I agree that not all “older adults” are the same, but at a certain age, falls tend to increase in frequency. Even some really “fit” older folks have falls. For that reason, I appreciate that people that are in the “older adult” category might be outliers as far as fitness levels, but they may still have a higher fall risk.
To be honest, I think that balance exercises are great, but moreso because you have to catch yourself after losing your balance. Just practicing the act of balancing alone isn’t enough. Almost everyone stumbles at some point. However, when I stumble, I have the strength to catch myself before I end up on the floor. In the rare case that a younger person does fall (from a minor stumble), they have stronger bones and more muscle mass to protect their bones.
Taking all of this into consideration, I think that basic strengthening exercises are very important to start with. These help us to achieve improvements in strength and muscle mass. I try to get almost every older adult to squat. This is a very “functional” exercise because it is something they have to do everyday. They will have to squat to use the restroom, get in/out of bed, or even sit down to eat.
From there, I will include any variety of exercises that will cause them to lose their balance. From what I have seen, it seems to be more important to recognize and correct a stumble, rather than avoiding any loss of balance at all. I’ve seen patients (in a rehabilitation setting) that have lost their balance and literally seem to have no perception of it. If you were not to intervene, they would hit the ground before they realized that they have lost their balance. Even though these folks might display good balance most of the time, all it takes is that one time and where they don’t have the ability to stop themselves from falling. Even with perfect balance, someone will eventually lose their balance because of medications, a trip over a rug, improper footwear, ice, or any number of environmental factors.