Fall Risk in Older Adults: Medications That Increase Injury Potential

Why So Many Older Adults Fall-And What Medications Are to Blame

One in three adults over 65 falls each year. That’s not just a statistic-it’s a real person slipping on a rug, hitting their head, breaking a hip, and losing their independence. And while poor lighting or loose rugs get all the attention, the real culprit is often hiding in plain sight: the medications they’re taking. Many older adults don’t realize that the pills they swallow to manage pain, sleep, anxiety, or blood pressure can be quietly stealing their balance.

The Top Medication Classes That Raise Fall Risk

Doctors prescribe these drugs to help people feel better. But for older adults, the side effects can be deadly. Nine major classes of medications are known to increase fall risk, according to research from the American Geriatrics Society and the CDC’s STEADI program.

• Antidepressants-especially tricyclics (like amitriptyline) and SSRIs (like sertraline)-are the most strongly linked to falls. They cause dizziness, low blood pressure, and slowed reaction times. Studies show people taking these drugs are up to 60% more likely to fall than those who aren’t.
• Benzodiazepines-such as Xanax, Valium, and Ativan-are prescribed for anxiety and insomnia. But they make people groggy, unsteady, and confused. Long-term use (beyond two weeks) doubles the risk of falling. Even worse, the effects can linger into the next day.
• Sedative-hypnotics-like Ambien, Lunesta, and Sonata-are marketed as sleep aids. But they disrupt normal sleep cycles and can cause people to get up and walk around while half-asleep. One 78-year-old woman fell three times in two months after starting Ambien-and broke her hip on the third fall.
• Opioids-including oxycodone and hydrocodone-cause dizziness, drowsiness, and poor coordination. The higher the dose, the greater the risk. High-potency opioids can increase fall risk by up to 80%.
• Antipsychotics-used for dementia-related agitation or psychosis-can cause muscle stiffness, tremors, and sudden drops in blood pressure. First-generation antipsychotics like haloperidol are especially dangerous.
• Diuretics and antihypertensives-medications for high blood pressure and fluid retention-can cause orthostatic hypotension. That’s when your blood pressure plummets the moment you stand up. One moment you’re sitting, the next you’re on the floor.
• NSAIDs-like ibuprofen and naproxen-don’t just hurt your stomach. They can lower blood pressure and cause dizziness, especially when taken daily over long periods.
• Anticholinergics-used for overactive bladder, COPD, or allergies-dry out the mouth and eyes, cause blurred vision, and make people feel foggy. Many seniors don’t realize their allergy pills or incontinence meds are part of the problem.
• Muscle relaxants-particularly baclofen-cause intense drowsiness. One study found baclofen increases fall risk by 70% compared to other muscle relaxants.

Why This Problem Is Getting Worse

In 2020, 90% of adults over 65 in the U.S. were taking at least one prescription drug. Nearly half were taking five or more. That’s called polypharmacy-and it’s a ticking time bomb.

Many of these medications were prescribed for conditions that no longer need treatment, or were added without reviewing what’s already being taken. A 2023 JAMA Health Forum study found that 45% of older adults were taking at least one "potentially inappropriate" medication-meaning the risks outweigh the benefits.

And it’s not just prescriptions. Over-the-counter sleep aids, allergy meds, and herbal supplements like valerian root or melatonin can also throw off balance. One CDC survey found that 65% of seniors didn’t know their allergy pills could make them fall.

Who’s Most at Risk-and Why

It’s not just about the drugs. It’s about combinations. Taking two or more of these medications multiplies the risk. Someone on an antidepressant and a benzodiazepine? Their fall risk jumps from 60% to over 150%.

Age itself plays a role. As people get older, their liver and kidneys don’t clear drugs as quickly. That means medications stay in the body longer, increasing side effects. Even a "normal" dose for a 40-year-old can be too much for a 75-year-old.

And then there’s the knowledge gap. A 2023 study in the Journal of Geriatric Physical Therapy found that 63% of older adults taking multiple fall-risk medications had no idea they were at risk. They didn’t ask. Their doctors didn’t explain. So they kept taking them-until they fell.

What Can Be Done? The STEADI Approach

The CDC’s STEADI program gives a clear, practical plan: STOP, SWITCH, REDUCE.

• STOP medications that aren’t needed. For example, if someone’s on a benzodiazepine for anxiety that started five years ago, it’s time to ask: Is this still helping?
• SWITCH to safer alternatives. For insomnia, cognitive behavioral therapy for insomnia (CBT-I) works better than Ambien-and has no fall risk. For anxiety, non-benzodiazepine options like buspirone are much safer.
• REDUCE doses to the lowest effective level. Many seniors take the same dose they did at 50. But their body doesn’t process it the same way anymore.

Pharmacists can be lifesavers here. A pharmacist-led medication review cuts fall risk by 22%. That’s because they see the full picture: prescriptions, OTCs, supplements, even what’s in the medicine cabinet.

The "brown bag method" works wonders: bring every pill, capsule, and bottle to your doctor’s visit. No judgment. Just a clean look at what’s really being taken.

What You Can Do Right Now

If you or someone you care for is over 65 and taking any of these medications:

1. Make a list of every medication, including supplements and OTC drugs.
2. Ask the doctor: "Could any of these be making me unsteady?" Don’t be afraid to push for an answer.
3. Ask about alternatives. "Is there a non-sedating option for my sleep or anxiety?"
4. Request a medication review at least once a year.
5. Watch for signs: dizziness when standing, confusion, blurry vision, or feeling "off" after taking a new pill.

Don’t stop any medication cold turkey. Some drugs, like benzodiazepines, can cause dangerous withdrawal if stopped suddenly. Work with your doctor to taper slowly-over weeks or months.

The Bigger Picture: It’s Not Just About Falls

Falls cost the U.S. healthcare system $50 billion a year. Medication-related falls alone account for $11 billion of that. But money isn’t the real cost. It’s the loss of independence. The fear of walking alone. The move to a nursing home. The grief of a family who lost someone to a fall that could have been prevented.

Research shows that addressing medication-related fall risks could prevent nearly a quarter of all falls in older adults. That’s millions of people who could stay living safely at home.

New tools are emerging too. AI systems can now scan medication lists and flag dangerous combinations with 89% accuracy. The National Institute on Aging is funding $15 million in research to improve deprescribing protocols. And Medicare is starting to penalize doctors who overprescribe high-risk drugs.

This isn’t just a medical issue. It’s a human one. And it’s fixable.

Frequently Asked Questions