Fall Risk in Older Adults: Medications That Increase Injury Potential

Every year, nearly one in three adults over 65 falls. For many, it’s not just a stumble-it’s a fracture, a hospital stay, or worse. And while poor balance, dim lighting, or loose rugs get all the attention, one of the biggest hidden dangers is something many seniors are taking every day: their medications.

Medications That Make Falls More Likely

It’s easy to assume that if a doctor prescribed it, it’s safe. But the truth is, some common drugs-especially when taken together-can turn a steady walk into a dangerous gamble. The American Geriatrics Society calls these fall risk-increasing drugs (FRIDs), and they’re behind up to 93% of fall-related injuries in older adults, according to a major 2013 meta-analysis.

Here are the top drug classes linked to higher fall risk:

• Antidepressants - Both tricyclics (like amitriptyline) and SSRIs (like sertraline) can cause dizziness, low blood pressure, and slowed reaction time. Studies show they have the strongest link to falls among all medication classes.
• Benzodiazepines - Drugs like diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax) are prescribed for anxiety or sleep, but they linger in the body, causing daytime drowsiness and poor coordination. Long-term use-even for just a few months-can double fall risk.
• Sedative-hypnotics - Zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata) may help you fall asleep, but they can leave you groggy, confused, or even sleepwalking. The CDC warns these drugs are especially dangerous because people often don’t feel fully awake when they get up at night.
• Antipsychotics - Used for dementia-related behaviors, these drugs (like haloperidol or risperidone) can cause stiffness, tremors, and sudden drops in blood pressure. First-generation types carry the highest risk.
• Opioids - Painkillers like oxycodone or hydrocodone cause dizziness, confusion, and slow reflexes. The higher the dose, the greater the risk. High-potency opioids can increase fall risk by up to 80%.
• Diuretics and antihypertensives - Water pills and blood pressure meds can cause sudden drops in blood pressure when standing up, leading to lightheadedness or fainting. This is called orthostatic hypotension.
• NSAIDs - Ibuprofen and naproxen aren’t just for pain-they can interfere with blood pressure control and kidney function, indirectly increasing fall risk.
• Anticholinergics - Found in many over-the-counter sleep aids, bladder medications, and allergy pills, these drugs cause dry mouth, blurred vision, and mental fogginess. Many seniors don’t realize their daily allergy pill could be making them unsteady.
• Muscle relaxants - Baclofen, in particular, is strongly linked to falls. It causes deep sedation and weakens coordination more than other muscle relaxants.

Why This Is Worse Than You Think

Most people don’t take just one of these drugs. The average older adult in the U.S. takes four prescription medications. Nearly half take five or more. And when you stack them-say, an antidepressant, a benzodiazepine, and a diuretic-the risk doesn’t just add up. It multiplies.

A 2023 JAMA Health Forum study found that 45% of older adults were taking at least one medication classified as “potentially inappropriate” for their age group. Many of these were prescribed years ago and never re-evaluated. People assume if it worked before, it’s still fine. But aging changes how your body processes drugs. Your liver and kidneys slow down. Your brain becomes more sensitive. What was safe at 70 can be dangerous at 80.

And here’s the quiet crisis: most seniors don’t know they’re at risk. A 2023 study in the Journal of Geriatric Physical Therapy found that 63% of older adults taking multiple fall-risk drugs had no idea their meds could make them fall. Only 15% ever brought it up with their doctor.

Real Stories Behind the Numbers

On Reddit, a caregiver named Jane shared that her 78-year-old mother fell three times in two months after starting Ambien. The third fall broke her hip. She needed surgery and never walked without a cane again.

Another user on GoodRx, age 72, said after taking Xanax for anxiety for six months, she became so unsteady she installed grab bars in every room. “I didn’t think the anxiety medicine was the problem,” she wrote. “I thought I was just getting older.”

These aren’t rare cases. The CDC estimates that nearly 36,000 older Americans die each year from falls-and many of those deaths are tied to medications. The financial toll is just as heavy: medication-related falls cost the U.S. healthcare system $11 billion annually.

What You Can Do: The STOP, SWITCH, REDUCE Plan

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

• STOP - Ask your doctor: “Is this medication still necessary?” Many prescriptions are never reviewed after they’re started. A 2024 study showed that 40% of seniors are still taking medications they no longer need.
• SWITCH - If a drug is risky, ask if there’s a safer alternative. For insomnia, cognitive behavioral therapy (CBT-I) works better than sleep pills and has no fall risk. For anxiety, non-benzodiazepine options like buspirone carry less risk.
• REDUCE - Sometimes, lowering the dose helps. For benzodiazepines, tapering slowly over 8-12 weeks reduces withdrawal and keeps you safer. Never stop cold turkey.

Bring all your meds to every appointment-prescription, over-the-counter, vitamins, and herbal supplements. Use the “brown bag method.” Many people don’t realize their daily antihistamine or sleep aid is part of the problem.

Who Should Be Involved

This isn’t just your doctor’s job. Pharmacists are key. A CDC study found that when pharmacists lead medication reviews, fall risk drops by 22%. They catch interactions doctors miss. They know which drugs are outdated or dangerous for seniors.

Geriatricians specialize in this. If your doctor doesn’t regularly treat older adults, consider asking for a referral. The American Geriatrics Society reports a 35% increase in geriatric consultations between 2018 and 2023-more people are realizing this is a solvable problem.

What’s Changing for the Better

Medicare Part D now penalizes doctors who overprescribe high-risk meds to seniors. That’s pushing change at the system level.

New tools are emerging, too. AI-powered systems can now scan a patient’s full medication list and flag dangerous combinations with 89% accuracy. In 2024, the American Geriatrics Society updated its Beers Criteria to include newer drugs and their fall risks. And the National Institute on Aging has invested $15 million into research on safe ways to stop unnecessary medications.

Some safer alternatives are available-like non-benzodiazepine anxiolytics-but they’re expensive. A month’s supply can cost $450, compared to $30 for a generic benzodiazepine. That’s a barrier, but safety should come before cost when balance and independence are on the line.

Don’t Wait for a Fall

Falls aren’t accidents. They’re warning signs. If you or someone you love is over 65 and taking any of these medications, don’t assume it’s normal to feel dizzy or unsteady. That’s not aging-that’s a side effect.

Start the conversation. Ask your doctor: “Could any of my medications be making me more likely to fall?” Bring your brown bag. Get a pharmacist’s opinion. Consider a medication review.

It’s not about cutting all meds. It’s about keeping only what’s truly necessary-and replacing the risky ones with safer options. That’s how you protect not just your body, but your freedom to live independently, safely, and without fear.