Balance problems in patients with advanced age is extremely common, often greater than 20-30% of this population of this age group. The downstream effect of this problem leads to significant morbidity and mortality. In this instructional course we discuss the common factors contributing to this problem and the impact balance problems makes on this population. Polypharmacy is a common issue in the aged population and can be a major contributing factor to poor balance function. We discuss how to recognize polypharmacy and how we can take an active role in mitigating its effects. Finally, the role of vestibular therapy will be explored and how it can be a useful tool in the armamentarium for clinicians treating this challenging problem.