Disequilibrium, or imbalance, is a type of dizziness typically described as a feeling of unsteadiness when standing or walking that is not present while sitting or lying down. Patients with disequilibrium often complain of vertigo, lightheadedness, or a similar ‘head’ sensation as the main symptom, but disequilibrium also occurs in isolation. The first step in determining the cause is to define exactly what the patient is experiencing, and any associated symptoms. The complaint of imbalance is very common among older people. Since the population is quickly aging, we can only expect the number of patients presenting with it to increase. As a result of this frequent presentation and the many potential causes of the symptom, some authors even argue that disequilibrium should be considered part of a geriatric syndrome. Further complicating the evaluation is the fact that most elderly people have at least one chronic disease and are taking several medications, factors that could contribute to, or even cause, disequilibrium. Signs on examination that could indicate early features of neurodegenerative disorders are also common in older people. Because dizziness and imbalance have a strong association with falls, searching for a reversible disorder and directing attention to fall-prevention strategies are paramount. Falls themselves are a major source of morbidity and mortality in the elderly population.