Physicians routinely track measures that can reveal changes in a patient’s health long before those changes become symptomatic. Blood pressure, heart rate, weight, and other familiar measures have earned a place in clinical care because following them over time provides information that can guide intervention. For an aging population, balance deserves similar attention because it can reveal changes in functional health before they result in injury or loss of independence.
Balance is often treated primarily as a fall-prevention issue. A patient falls, reports unsteadiness, or begins using an assistive device, and only then does balance become an explicit clinical concern. A more effective approach would identify changes earlier, before they lead to injury or loss of independence.
Balance reflects the combined performance of multiple physiological systems. Vision, vestibular function, proprioception, neuromuscular response, and lower-extremity strength all contribute to the ability to remain upright and recover when stability is disrupted. Changes in balance can therefore reveal important information about functional health that conventional vital signs may not capture. For these reasons, balance merits consideration as a sixth vital sign for healthy aging.
Function can change before the diagnosis does
A patient’s laboratory values can remain reassuring while functional reserve quietly deteriorates. The patient may begin holding the railing more tightly on stairs, avoiding uneven ground, feeling less comfortable stepping backward, or using their hands to rise from a chair. Individually, these changes may appear minor, but collectively they may indicate declining strength and postural control.
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They can also initiate a damaging cycle. People who feel unstable may move less because they fear falling, and reduced activity can lead to further loss of strength. That loss can make it even more difficult to maintain balance and recover from a stumble.
Falls represent the leading cause of injury for adults ages 65 years and older. Every year, over 14 million (or 1 in 4 older adults) report falling. Even more alarmingly, 40 percent of seniors who are hospitalized for hip fractures die within six months.
Waiting for a fall to identify impaired balance is analogous to waiting for a cardiovascular event before becoming interested in blood pressure. Routine measurement creates an opportunity to identify a patient’s functional trajectory rather than simply document an adverse event.
Balance does not require complicated testing
Balance lends itself to routine monitoring because clinically useful information can come from relatively straightforward functional assessments. A single-leg stand challenges static postural control, while tandem standing and heel-to-toe walking narrow the base of support and add a dynamic component. Chair rises provide insight into lower-extremity strength, and multidirectional stepping challenges the ability to shift the center of mass and regain stability.
These movements should not necessarily become universal pass-or-fail tests with a single cutoff applied to every patient. Age, underlying conditions, and baseline function all influence performance, so their greatest value may lie in longitudinal assessment.
The key questions to evaluate with a balance assessment are straightforward: What can the patient do today? How does that performance compare with six months or a year ago? Is function improving, remaining stable, or deteriorating? Clinicians routinely ask similar questions about other health measures, and functional balance deserves the same longitudinal approach.
Measurement matters because balance is modifiable
Routine measurement has limited value unless the condition being measured can be meaningfully influenced. Balance meets that standard because evidence from fall-prevention programs supports exercise that progressively challenges balance and incorporates lower-extremity strengthening. Effective programs typically require repeated training rather than sporadic activity, with exercises performed several times per week and continued for at least 12 weeks.
Progression is essential. Patients may begin by holding a stable surface and then gradually reduce their reliance on that support. They can narrow their base of support, introduce movement, or increase the complexity of a task as their ability improves.
Strength training should be part of the same clinical conversation. Maintaining postural control is only one component of preventing a fall; patients also need sufficient muscular capacity to respond when balance is lost. Resistance training alongside balance exercises can help address both needs when appropriate for the patient.
GLP-1 therapy adds another reason to watch function
The rapid adoption of glucagon-like peptide-1 (GLP-1)-based therapies is yet another reason why functional balance measurement deserves greater attention. These medications have demonstrated important benefits for patients with obesity, diabetes, and cardiovascular risk, and their appropriate use should not be discouraged. However, weight loss associated with GLP-1 therapy can include loss of lean tissue as well as fat, raising questions about whether this may be especially relevant for populations already vulnerable to sarcopenia, including some older and frail adults.
The evidence requires careful interpretation. Current research does not establish that GLP-1 therapies broadly cause falls, and the relationship between changes in lean mass and actual muscle strength remains complex. Emerging findings nevertheless suggest that strength and physical function may warrant particular attention in older patients and other higher-risk groups.
This creates a practical clinical question. When an older patient loses 20 or 30 pounds, clinicians will track changes in body weight and metabolic health, but they should also assess whether the patient can still rise easily from a chair, walk confidently, and maintain balance.
For patients at elevated risk of sarcopenia, monitoring strength and physical function alongside weight may provide a more complete picture of whether treatment is improving overall health. Recent clinical reviews have similarly recommended attention to functional measures such as chair stands, grip strength, and mobility in older adults receiving anti-obesity medications.
GLP-1 therapy adds urgency to the monitoring of balance, but the need is universal. Balance matters for the 70-year-old taking semaglutide and the 70-year-old who is not, as well as for the active 55-year-old who has never fallen and the 80-year-old who is beginning to worry about stability.
Measure health before it disappears
As physicians, we’ve become extraordinarily sophisticated at measuring disease risk. Healthy aging requires attention to another dimension of health: the ability to function. Can the patient stand confidently, shift weight, recover when the center of gravity changes, and maintain the strength required to support those abilities? These questions speak directly to mobility and quality of life.
Balance can deteriorate with age and can improve with appropriately designed exercise. The missing step is making balance a routine part of clinical assessment rather than an issue addressed only after it has become a problem. For an aging population, balance is too important a signal to ignore.
This essay is cited in the KevinMD record on GLP-1 drugs.
Sanjeev Sharma is chief medical officer of UpRight Science. He earned his undergraduate and medical degrees from Ontario’s McMaster University and completed his postgraduate medical training at University of Toronto. He then spent nearly two decades as a physician specializing in emergency medicine at North York General Hospital, Trillium Health Partners, and the William Osler Health System. But he came to realize that business skills would be needed to make the kinds of changes he thought the combination of technology and medicine would require, so he returned to school and earned an MBA from Wilfrid Laurier University.
With his brother, Sunil, he founded Wellpoint, an occupational health services company. After a successful exit, he was a founder of Highmark, the company that developed the FDA-cleared Software as a Medical Device balance technology that UpRight Science is bringing to market. His goal is to use that technology’s ability to collect neurological data to make balance a key physiological marker that guides medical treatment.
The company’s work reaches beyond the clinical setting to StayUpRight!, a free app from UpRight Science that gives everyday users a window into their own balance health and a powerful introduction to what the company’s medical technology makes possible. With fall-related deaths among adults 65 and older rising sharply over the past two decades, it is the mission of UpRight Science to flatten that curve with technology that is simple, scalable, and scientifically sound. He shares updates on LinkedIn.
