When he tells stories of patients who have lost their sense of balance, Jared Browning talks about how the person's entire life is altered.

"Falls, physical and emotional health, economics, vocational issues, they're all part of balance. It can affect people in all those ways. They can't go to work. Some vertigo is so violent a person can't get out of bed, sometimes for several days at a time. They can't hold a job or take care of the family or just be with the family. Some balance problems can be very debilitating," says Browning, a certified clinical audiologist at Rocky Mountain Hearing and Balance in Salt Lake City.

Balance problems can hit at any age, although they're particularly common among senior citizens. The National Institutes of Health says most individuals over 70 experience dizziness and imbalance. And one-third of people 65 to 75 say the condition degrades their quality of life.

The NIH also reports that balance-related falls cause more than half of the accidental deaths among the elderly. About 40 percent of people over 65 fall each year — more than 13 million falls a year — at a cost of at least $20 billion. At least 1,600 senior citizens die as a direct or indirect result of falls.

The culprit can be well-hidden and even unexpected. Inner ear disorders are often to blame, as are vision problems. Medication can affect balance. So can stroke — including little, previously undiagnosed strokes with a cumulative effect. Weakness in part of the body, orthopedic problems, vascular or central nervous system disorders can result in imbalance. Balance is frequently one of the deficits for people with degenerative diseases like Alzheimer's and Parkinson's. Alcohol and brain atrophy can create discoordination. So can heart attack and fatigue.

There is some component of balance impairment with most strokes, says Dr. Elaine Skalabrin, director of Neurology, Critical Care and Stroke at University Hospital. "People think of stroke as being one side of the body. When someone is over age 60 and has sudden onset of balance problems — listing — they should think stroke is a possibility."

Small strokes, called small vessel disease, cause gradual onset of balance impairment. It's usually not detected, though, until it's severe enough to cause a fall, she says. Controlling blood pressure and diabetes and quitting smoking all slow the progression and prolong independence.

"Sudden onset" is key to recognizing stroke. Sudden weakness or numbness on one side or inability to speak or understand, or vision loss or loss of balance or any combination indicates possible stroke. "If it's a possibility, get to the hospital and let the professionals figure it out. If it's a false alarm, that's wonderful. I hope it is. If it is a stroke, the sooner you get help, the more effective treatment will be."