Balance control is a complex skill that requires coordination of peripheral sensorimotor systems and higher-level cognitive input. Ageing is associated with a decline in balance control and consequent increased risk of falling, particularly in challenging situations that require a person to react quickly and appropriately in order to prevent a fall. This reduced balance control may be partly explained by one or more sensorimotor deficits. Recent evidence also suggests the important role of higher order cognitive processing, i.e. executive functioning and attentional resources, in predisposing older people to falls. Impaired executive functioning may reduce the ability of an individual to attend to relevant sensory information required for maintaining balance when walking. The effect of attentional limitation on balance and gait is especially apparent during dual-tasking when motor and cognitive tasks are required to be performed concurrently (e.g., walking when talking) or when walking in busy or complex environments (e.g., when walking in crowded areas). Overall, there is ample evidence indicating that balance control utilizes higher cognitive processing, and impaired executive function and attention may lead to increased risk of falling.Balance requires the structural and functional integrity of neural networks to process sensorimotor input. Structural changes of the brain occur with ageing, particularly in the prefrontal area that has been associated with executive function. Both brain grey matter and white matter are essential for fast and efficient operation of the neural networks, but it is primarily white matter that reflects the integrity of the connectivity of brain systems. Changes in white matter have been associated with several fall risk factors including impaired executive functioning, poor balance and slow gait, and also with falls themselves. Subcortical infarcts and large volumes of white matter hyperintensities have been associated with an increased risk of multiple falls. Both subcortical infarcts and white matter hyperintensities are commonly found in frontal and subcortical areas and could disrupt the integrity of neural networks including the long descending motor fibers and frontal-subcortical circuits that are important for control of motor and cognitive function. In recent years, advances in brain imaging techniques (e.g. Diffusion Tensor Imaging Tractography) have allowed us to look white matter integrity directly based on the strength and direction of water diffusivity in white matter. Disruption in white matter integrity, especially in the corpus callosum and longitudinal association fibres, has been associated to gait and balance impairments. Compromised white matter integrity leads to impairments in brain connectivity. This may have an important effect on processing speed which in turn impacts both motor and cognitive functions. Further, the ability to process and integrate information from sensory, visual and motor domains – essential for balance and gait – are compromised as a result of white matter damage.Looking at interrelationships between brain imaging and the neuropsychology of risk factors for falls helps to advance our understanding of the mechanisms underpinning physical impairments in older people. Poorer performance in measures of executive and sensorimotor function may reflect early brain structural changes, which could impact on physical and cognitive function, falls and fractures in older people. Interventions targeting physical fall risk factors along with strategies to prevent or slow the development of small vessel disease may reduce the risk of falls.