on.

SOURCES

National Council on Aging. "6 Steps to Help Prevent Falls in Older Adults." Falls Free Initiative, 2024. ncoa.org/FallsPrevention

National Council on Aging. "5 Ways Taking Care of Your Vision and Hearing Help Lower Falls Risk." Falls Prevention Awareness Week handout, 2023.