Medications That Increase Fall Risk in Older Adults: What You Need to Know

Why Falls Are More Dangerous Than You Think

One in three adults over 65 falls each year. That’s not just a stumble-it’s a life-changing event. A broken hip, a head injury, or even the fear of falling again can lead to hospital stays, nursing home placement, or worse. And here’s the hard truth: many of these falls aren’t caused by slippery floors or poor lighting. They’re caused by medications.

Between 2017 and 2020, nearly 90% of older adults in the U.S. were taking at least one prescription drug. Over 40% were taking five or more. And nearly half of those were on medications known to increase fall risk. The CDC calls this an epidemic. The numbers don’t lie: about 36,000 older Americans die from falls each year, and medication use is a major contributor.

The Top 9 Medication Classes That Increase Fall Risk

Not all drugs are created equal when it comes to balance and safety. Nine classes of medications have been consistently linked to higher fall rates in older adults. Some are obvious-like sleep aids. Others are surprising-like common painkillers.

• Antidepressants-especially tricyclics (like amitriptyline) and SSRIs (like sertraline)-are the strongest predictors of falls. They affect balance, reaction time, and can cause dizziness. Studies show people on these drugs are up to 60% more likely to fall.
• Benzodiazepines-drugs like diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax)-are prescribed for anxiety and sleep. But they slow brain function, blur vision, and cause next-day grogginess. Long-term use (beyond two weeks) triples fall risk.
• Sedative-hypnotics-including zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata)-are marketed as safer than benzodiazepines. But they still cause confusion, sleepwalking, and poor coordination. The CDC says these are among the most dangerous for seniors.
• Antipsychotics-used for dementia-related agitation or psychosis-can cause stiffness, slow movement, and tremors. First-generation types like haloperidol carry the highest risk, increasing falls by 40%.
• Opioids-even low-dose painkillers like codeine or tramadol can make you dizzy. High-dose opioids like oxycodone or fentanyl raise fall risk by 80%. Many seniors don’t realize pain meds can make them unsteady.
• Diuretics-water pills like furosemide (Lasix)-cause frequent urination and can lead to sudden drops in blood pressure when standing up. This is called orthostatic hypotension, and it’s a silent fall trigger.
• Antihypertensives-blood pressure meds like amlodipine or lisinopril-can lower pressure too much, especially when standing. The CDC’s STEADI program says these are among the most common culprits in medication-related falls.
• NSAIDs-ibuprofen, naproxen, and others-don’t just hurt your stomach. They can raise blood pressure or cause fluid shifts that lead to dizziness. Studies show a 25% higher fall risk in users.
• Anticholinergics-used for overactive bladder, COPD, or allergies-cause dry mouth, blurred vision, and confusion. Common ones include diphenhydramine (Benadryl), oxybutynin, and tolterodine. Many seniors don’t know these are in their cold medicines.

Why Some Medications Are Worse Than Others

Not all drugs in these classes are equally risky. Longer-acting versions stick around longer in the body, making them more dangerous. For example:

• Diazepam (Valium) lasts up to 48 hours-far longer than lorazepam (Ativan), which clears in 10-20 hours.
• Tricyclic antidepressants (TCAs) like amitriptyline are far riskier than newer SSRIs like escitalopram.
• Baclofen, a muscle relaxant, increases fall risk by 70%-more than other muscle relaxants like cyclobenzaprine.
• First-generation antipsychotics like haloperidol are far more likely to cause falls than newer ones like quetiapine.

The American Geriatrics Society’s Beers Criteria, updated in 2023, clearly labels which drugs are most dangerous. But here’s the problem: many doctors still prescribe them because they’re cheap, familiar, or easy to write.

What Patients Don’t Know (And Why It Matters)

A 2023 study found that 63% of older adults taking multiple fall-risk medications had no idea their drugs could make them unsteady. They think dizziness is just part of aging. It’s not.

Real stories show how dangerous this gap is:

• A 78-year-old woman in Ohio 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.
• A 72-year-old man in Florida took Xanax for anxiety for six months. He started bumping into doorframes and tripping over rugs. He installed grab bars-but didn’t tell his doctor until after the third fall.
• A woman in Texas was taking Benadryl every night for sleep. She didn’t realize it was an anticholinergic. After a fall that fractured her pelvis, her pharmacist pointed out the link.

Only 15% of older adults who attribute falls to medications ever discuss it with their doctor. That’s not negligence-it’s lack of awareness. Most assume their doctor already knows what they’re taking.

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

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

1. STOP-Ask your doctor: ‘Is this medication still necessary?’ Many seniors take drugs for conditions that no longer exist. A sleep aid prescribed for temporary stress shouldn’t be taken for five years.
2. SWITCH-Ask if there’s a safer alternative. For anxiety, CBT (cognitive behavioral therapy) is as effective as Xanax-with zero fall risk. For insomnia, CBT-I (cognitive behavioral therapy for insomnia) works in 70-80% of cases and has no side effects.
3. REDUCE-Never stop a drug cold turkey. Work with your doctor to taper slowly. Benzodiazepines, for example, should be reduced over 8-12 weeks to avoid seizures or rebound anxiety.

Bring all your medications to every appointment-prescriptions, over-the-counter pills, vitamins, and herbal supplements. Use the ‘brown bag method’: dump everything out on the table. Pharmacists can spot dangerous combinations you might miss.

Who Should Be Involved in Your Medication Review

You don’t have to do this alone.

• Your primary care doctor-should review your meds at least once a year, especially if you’re 65+.
• Your pharmacist-they see all your prescriptions. Pharmacist-led reviews reduce fall risk by 22%.
• A geriatrician-if you’re on five or more meds, see one. Geriatricians specialize in aging and polypharmacy.
• A physical therapist-they can assess your balance and suggest exercises to improve stability, even while you’re on meds.

Medicare Part D now tracks inappropriate prescribing. Doctors who overprescribe fall-risk drugs may face lower reimbursements. That’s changing how care is delivered.

The Bigger Picture: Why This Is Getting Worse

Falls aren’t just a medical issue-they’re a systemic failure. The U.S. spends $50 billion a year on fall-related injuries. $11 billion of that is from medication-related falls. Yet, most seniors aren’t warned.

Pharmaceutical companies are developing newer, safer alternatives-like non-benzodiazepine anxiolytics. But they cost $450 a month. Generic benzodiazepines? $30. Cost drives prescribing, not safety.

AI tools are now being tested to flag dangerous drug combinations with 89% accuracy. The National Institute on Aging is funding $15 million in research on deprescribing protocols. Change is coming-but it’s slow.

The real solution? Awareness. Education. Courage to ask: ‘Is this drug helping me-or hurting me?’

Questions to Ask Your Doctor

Don’t wait for a fall to start this conversation. Bring these questions to your next appointment:

• Which of my medications could make me unsteady or dizzy?
• Can any of these be stopped or lowered in dose?
• Is there a non-drug option for my condition-for example, therapy instead of a sleep pill?
• Am I taking any over-the-counter drugs or supplements that could increase my fall risk?
• Could we do a full medication review this year?

If your doctor dismisses your concerns, get a second opinion. Your balance matters more than your prescription pad.