Falling Risk: 10 Medications to Review

Rising Tides of Falls: 10 Common Medications That Increase Risk for Seniors

Falls are the leading cause of injury and injury-related death among older adults in the United States. More than one in four Americans aged 65 and over experience a fall each year, often resulting in serious consequences like hip fractures and traumatic brain injuries. While age-related changes in sensory perception, balance, and physical strength contribute to this risk, a growing body of evidence points to a significant, and often overlooked, factor: medication side effects. In fact, the number of fall-related deaths among those 65 and older has more than tripled in the last 30 years, a surge researchers believe is linked to the increasing use of certain prescription drugs.

“Aging itself can reduce the body’s ability to mount an appropriate response to a fall, making it harder to catch yourself,” explains a senior official at the Duke University School of Medicine. “When you combine that with a drug that impacts your perception, balance, or coordination, you further increase the risk.” Here are 10 types of medications commonly linked to an elevated fall risk in older adults.

1. Z-Drugs: The Hidden Dangers of Sleep Aids

Z-drugs – including zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata) – are frequently prescribed for insomnia. However, these sedative-hypnotic medications can significantly increase fall risk due to a range of side effects. These include orthostatic hypotension (a sudden drop in blood pressure upon standing), dizziness, imbalance, muscular weakness, and ataxia (a lack of muscle coordination).

The risks are particularly pronounced in older adults, as the body’s ability to process medications slows with age. “As you get older, your body absorbs, distributes, metabolizes, and excretes medications more slowly, meaning they stay in your system longer,” notes a postdoctoral research fellow at Thomas Jefferson University. This prolonged exposure increases the likelihood of side effects like confusion, memory issues, and unsteadiness, all of which contribute to falls. The risk is highest when starting these medications or using them long-term.

2. Benzodiazepines: A Risky Calm

Benzodiazepines, such as alprazolam (Xanax), lorazepam (Ativan), and diazepam, are often prescribed for anxiety, insomnia, and seizures. However, these sedatives can cause dose-dependent drowsiness, slowed reflexes, and impaired balance, directly increasing the risk of falls.

“Benzodiazepines linger in the body longer in older adults and can cause confusion, which increases fall risk,” explains a geriatric specialist. Combining these drugs with alcohol or other sedatives further amplifies these effects, as both substances depress the central nervous system. “You definitely don’t want to drink while taking a benzo,” cautions the specialist.

3. Antidepressants: Beyond Mood Stabilization

Both selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) have been linked to increased fall risk in older adults. A nationwide study of over 558,000 older adults in Korea found that SSRIs like escitalopram (Lexapro) and paroxetine (Paxil), as well as TCAs like amitriptyline and imipramine, significantly increased the risk of fall-related injuries.

Several factors contribute to this risk. SSRIs can cause orthostatic hypotension, leading to dizziness and lightheadedness. Additionally, loss of appetite and nausea – common side effects of SSRIs – can lead to dehydration, exacerbating orthostatic hypotension. TCAs can also cause orthostatic hypertension and sleepiness, further increasing fall risk.

4. Antipsychotics: A Delicate Balance

Regular use of antipsychotic medications has been associated with an increased risk of falls, particularly in nursing home residents. “Antipsychotics can increase fall risk because of their sedative properties and effects on motor control,” says a researcher. These drugs also impact the central nervous system, making alcohol consumption especially dangerous.

5. Antihypertensives: When Lowering Blood Pressure Goes Too Far

While essential for managing high blood pressure, antihypertensive medications can sometimes lower blood pressure too much, leading to dizziness, lightheadedness, and loss of balance, particularly when standing. “This is especially common when people are first put on the drugs, before their body has gotten acclimated to them,” explains a geriatrician. A study of nearly 30,000 older adults in nursing homes showed that those starting new blood pressure medications were more than twice as likely to experience a fracture compared to those who didn’t.

6. Dopaminergic Drugs: Navigating Parkinson’s and Fall Risk

Dopaminergic drugs, used to treat conditions like Parkinson’s disease, have also been linked to falls. A recent study of almost 80,000 older adults found that those using dopaminergic drugs and antidepressants had the greatest likelihood of falls compared to those taking other medications.

Levodopa, a common dopaminergic drug for Parkinson’s, can cause lightheadedness, lowered blood pressure, and dyskinesias (involuntary movements), all of which contribute to fall risk.

7. Anticonvulsants: Beyond Seizure Control

Anticonvulsant or antiepileptic drugs like gabapentin, pregabalin, and carbamazepine, while used to treat epilepsy, are also commonly prescribed for neuropathic pain. However, a meta-analysis of 23 studies found a significant link between using these drugs for neuropathic pain and an increased fall risk in older adults, with higher doses carrying greater risks. These medications exert significant effects on the central nervous system, causing dizziness, sedation, ataxia, and drowsiness – all factors strongly associated with falls.

8. Opioids: The Pain-Fall Connection

Opioids, such as oxycodone, hydrocodone, and morphine, are used to manage pain, but their side effects – including drowsiness, orthostatic hypotension, dizziness, and cognitive impairment – can significantly increase fall risk. These risks are amplified when opioids are combined with other drugs, particularly benzodiazepines, sedatives, anticonvulsants, and muscle relaxers.

9. Muscle Relaxants: Impaired Coordination and Falls

Muscle relaxants like cyclobenzaprine, tizanidine, baclofen, and carisoprodol, prescribed for muscle spasms and chronic pain, are also known to contribute to falls in older adults due to their sedative effects. “In older adults, muscle relaxants can lead to impaired coordination, as the benefit to muscles can also impair movement,” explains a pharmacist. A study in Korea found muscle relaxants among the medications most associated with fall-related injuries in those 65 and older.

10. Anticholinergics: A Subtle Threat

Anticholinergics, such as benztropine, diphenhydramine (Benadryl), and oxybutynin, are used to treat conditions like Parkinson’s disease, allergies, depression, and overactive bladder. However, side effects like blurry vision and diminished muscle contraction can impair walking and increase fall risk. “If you’re currently taking an anticholinergic drug, talk to your healthcare provider about switching medications, as there are alternatives that don’t typically cause falls,” advises a geriatric specialist.

How to Lower Your Fall Risk

To reduce your risk of medication-related falls, proactive steps are crucial. First, discuss all medications you’re taking with your doctor, including over-the-counter drugs and supplements, to identify potential fall risks and interactions. “Check in with your doctor regularly to make sure the medicine list is correct and always ask if they are all necessary,” suggests a geriatrician at the University of North Carolina School of Medicine. Be wary of any medication that causes dizziness or sleepiness. Avoid recreational drugs and alcohol while taking prescription medications, as the combination can be unpredictable and dangerous. Finally, ensure your home is clean, clear, and well-lit to minimize environmental hazards.

“Decisions about medications should be made in conjunction with your prescriber, taking into account personal preferences, comorbidities, and past history of falling,” emphasizes a senior official.

Falls are a serious and growing health risk for older adults, and many commonly used medications can worsen that risk by causing side effects like dizziness, drowsiness, or slower reflexes. Sedatives, muscle relaxers, and antidepressants can increase your risk of falling due to impaired coordination and sleepiness. Talk to your doctor about whether the medications you’re taking can increase your risk of falls, and regularly review your medication list with your healthcare provider or pharmacist to see if safer alternatives or dose adjustments are possible.