Fall Risk in Older Adults: Medications That Increase Injury Potential

Every year, one in three adults over 65 falls. For many, it’s not just a stumble-it’s a broken hip, a hospital stay, or worse. And while poor lighting or slippery floors get blamed, the real culprit is often hidden in the medicine cabinet. Many common prescriptions, even those taken for years without issue, can quietly steal balance, slow reflexes, and turn a simple step into a life-changing event.

What Medications Are Most Dangerous?

It’s not just one drug. It’s a group. The American Geriatrics Society calls them fall risk-increasing drugs (FRIDs). Nine classes stand out, each with its own way of tipping the scales toward a fall.

Antidepressants top the list. Both tricyclics (like amitriptyline) and SSRIs (like sertraline or fluoxetine) can cause dizziness, low blood pressure, and slowed reaction times. A 2023 Mayo Clinic analysis found they carry the strongest link to falls among all medication classes. Many older adults take them for depression or even chronic pain, not realizing their balance is being affected.

Benzodiazepines-drugs like diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax)-are another major concern. These are often prescribed for anxiety or insomnia, but they linger in the body, especially in older adults. Their sedative effects don’t just help you sleep-they make you groggy the next morning, even if you feel fine. The American Geriatrics Society says they increase fall risk by 50%. Long-term use? That’s a recipe for disaster.

Sedative-hypnotics like zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata) are marketed as safer alternatives to benzodiazepines. But they’re not. The CDC’s STEADI program warns these drugs can trigger complex sleep behaviors-walking, eating, even driving-without full awareness. One 78-year-old woman in Wisconsin fell three times in two months after starting Ambien. Her third fall broke her hip. She didn’t connect the dots until her pharmacist asked about her sleep meds.

Opioids-even low-dose ones like codeine or tramadol-can make you dizzy and confused. High-dose opioids? That’s an 80% higher fall risk, according to a 2023 JAMA Health Forum study. Pain is real. But if you’re taking opioids for arthritis or back pain, ask: Is this the only way? Are there safer alternatives?

Antipsychotics like haloperidol or risperidone are sometimes prescribed off-label for agitation or dementia. First-generation versions carry a 40% higher fall risk than newer ones. But even the newer ones aren’t risk-free. They can cause muscle stiffness, slowed movement, and orthostatic hypotension-when your blood pressure drops too fast standing up.

Diuretics and antihypertensives are meant to lower blood pressure. But if they drop it too low, especially when standing, you can feel lightheaded or faint. This is called orthostatic hypotension. It’s not rare-it’s common. A 2017 CDC report found nearly half of older adults on these drugs experience it at least once a week.

NSAIDs like ibuprofen or naproxen are over-the-counter, but they’re not harmless. They can interfere with blood pressure control and cause fluid shifts that lead to dizziness. Studies show they increase fall risk by 25%.

Anticholinergics-used for overactive bladder, COPD, or even allergies-dry out the mouth, blur vision, and cause confusion. Medications like oxybutynin or diphenhydramine (Benadryl) are often taken without thinking. But they’re among the most dangerous for balance. One study found 65% of older adults didn’t realize their allergy meds could make them fall.

Why Do These Drugs Affect Balance?

It’s not magic. It’s physiology. As we age, our bodies change. Liver and kidney function slow. Fat increases, muscle mass declines. Drugs stay in the system longer. The brain’s ability to process signals from the inner ear, eyes, and feet weakens. Add a medication that affects the central nervous system, and the system breaks down.

Take a benzodiazepine. It calms the brain. But it also slows the signals that tell your legs to adjust when you step on an uneven sidewalk. A diuretic makes you pee more. That’s good for swelling-but if you stand up too fast, your blood pressure plummets. Your body doesn’t have time to react. Your brain says, “Stand up.” Your body says, “Nope.” And you’re on the floor.

And here’s the cruel part: most people don’t feel it coming. They don’t feel dizzy until after they’ve already fallen. That’s why so many older adults say, “I didn’t even know I was unsteady.”

What’s Being Done About It?

Healthcare systems are waking up. The CDC’s STEADI program-Stopping Elderly Accidents, Deaths & Injuries-is now in over 80% of U.S. primary care clinics. It’s not just a checklist. It’s a shift in thinking.

Doctors are being trained to ask three questions:

1. Are you taking any meds that make you drowsy or dizzy?
2. Have you fallen in the past year?
3. Can we review all your pills-prescription, over-the-counter, and supplements-together?

Pharmacists are stepping up too. A 2023 study showed pharmacist-led medication reviews reduced falls by 22%. They use the “brown bag method”-ask patients to bring every bottle, capsule, and herbal packet to the appointment. That’s how they found the 72-year-old man taking three different sleep aids, plus Benadryl for allergies, plus a muscle relaxant. He didn’t think any of it was connected to his falls. The pharmacist stopped two, switched one, and reduced the dose of the third. Within six weeks, he stopped falling.

Medicare now tracks inappropriate prescribing. Providers who over-prescribe high-risk meds may face lower reimbursements. That’s pushing change.

What Can You Do?

You don’t have to wait for your doctor to bring it up. Here’s what you can do today:

• Make a list. Write down every pill, patch, cream, and supplement you take. Include dosages and times. Don’t forget herbal teas, melatonin, or CBD oils-they can interact too.
• Bring it to your next appointment. Don’t just hand it over. Say: “I’m worried I might be at risk for falls. Can we go through this together?”
• Ask about alternatives. For insomnia, ask about CBT-I (cognitive behavioral therapy for insomnia). It’s as effective as sleep meds-without the risk. For anxiety, ask about SSRIs with lower fall risk or non-drug options like mindfulness or exercise.
• Don’t stop cold turkey. Benzodiazepines and antidepressants can cause withdrawal if stopped suddenly. Work with your provider to taper slowly-usually over 8 to 12 weeks.
• Check for interactions. Use a free tool like the Beers Criteria list from the American Geriatrics Society. Or ask your pharmacist to run a safety check.

It’s Not About Taking Less-It’s About Taking Right

Medications save lives. But they can also take them away-slowly, quietly, through a single fall. The goal isn’t to stop all drugs. It’s to stop the ones that aren’t worth the risk.

One 81-year-old woman in New Zealand stopped her nighttime benzodiazepine after her pharmacist pointed out the fall risk. She started a walking program, used a nightlight, and began a gentle yoga class. She didn’t fall again in 18 months. Her independence? Preserved.

Every pill you take has a purpose. But not every purpose is worth the cost. Ask the question. Review the list. Protect your balance. Because falling isn’t just an accident-it’s often a warning sign that something in your medicine cabinet needs to change.