Fall Risk in Older Adults: Medications That Increase Injury Potential
Nov, 23 2025
Medication Fall Risk Assessment Tool
How Many Fall-Risk Medications Are You Taking?
Select any medications you or a loved one is currently taking to assess fall risk. This tool is based on CDC and AGS research on medication-related falls in older adults.
Select Medications
Check all medications that apply to your situation
Increases risk by up to 60%
Increases risk by 100% (long-term use)
Increases risk by 50-80% (with sleepwalking)
Increases risk by 80% (at high doses)
Increases risk by 50% (muscle stiffness)
Increases risk by 30-50% (orthostatic hypotension)
Increases risk by 20-30% (low blood pressure)
Increases risk by 40% (blurry vision)
Increases risk by 70% (drowsiness)
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:
- Make a list of every medication, including supplements and OTC drugs.
- Ask the doctor: "Could any of these be making me unsteady?" Don’t be afraid to push for an answer.
- Ask about alternatives. "Is there a non-sedating option for my sleep or anxiety?"
- Request a medication review at least once a year.
- 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
Can over-the-counter medications cause falls in older adults?
Yes. Many OTC drugs contain anticholinergics, like diphenhydramine (found in Benadryl, NyQuil, and sleep aids), which cause drowsiness, confusion, and blurred vision. Even cold and allergy pills can increase fall risk. Seniors often don’t realize these aren’t "harmless"-they’re just as risky as prescription drugs.
Are there safer alternatives to benzodiazepines for anxiety or sleep?
Yes. For anxiety, buspirone is a non-sedating option with low fall risk. For sleep, cognitive behavioral therapy for insomnia (CBT-I) is the gold standard-it’s as effective as sleeping pills but without the side effects. Melatonin, in low doses (0.5-1 mg), may help reset sleep cycles without causing dizziness. Always talk to a doctor before switching.
How long does it take for a medication to stop affecting balance after stopping it?
It depends on the drug. Benzodiazepines and antidepressants can take weeks to fully leave the system, especially in older adults. Withdrawal symptoms can mimic fall risk-like dizziness or anxiety-so tapering slowly (over 8-12 weeks) under medical supervision is essential. For short-acting drugs like zolpidem, balance may improve within days after stopping.
Should all older adults stop taking antidepressants?
No. Antidepressants are vital for many seniors with depression. But if they’re taking them for mild symptoms or without regular follow-up, it’s worth reviewing. SSRIs like sertraline are safer than tricyclics, and lower doses often work just as well. The goal isn’t to stop them all-it’s to make sure each one is still necessary and at the right dose.
What role do pharmacists play in preventing medication-related falls?
Pharmacists are key. They review all medications-including OTCs and supplements-and spot dangerous combinations. Studies show pharmacist-led reviews reduce fall risk by 22%. Many pharmacies now offer free medication reviews for seniors. Ask for one. Bring your brown bag.
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