Hearing, Vision and Falls: Two Senses in Your Balance System
A three-year controlled trial just measured what happens when you fix one of them. The real number is smaller than the one making the rounds online — and that gap is the most useful part of this issue.
27% FEWER FALLS — 977 adults, ages 70–84, randomly assigned to hearing treatment or not, tracked for 3 years. This is the trial number — not the marketing number.
Issue 15 covered balance as a nervous-system skill — reaction time, ankle strength, how fast you catch yourself. This article is about the two inputs that feed that system before it ever gets a chance to react: what you can see, and what you can hear. Three papers below. The second is a real randomized trial. The third is the bigger, flashier number you've probably seen in a headline somewhere — and it's here specifically so you can see why I didn't lead with it.
This wasn't a frail, sedentary group. That's what makes it count.
Journal of the American Medical Directors Association, 2024
The DO-HEALTH trial followed 2,131 adults, average age 74.9, for three years. This wasn't a nursing-home population — it was screened specifically for people who were healthy, independent and active, which describes most active older adults.
Worse vision at the start of the trial predicted 22% more falls of every kind over the next three years (adjusted incidence rate ratio 1.22, 95% CI 1.07–1.38, p=.003) and 20% more falls that caused an injury (aIRR 1.20, 95% CI 1.05–1.37, p=.007). This held after accounting for age, sex and other health factors.
The authors' own words matter here: the effect showed up “even in generally healthy and active older adults.” This isn't a warning aimed at people who are already frail. It's aimed at people who feel fine.
The trial that actually randomized people to hearing aids
The Lancet Public Health, June 2025
This is a secondary analysis of ACHIEVE, a real randomized controlled trial. 977 adults aged 70–84 with hearing loss were assigned by coin-flip to either a full hearing intervention — audiologist visits, bilateral hearing aids, ongoing support — or a health-education control that did not treat their hearing. Both groups were tracked for three years.
The hearing-intervention group averaged 1.45 falls per person (95% CI 1.28–1.61) versus 1.98 in the control group (95% CI 1.82–2.15) — a difference of −0.54 falls (95% CI −0.77 to −0.31), which works out to 27% fewer falls. Injurious falls dropped too: 0.49 versus 0.81 per person (difference −0.33, 95% CI −0.49 to −0.17).
The researchers' own explanation is honest about what they don't know: better hearing may free up attention that would otherwise go toward straining to listen, leaving more of it available for balance and movement. The lead investigator called it “the first study of its kind” and said outright that more research is needed before treating this as settled.
The number I didn't put in the headline
Journal of the American Geriatrics Society, 2023
A separate, earlier study — the one behind most of the hearing-aid-and-falls headlines you may have seen — found hearing aid wearers had roughly 50–60% lower odds of a fall than non-wearers, with an even bigger gap among people wearing them at least 4 hours a day.
That's a real, peer-reviewed, published number. It's also a cross-sectional, observational study: it compared people who already chose to wear their hearing aids consistently against people who didn't, at a single point in time. The study's own lead author said it plainly in a later interview: “we don't know any sort of causality yet.” People who wear their hearing aids might simply be healthier, more socially active and more engaged with their own care in the first place — and that alone could produce a gap this size with the hearing aids doing nothing at all.
50–60% is a better headline than 27%. It is not a better number. The 27% came from an actual coin-flip trial; the 50–60% came from comparing two different kinds of people. I used the smaller one.
Matt's take
Read this part first if you've had a recent fall, or if anything about your balance feels different lately. New dizziness, new unsteadiness, ringing in the ears, or a fall that came out of nowhere is a medical question before it's a training question — it could be your inner ear, your blood pressure, a medication interaction, or something else entirely, and I genuinely cannot tell the difference from an article. See your physician, your audiologist or your ENT first. Nobody should stop training because of this issue, and nobody should try to train through new symptoms without a diagnosis either.
The honest bit, up front: I could have opened this newsletter with “hearing aids cut your fall risk in half” and it would have been a stronger hook. I didn't, because that number comes from a study that can't tell you whether the hearing aids did it or whether the kind of person who wears their hearing aids consistently was already at lower risk for other reasons. The real trial — people randomly assigned, not self-selected — found a smaller, still-real 27%. Smaller and true beats bigger and unproven.
If you're training at 5:30 or 6:30am and sitting at a desk the rest of the day: none of this is about your eyes or ears failing any time soon. It's about the other two legs of the balance system — your inner ear and what your joints and muscles tell your brain about where you are in space — getting almost no challenge from a day that's mostly flat floors and a chair. Single-leg work, balance holds where you turn your head instead of staring at a fixed point, and just standing on uneven ground occasionally all train the two systems you still fully control. Do that now and the two you don't fully control — vision and hearing, which drift with age no matter what you do — matter less later.
If you're managing a real condition — joint replacement, cardiac history, a recent fall, post-rehab: this one is simple and I'm not going to dress it up. If you have glasses or hearing aids prescribed to you, wear them, including around the house, including getting up at night in the dark, which is exactly when a small vision or hearing gap turns into a fall. If it's been over a year since your last eye exam or hearing check, book it — not because your eyes or ears are necessarily worse, but because catching a small change early is the entire point of study one. Do not stop wearing a prescribed device to “get used to functioning without it.” That instinct runs backwards on fall risk.
I'm a strength coach, not a physician, an audiologist or an ophthalmologist. Nothing here replaces your annual eye exam, your hearing check, or a conversation with your doctor about a fall, dizziness or new symptom — it sits alongside those, not in place of them.
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This article first ran in the Forged Home Fitness weekly newsletter. It is general fitness education, not medical advice, and does not replace your physician.
