Q: I don't really want to use a cane but I am afraid of falling. How can I improve my balance?

A.: In the U.S., an estimated one-third of seniors over 65 and one-half of those over 80 will fall each year, says the National Council on Aging.

Older adults typically experience loss of balance because of changes in muscle strength, loss of flexibility, and shorter reaction time.

As you age, your posture and center of gravity may shift, leading to changes in gait and an increased risk of falling.

People at risk may have poor coordination, unsteadiness or difficulty walking, dizziness, leg weakness, or difficulty performing daily activities such as dressing and negotiating stairs.

Conditions that can affect risk include: neck pain and limited neck motion, limited range of motion and strength in the legs, ear infections and viruses affecting the inner ear, vision changes, head trauma/post concussion, neurologic disorders such as multiple sclerosis, Parkinson's disease, and stroke.

Balance is a complex coordination of many bodily systems. By understanding which systems are impaired, a physical therapist can design a program.

An exercise program can help strengthen muscles, and specific balance exercises may improve balance to minimize falls.

People in balance programs see great improvement and a strong reduction in the fear of falling. Improvements can be made through balance therapy, which combines innovative computer-based assessment and retraining technology with comprehensive patient education and therapeutic exercises to improve balance, strength, stamina, and mobility.

Making minor adjustments to your home can also help prevent falls.

Ann Driscoll, physical therapist, Mercy Fitzgerald Hospital Balance Program.