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

Every year, one in three adults over 65 falls. Many of these falls aren’t bad luck-they’re caused by medications they’re taking every day. It’s not just about being unsteady on your feet. It’s about what’s in your medicine cabinet. Some common prescriptions, even ones prescribed for years, can quietly rob you of your balance, your confidence, and your independence.

Why Medications Are a Silent Threat

Falls aren’t just bruises or bumps. For older adults, a fall can mean a broken hip, a long hospital stay, or even death. In the U.S., over 36,000 older adults died from falls in 2023. And research shows that in 65% to 93% of those cases, the person was taking at least one medication known to increase fall risk.

These aren’t rare or experimental drugs. They’re the ones doctors prescribe regularly-for sleep, anxiety, blood pressure, pain, and depression. The problem isn’t always the drug itself. It’s how the body changes with age. Older adults process medications differently. Their kidneys and liver don’t clear drugs as fast. Their nervous system becomes more sensitive. A dose that was fine at 50 can become dangerous at 75.

The Top 9 Medication Classes That Raise Fall Risk

Not all medications are created equal when it comes to falls. Some are far more dangerous than others. Here are the nine main classes linked to higher fall risk, ranked by how strongly they’re tied to injuries:

• Antidepressants - These have the strongest link to falls. Both tricyclics (like amitriptyline) and SSRIs (like sertraline or fluoxetine) can cause dizziness, low blood pressure, and slowed reactions. A 2023 Mayo Clinic review found that older adults on antidepressants were up to 50% more likely to fall than those not taking them.
• Benzodiazepines - Drugs like diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax) are prescribed for anxiety and sleep. But they cause drowsiness, confusion, and poor coordination. Long-term use (more than two weeks) is especially risky. The American Geriatrics Society says these drugs should be avoided in older adults whenever possible.
• Sedative-Hypnotics - Sleep aids like zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata) don’t just help you sleep-they can make you sleepwalk, act confused, or fall the next morning. The CDC calls them “high-risk” because their effects linger into daylight hours.
• Antipsychotics - Used for dementia-related agitation, drugs like haloperidol and risperidone increase fall risk by 40%. First-generation antipsychotics are worse than newer ones, but none are safe for long-term use in older adults.
• Muscle Relaxants - Baclofen, cyclobenzaprine, and methocarbamol can make you feel drugged. Baclofen, in particular, has been linked to a 70% higher fall risk. These are often prescribed for back pain, but the trade-off isn’t worth it.
• Opioids - Painkillers like oxycodone, hydrocodone, and tramadol cause dizziness, slow reflexes, and impaired thinking. The higher the dose, the higher the risk. High-potency opioids can increase fall risk by 80% compared to low-dose options.
• NSAIDs - Common pain relievers like ibuprofen and naproxen can lower blood pressure, especially when standing up. This sudden drop-called orthostatic hypotension-is a major cause of falls. NSAIDs also interact badly with blood pressure meds.
• Diuretics - Water pills like furosemide (Lasix) help with fluid retention but can cause dehydration and low blood pressure. A sudden trip to the bathroom at night can become a fall risk if you’re dizzy or weak.
• Anticholinergics - Found in many over-the-counter sleep aids, allergy meds, and bladder pills (like diphenhydramine or oxybutynin), these drugs block a key brain chemical. The result? Blurry vision, confusion, dry mouth, and poor balance. Many older adults don’t realize their nighttime allergy pill is putting them at risk.

It’s Not Just Prescription Drugs

Many people think only prescriptions matter. But over-the-counter meds can be just as dangerous. Antihistamines like Benadryl, sleep aids like Unisom, and even some herbal supplements like valerian root can cause drowsiness and disorientation. A 2023 study found that 65% of older adults didn’t know their allergy or sleep meds could make them fall.

One woman in Bristol, 76, fell twice in one month after starting a new OTC sleep aid. She didn’t tell her doctor because she thought it was “just a pill.” Her pharmacist later flagged it as a high-risk anticholinergic. She switched to a non-sedating option and hasn’t fallen since.

How Doctors Miss the Signs

Doctors aren’t ignoring the risk. But they’re often overwhelmed. A typical visit lasts 15 minutes. Medication lists are long. Patients don’t always mention what they’re taking-especially if they think it’s harmless. Only 15% of older adults who’ve fallen talk to their doctor about it.

Many patients take meds for years without review. A 2023 study showed 63% of older adults on multiple fall-risk drugs didn’t know they were at risk. That’s not their fault. It’s a system failure.

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

The CDC’s STEADI program gives a clear, simple plan:

1. STOP - Ask your doctor if any meds can be stopped entirely. Many sleep aids, anxiety meds, and painkillers are taken long after they’re needed.
2. SWITCH - Can a safer alternative work? For insomnia, cognitive behavioral therapy (CBT-I) works better than Ambien and has no fall risk. For anxiety, non-benzodiazepine options like buspirone are safer. For pain, physical therapy and acetaminophen may be enough.
3. REDUCE - Lower the dose. Even cutting a benzodiazepine in half can reduce fall risk significantly. Always do this slowly under medical supervision.

How to Have This Conversation

Don’t wait for your doctor to bring it up. Be ready. Bring your entire medication list to every appointment-including vitamins, supplements, and OTC drugs. Use the “brown bag method”: dump everything out on the table. It’s easier to see what you’re really taking.

Ask these questions:

• “Is this medication still necessary?”
• “Could it be making me dizzy or unsteady?”
• “Is there a safer option?”
• “Can we try stopping or lowering this one?”

Pharmacists are your allies. Many offer free medication reviews. They spot interactions and risks doctors miss. A 2023 study found pharmacist-led reviews cut fall risk by 22%.

What’s Changing in 2025

The landscape is shifting. The American Geriatrics Society’s 2024 Beers Criteria update will include new warnings for recently approved drugs. Medicare now penalizes doctors who overprescribe fall-risk meds. AI tools are being tested to flag dangerous combinations before they’re even written.

The National Institute on Aging just funded $15 million in research to develop better deprescribing protocols-ways to safely stop harmful meds without causing withdrawal or rebound symptoms.

And while safer alternatives exist, they’re not always affordable. New non-benzodiazepine anxiety drugs can cost $450 a month-15 times more than generic Xanax. But for many, the cost of a fall-hospital bills, rehab, lost independence-is far higher.

The Bigger Picture

Falls aren’t inevitable. They’re preventable. And medication is one of the most powerful tools we have to prevent them-not by adding more, but by removing the wrong ones.

Every medication you take has a purpose. But not every purpose is worth the risk. If you or a loved one is over 65 and taking more than three medications, it’s time to ask: Are any of these making me less safe?

The goal isn’t to stop all meds. It’s to stop the ones that are hurting you more than helping. Balance isn’t just about physical therapy or handrails. It starts with the pills you swallow every morning.

Real Stories, Real Consequences

A Reddit user in Ohio shared that her 78-year-old mother fell three times 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 Texas wrote on GoodRx: “I took Xanax for six months. I didn’t realize how wobbly I’d become until I started installing grab bars in my bathroom. My wife said I looked like I was drunk-even when I hadn’t had a drink.”

These aren’t outliers. They’re examples of what happens when we treat symptoms without seeing the full picture.

Take Action Today

- Make a list of every medication you take, including vitamins and OTC drugs.

Bring that list to your next doctor or pharmacist visit.

Ask: “Could any of these be making me more likely to fall?”

Don’t stop any meds on your own-but do ask if it’s safe to taper off.

Your balance matters. Your independence matters. And your medications shouldn’t be working against you.