Poor balance, the inability to control the position of the body, is a significant contributor to of falls in older people. Balance requires the complex integration of sensory information regarding the position of the body relative to the surroundings, and the ability to generate appropriate motor responses to control body movement. The sensory component calls upon contributions from vision, peripheral sensation and vestibular sense, while the motor component requires muscle strength, neuromuscular control and reaction time. Linking these two components together are the higher level neurological processes enabling anticipatory mechanisms responsible for planning a movement, and adaptive mechanisms responsible for the ability to react to changing demands of the particular task. With increased age, there is a progressive loss of functioning of sensory, motor and central processing systems and an increased likelihood of falls. Instability and falls in older people can result from impairment in any of these systems. These physiological risk factors have been adapted into assessment tools and have been either directly or indirectly addressed in many successful fall prevention trials. These interventions include: exercise to promote strength and balance, interventions to maximise vision, cognitive training to improve central processing and executive functioning, strategies for reducing hazardous medication use and podiatric interventions to maximise foot and ankle stability. Core themes that have emerged from this research are: (a) falls provide a unique physiological window into brain function, ageing and neurodegeneration, (b) Valuable information about both fall prediction and prevention has literally come from top to toe (c) interventions that maximise physiological function and reduce motor impairment are effective in preventing falls.