By Keith N. Darrow, Ph.D., CCC-A · Harvard Medical and M.I.T. Trained Neuroscientist · Director of Audiology Research, Hearing and Brain Centers
There was a time in life when you could trip, fall down, dust yourself off and keep going.
As we get older, the consequences of a fall can be dramatically different.
A fall can mean a broken hip, a head injury, hospitalization, loss of confidence, reduced mobility and, for some older adults, the beginning of a loss of independence.
That is why September, Falls Prevention Awareness Month, is such an important opportunity to talk about something I want every aging adult and every family to understand:
Falling may become more common as we age, but falls should never simply be dismissed as “a normal part of getting older.”
Many fall risks can be identified. Many can be modified. And the earlier we start paying attention to hearing, balance, strength, medications, vision and the home environment, the more we can do to protect the active, independent life we have worked so hard to build.
The Centers for Disease Control and Prevention reports that more than one in four Americans age 65 and older falls each year. Falls are the leading cause of both fatal and nonfatal injury among older adults, and falling once doubles the chance of falling again.
That is not a statistic we should accept passively. It is a reason to act.
And one risk factor that deserves much more attention is the relationship between your ears, hearing, brain and balance system.
If you want to learn more right now, I invite you to watch my free Falls Reduction Online Seminar: Watch Dr. Darrow’s Falls Reduction Online Seminar.
Why Falling Becomes More Dangerous As We Age
Balance is not controlled by one organ. Staying upright requires your brain to continuously integrate information coming from several systems:
- Your eyes tell your brain what is happening around you.
- Your muscles and joints help your brain understand where your body is positioned.
- Your inner ear vestibular system detects movement and changes in head position.
- Your hearing provides additional environmental and spatial information.
- Your brain must process all of this information and tell your body how to respond.
This is happening constantly, often without you consciously thinking about it.
When we are younger, these systems typically respond quickly and efficiently. With aging, however, changes can occur across several systems simultaneously.
Vision may become less reliable. Muscle strength can decrease. Reaction time may slow. Certain medications may contribute to dizziness or instability. The sensory structures responsible for hearing and balance can change as well.
The HBCA Aging and Falls report explains this as a multisystem problem involving auditory, vestibular, visual, proprioceptive and cognitive input rather than simply an issue of “weak legs” or clumsiness.
That distinction matters. If we only think about preventing falls by removing a rug or installing a handrail, we may miss important underlying health factors.
Your Inner Ear Does More Than Hear
Most of us learned this in school and then forgot it: the inner ear participates in both hearing and balance.
Your cochlea is responsible for hearing. Nearby vestibular structures provide information your brain uses to determine motion, acceleration and position.
That does not mean that everyone with hearing loss has a vestibular disorder, nor does hearing loss automatically mean you will fall.
What it does mean is that hearing and balance exist within interconnected sensory systems, and research has repeatedly identified an association between hearing impairment and increased fall risk.
One landmark analysis by researchers Frank Lin, M.D., Ph.D., and Luigi Ferrucci, M.D., examined more than 2,000 adults and found that for every additional 10 decibels of hearing loss, the odds of reporting a fall increased approximately 1.4 times. The association persisted after adjustment for age and several cardiovascular and vestibular factors.
Notice what the research actually says. It does not mean hearing loss directly causes every fall. It tells us that hearing loss can be an important marker and potential contributor to fall vulnerability. That is enough reason to pay attention.
How Hearing Loss May Contribute to Fall Risk
Researchers have proposed several possible mechanisms connecting hearing difficulty and falls.
1. Reduced Environmental Awareness
Hearing gives us information about what is happening outside our direct field of vision: footsteps behind us, a vehicle approaching, a person calling from another room, the direction from which a sound originates.
Environmental sound contributes to our awareness of space. When auditory information becomes degraded, one source of sensory information available to the brain becomes less reliable.
2. Greater Cognitive Demand
When hearing becomes difficult, listening takes more effort. Instead of effortlessly understanding a conversation, the brain may have to devote additional attention to decoding incomplete auditory information.
Imagine walking through a busy restaurant while simultaneously trying to understand your spouse. Your brain is processing sound, speech, movement, obstacles, visual information and body position at the same time.
Researchers continue to investigate whether this increased cognitive demand contributes to poorer mobility or balance in challenging environments. The HBCA Aging and Falls report refers to this concept as increased “cognitive load,” the possibility that more mental resources devoted to listening leave fewer available for other simultaneous tasks.
3. Shared Effects of Aging
Hearing loss can also be a sign of broader age related sensory and neurological changes. The National Institute on Deafness and Other Communication Disorders reports that hearing loss becomes substantially more common with age. Approximately 22% of Americans ages 65 to 74 and 55% of people age 75 and older have disabling hearing loss.
That is one reason I encourage older adults not to think about hearing testing merely as a question of “Can I hear?” The better question is, “How well are my auditory and related sensory systems functioning as I age?”
A Fall Can Change Far More Than Your Physical Health
When I talk with older adults about fall prevention, I am not simply trying to prevent a bruise. I am trying to protect independence.
The CDC reports that falls are the leading cause of injury for adults 65 and older. More than 14 million older Americans report falling each year. The age adjusted fall death rate increased 21% between 2018 and 2024. Approximately three million older adults visit an emergency department each year because of falls, and approximately one million are hospitalized.
But statistics still do not fully describe what happens after a serious fall. A person who falls may become afraid to walk outside. They stop going to exercise class. They stop golfing. They avoid stairs. They stop visiting friends. Their family begins doing more for them. Someone takes away the car keys. A son or daughter starts talking about assisted living.
Independence can begin disappearing one small decision at a time.
Fear of falling itself can therefore become part of the problem. Avoiding activity can contribute to loss of strength and confidence, which may make maintaining mobility even more difficult.
That is why my message is not simply “be careful.” My message is: build a plan.
Hearing Treatment and Falls: What Does the Research Actually Show?
This is an area where I believe accuracy matters tremendously.
We have strong evidence that hearing loss is associated with greater fall risk. We also have emerging evidence suggesting that appropriate hearing aid use may be associated with reduced fall risk.
A 2023 study involving adults age 60 and older with bilateral hearing loss found that hearing aid users had lower odds of reporting falls than nonusers. Consistent hearing aid users showed an even stronger association. However, the study was observational, meaning it demonstrates an association rather than proving that hearing aids themselves prevented those falls.
That distinction is important. We should not promise that putting hearing aids on someone will magically eliminate their risk of falling. Fall risk is multifactorial.
But when an older adult has hearing loss, treating that hearing loss appropriately can be one logical component of a comprehensive healthy aging and fall risk strategy.
The goal is not simply louder sound. The goal is helping the individual communicate, remain socially engaged, improve access to environmental information and reduce the burden created by untreated hearing difficulty.
What About Hearing Loss and the Brain?
This conversation becomes even more important when we consider cognitive health. Hearing loss has consistently been associated with cognitive decline and dementia risk in older adults. Researchers are now studying whether treating hearing loss can alter that trajectory.
The landmark randomized ACHIEVE trial compared a comprehensive hearing intervention with health education among adults ages 70 to 84. Across the entire study population, researchers did not find a statistically significant difference in three year cognitive decline between the two groups.
However, among participants at greater baseline risk for cognitive decline, hearing intervention appeared to provide meaningful benefit. Subsequent analysis found the greatest reduction in cognitive decline among participants with the highest predicted cognitive risk.
That is much more scientifically accurate than saying hearing treatment “prevents dementia.” What we can say is that hearing health has become an increasingly important part of the conversation about healthy brain aging, and treating clinically significant hearing loss is a reasonable step for communication, engagement and overall health.
Five Steps You Can Take This September to Reduce Your Fall Risk
Falls prevention should never depend on one single intervention. The best approach is comprehensive.
1. Have Your Hearing Evaluated
If you are over 60, or if you notice difficulty understanding speech, hearing in background noise, locating sounds or experiencing tinnitus, schedule a comprehensive hearing evaluation. Do not wait until hearing loss becomes “bad enough.” Age is one of the strongest predictors of hearing loss. NIDCD describes age related hearing loss as one of the most common conditions affecting older adults. A hearing evaluation gives you a baseline and allows your provider to determine whether treatment is appropriate.
2. Ask About Balance and Fall Risk Screening
Tell your healthcare providers if you:
- Feel unsteady.
- Have experienced dizziness.
- Have had a near fall.
- Have already fallen.
- Feel less confident walking in the dark.
- Struggle on uneven surfaces.
- Avoid activities because you are afraid of falling.
Do not hide a fall because you are embarrassed. The CDC notes that fewer than half of older adults who fall tell their doctor. Your healthcare team cannot address a problem they do not know exists.
3. Stay Strong and Active
Movement matters. Strength and balance training are important parts of many evidence based fall prevention programs. The CDC recommends interventions targeting modifiable risks including poor strength and balance. Depending on your medical history, that may include walking, strength training, tai chi, structured balance exercises or physical therapy. Talk with your physician or qualified healthcare professional before starting a new exercise program, particularly if you already have balance problems or significant medical conditions.
4. Review Your Medications
Some medications, and combinations of medications, can contribute to dizziness, sedation, blood pressure changes or instability. Bring your entire medication list to your physician or pharmacist and ask, “Could any of these medications, or the combination of them, increase my risk of dizziness or falling?” Do not discontinue medication on your own. Medication review is one of the risk management strategies incorporated into the CDC’s STEADI approach to older adult fall prevention.
5. Make Your Home Work for You
Most homes were designed for convenience and appearance, not for fall prevention at age 75. Look at your environment differently. Check:
- Loose rugs.
- Electrical cords.
- Cluttered walkways.
- Poor hallway lighting.
- Bathroom surfaces.
- Missing handrails.
- Uneven exterior steps.
- Frequently used objects stored too high or too low.
- Shoes or slippers with inadequate support.
Small changes can create meaningful reductions in environmental risk.
The Goal Is Not Simply to Avoid Falling. It Is to Keep Living.
This may be the most important point I can make during Falls Prevention Awareness Month. We are not trying to keep older adults sitting safely in a chair. That is not successful aging.
The goal is to help people remain active, engaged, confident and independent. I want you traveling. Walking. Playing golf. Going to dinner. Playing with your grandchildren. Living in your home. Participating in your community. Doing the things that give your life meaning.
Fall prevention is about preserving that freedom. And because hearing, balance and brain health are interconnected pieces of the aging puzzle, your hearing evaluation deserves a place alongside your eye examination, physical examination, medication review and other preventive healthcare.
Do not wait for the first serious fall before asking whether something could have been done. Start now.
Balance is about more than staying upright. It is about preserving your independence, staying in your home longer and maintaining the confidence to keep living life on your terms.
Watch the Falls Reduction Online Seminar
During September, take one simple step for yourself, or for someone you love. Learn more about the relationship between aging, hearing, balance, the brain and fall risk, then talk with your healthcare providers about your individual risks.
Watch the free seminarSchedule a hearing evaluationRequest Dr. Darrow’s bookGet your Brain Care Score
Frequently Asked Questions About Hearing Loss, Balance and Falls
Are falls a normal part of getting older?
No. Falls become more common with age, but they should not be considered inevitable. The CDC emphasizes that older adult falls can be prevented and recommends screening for and addressing modifiable risk factors including medications, strength, balance and environmental hazards.
Can hearing loss increase my risk of falling?
Research has found a significant association between hearing loss and falls. One U.S. study found approximately 1.4 times higher odds of reporting a fall for every additional 10 dB of hearing loss. That does not prove hearing loss alone causes falls, but it supports including hearing health when evaluating an older adult’s overall fall risk.
Will hearing aids prevent me from falling?
No device can guarantee that someone will not fall. Fall risk involves hearing, balance, strength, medications, vision, neurological health, environmental hazards and other factors. Some observational research has found lower odds of falling among consistent hearing aid users with hearing loss, but additional research is needed to establish causation.
Why are hearing and balance related?
The cochlea, which supports hearing, and the vestibular organs, which provide information about head movement and position, are both located within the inner ear. They are distinct systems, but the brain integrates auditory, vestibular, visual and body position information to understand the environment and maintain stability.
If I have already fallen once, am I more likely to fall again?
Yes. According to the CDC, falling once approximately doubles the chance of falling again. A previous fall should therefore prompt a conversation with your healthcare team about identifying and reducing fall risks.
At what age should I start paying attention to hearing and fall risk?
There is no single age that applies to everyone, but both hearing loss and fall risk become substantially more common in later adulthood. NIDCD reports that disabling hearing loss affects approximately 22% of adults ages 65 to 74 and 55% of adults age 75 and older. Regular hearing assessment becomes increasingly valuable as we age.
What should I do first if I feel unsteady?
Tell your physician or healthcare provider. Dizziness and instability have many possible causes, including vestibular disorders, medication effects, cardiovascular conditions, neurological disorders, vision problems and other medical issues. A hearing and balance evaluation may be one part of a broader medical assessment.
Where can I learn more about reducing my risk of falling?
Watch Dr. Keith Darrow’s free Falls Reduction Online Seminar, which explains the hearing, brain and balance connection and practical steps older adults can take to become more proactive about fall risk: watch the seminar here.