Prescription Pitfalls: How Medications Can Increase Fall Risk
While medications can be life-saving, certain types, especially when prescribed to older adults, can unknowingly raise the risk of falls. Understanding these drugs and their effects can help individuals and caregivers better assess fall risk and seek safer alternatives.
Falls remain the leading cause of injury among adults aged 65 and older in the U.S. Every year, more than one in four older adults reports a fall. That makes fall prevention a critical health goal.
Certain medications, often termed Fall Risk-Increasing Drugs (FRIDs), can affect balance, cognition, blood pressure, or muscle control. Common categories include:
Sedative-hypnotics (benzodiazepines and “Z-drugs”): Used for insomnia or anxiety (e.g., lorazepam, zolpidem), they cause drowsiness, impaired coordination, and confusion. In older adults, they sharply raise fall and hip fracture risk (Mayo Clinic).
Antidepressants: Prescribed for depression and anxiety, some (like tricyclics and SSRIs) can cause dizziness, sedation, or blood pressure changes.
Antipsychotics: Used for conditions like schizophrenia or bipolar disorder, they may cause dizziness or orthostatic hypotension.
Antiepileptics (seizure medications): Drugs such as gabapentin can cause drowsiness and unsteadiness, raising fall risk.
Muscle relaxants: Commonly prescribed for muscle spasms or back pain, they can impair coordination.
NSAIDs (nonsteroidal anti-inflammatory drugs): Used for arthritis or pain relief, they may contribute to balance issues indirectly by affecting blood pressure.
Anticholinergics: Found in medications for bladder issues, allergies, or motion sickness; they can cause confusion and blurred vision.
Polypharmacy (taking many medications): The more drugs someone takes, the greater the fall risk—especially when five or more are involved (NCOA).
The Overlooked Factor: Medication Mismanagement
Even when medications are appropriate, how they are taken can make a big difference in fall risk. Mismanagement—whether from missed doses, double doses, or mixing drugs incorrectly—can heighten side effects and confusion.
Some common mismanagement issues include:
Complex schedules: Many older adults take multiple prescriptions at different times of day. Missing or doubling up on a dose of blood pressure medication, for example, can cause dizziness or fainting.
Mixing medications with alcohol: Even small amounts of alcohol can amplify sedating effects of medications for sleep, anxiety, or pain, increasing unsteadiness.
Poor labeling or vision problems: Difficulty reading labels or pill bottles may lead to accidental misuse.
Outdated or duplicate prescriptions: Sometimes medications from different doctors overlap, or older prescriptions are never discontinued, creating unnecessary interactions.
Lack of communication: Patients may not realize over-the-counter medications, supplements, or herbal remedies can interact with prescriptions in ways that increase fall risk.
The numbers tell the story: On average, adults 65+ take four or more prescription medications daily, and medication mismanagement is a leading contributor to preventable hospitalizations in older adults.
The good news is that mismanagement is preventable. Tools like weekly pill organizers, automatic pill dispensers, and medication review appointments with pharmacists can significantly reduce the risks.
Here are a few suggestions for what you can do:
Annual medication reviews with a healthcare provider are vital to assess necessity, dosages, and safer alternatives.
Simplify routines: Using blister packs or reminder apps can reduce errors.
Add technology: I know, I know, older people and technology are not always a great mix, but there are great tools available that can make it easier to manage medicines — for example, caps that show when a pill bottle was last opened.
Address modifiable risk factors: Improve home safety, ensure good lighting and footwear, and add strength and balance exercises to daily life.
Medications serve vital roles—from managing pain, mood, seizures, and bladder control, to promoting sleep. Yet, they can inadvertently impair balance, cognition, or blood pressure—especially in older adults—boosting the chance of falls. When combined with medication mismanagement, the risks rise even higher.
With more than 37.3 million falls that are severe enough to require medical attention occur each year globally, understanding both the effects of medications and how they’re taken is critical for safety and independence. By staying informed, asking the right questions, and managing prescriptions carefully, older adults and caregivers can take meaningful steps toward fall prevention.
This article is for educational purposes only and is not medical advice. Always consult your healthcare provider before making changes to your medications or treatment.
