A cross-sectional study in Brazil included 170 adults aged 60 years and older attending a university clinic. Drug burden according to DBI index (none, low or high), postural balance as measured by center of pressure (COP) area and swing speed on the force platform, as well as recent falls were examined. Higher DBI (low or high) was significantly associated with worse balance, larger COP area, and higher swing speed (p < 0.0001). In multivariable analysis, female gender was protective against balance deficit (OR = 0.35, 95% CI: 0.15–0.78, p = 0.01), with DBI showing a dose effect (low: OR = 7.29; high: OR = 30.66). Higher DBI was correlated with recent falls (χ2 trend = 5.91, p = 0.0001). ROC analysis of the COP region achieved an AUC of 0.75 with a cut-off value of 0.5 and an accuracy of 72.9%. The study confirms the DBI as a practical tool for identifying older persons at risk of impaired balance and falls.