Carla, 84, suffered from chronic back pain while living independently. She was prescribed increasingly strong pain medications, from muscle relaxants to topical anesthetics and eventually narcotics. While the goal was to treat her pain, her stability faltered, and she fell in her home, resulting in multiple large bruises.
A few months later, Carla moved to an assisted living facility in California, but she struggled to adjust to the new living environment and was prescribed an antidepressant. Soon after, she had another fall.
Dr. Drew Maygren, a geriatric psychiatrist at Kaiser Permanente in Oakland, says the care team at the care home eventually determined that her medications likely contributed to both incidents. After making some adjustments, Maygren says Carla had no subsequent falls and started to thrive in her environment.
Over the past 20 years, fall-related deaths among older adults have increased, with falls now the leading cause of injury in adults age 65 and older, according to the Centers for Disease Control and Prevention.
Read on to learn about medications that increase fall risk in seniors, why these medications cause falls and proactive steps to prevent falls in older adults.
[READ: Fear of Falls in Older Adults]
Understanding Medication-Related Fall Risks in Seniors
Different drugs affect people in different ways — and sometimes, it’s the interaction of multiple medications that leads to a fall.
How medications affect fall risk
It’s not uncommon for older adults to be prescribed several types of medications at the same time to manage the effects of chronic diseases, such as diabetes, high blood pressure and major depression, says Dr. Erika Gray, a pharmacist in Draper, Utah, and cofounder and chief medical officer at ToolBox Genomics, a practitioner-focused genetic company that provides health and wellness reports.
“Taking more than one of these medication categories together, also called polypharmacy, can cause layered side effects that can increase the risk of falls,” she explains.
Common medication types that increase fall risk
The following table outlines common medication classes associated with high fall risk in older adults.
| Drug Class | Medication Use | Examples | Underlying Cause |
| Sedatives and benzodiazepines | Anxiety, insomnia | Valium, Xanax, Lorazepam | Drowsiness, delayed reaction time, decreased balance |
| Antidepressants | Depression, anxiety | Zoloft, Celexa | Dizziness with position changes, changes in balance and alertness |
| Antihypertensives | High blood pressure | Metoprolol, lisinopril, amlodipine | Dizziness or fainting with position changes |
| Antipsychotics | Bipolar disorder, schizophrenia, agitation | Seroquel, haldol, risperidone | Drowsiness, muscle rigidity, decreased balance |
| Sleep aids | Insomnia | Benadryl, Unisom, Ambien | Drowsiness, confusion, delayed reflexes |
| Nonsteroidal anti-inflammatory drugs (NSAIDs) | Pain, inflammation | ibuprofen, Motrin, Advil, Aleve | Dizziness, decreased blood pressure |
| Antiepileptics | Seizure control, neuropathic pain | gabapentin, carbamazepine | Dizziness, blurred vision, unsteadiness |
| Muscle relaxants | Muscle spasms, back pain | Flexeril, Baclofen | Sedation, lightheadedness, dizziness |
| Opioids | Moderate to severe pain | oxycodone, hydromorphone, morphine | Slowed reaction time, dizziness, sedation, low blood pressure, confusion |
| Anticholinergics | Allergies, urinary incontinence, motion sickness | oxybutynin, Benadryl, meclizine | Confusion, blurred vision, decreased alertness |
| Insulin and other diabetes medications | Diabetes management | insulin, glipizide | Low blood sugar, dizziness, confusion, fainting |
Anticoagulant medications, such as warfarin or Xarelto, used to treat or prevent blood clots or cardiac arrhythmias, may not directly cause a fall, but they can significantly increase the risk of bleeding and bruising if a fall does occur.
Seniors who take blood pressure medications should be carefully monitored, as they can make people feel dizzy, increasing the likelihood of falls.
For some medications, such as muscle relaxants, consider alternatives that are less likely to cause weakness and subsequent falls.
[Read: Deprescribing Medications for Seniors]
Assessing Fall Risk: What to Watch for and Questions to Ask
Taking medications to manage chronic conditions is often unavoidable, so make sure to ask and answer questions, such as the ones below, about medications that can increase the risk of falling.
Signs and scenarios indicating medication-related risk
To stay proactive with fall risk, consider these three questions:
1. Have you felt dizziness, drowsiness, unsteadiness or confusion after starting a new medication or increasing a dose?
2. Have you fallen, stumbled, bumped into something or felt close to falling recently?
3. Are you taking more than three over-the-counter or prescription medications daily?
If you respond “yes” to any of the above questions, make sure to discuss fall prevention with your doctor.
“If you notice these signs, especially if you have a fall or a close call within the first few weeks of changing a medication, make sure to communicate this with your medical provider,” Gray says.
Engaging health care providers in assessments
At your next appointment, bring a complete list of the prescription medications, over-the-counter drugs and supplements
you are taking to ensure your provider is aware.
Medical care, especially in the U.S., can be fragmented.
“Different specialists may prescribe different medicines,” Gray says. “If no one has reviewed all your medications together, it may be a good idea to bring all of your prescriptions and supplements to your next appointment with your primary care provider to see if there are any combinations causing heightened risk of falls.”
Use this checklist to verify your understanding of the fall risk for the medications:
— Will this medication or supplement increase my risk of falling?
— Is there a safer alternative or a lower dose that I should try?
— Should any of these medications be taken at a different time of day to reduce my fall risk?
Providers will also conduct a fall risk assessment of:
— Muscle strength
— Walking ability
— How you use supportive devices, such as a walker or a cane
— A neurological exam to assess coordination, strength in the extremities and balance
— Eyesight and hearing
Providers will also discuss whether physical therapy would be a useful fall prevention method for you, as it helps to maintain your strength and balance.
[8 Questions to Ask a Geriatrician at Your First Appointment]
Safe Medication Management at Home
By safely managing your medications at home, you can reduce your fall risk when taking medications that increase your fall risk as much as possible.
— Use pill organizers to make sure you are taking medications as directed and on time and not accidentally taking additional doses.
— Maintain up-to-date lists of all the medications and supplements you take, including directions and dosages.
— Track medication side effects in a journal or note in your phone.
— Watch for key warning signs, such as dizziness, sleepiness, brain fog, changes in sleep-wake patterns, blurry vision, confusion or low blood sugar.
— Tell your loved ones or those with whom you live that you are taking medications that might increase your risk of a fall. Talk to them about your fall prevention efforts.
Gray recommends these quick medication management tips to talk to your provider about:
| Strategy | Reason |
| Take diuretics in the morning | It cuts down on nighttime bathroom trips, which are often the culprit of falls. |
| Take blood pressure medications in the evening | You will be resting if dizziness occurs. |
| Space out medications that are known to increase fall risk | It can offset the layered side effects of multiple medicines. |
Integrating Fall Prevention Into Daily Life for Older Adults
When taking medications that increase fall risk, fall prevention extends far beyond medications. You can make a comprehensive fall prevention plan to maximize your safety and stability.
Home environment adjustments
Gray recommends:
— Maintaining clean hallways
— Removing loose rugs
— Keeping cords out of walkways
— Adding grab bars or railings to high-risk areas, such as stairs or the shower
— Having a well-lit path to the restroom or other areas you make trips to in the middle of the night
Strength and mobility
— Use an assistive device, such as a walker or cane, as directed by your health care provider
— Follow your physical therapy plan if you have one to maintain your strength and balance
— Exercise, including performing chair rise exercises. Maygren recommends this as a practical movement you can incorporate into your daily routine that will help prevent falls.
Lifestyle adjustments
— Wear supportive, nonslip shoes at home, “Oftentimes, proper footwear is not compatible with what is trendy or aesthetically pleasing,” Maygren says, but it is important as a fall prevention measure.
— Address vision or hearing trouble with a specialist or the appropriate aids
— Track your medications and side effects
— Have a blood pressure machine at home if recommended by your provider
Use available support resources
— The CDC’s Stopping Elderly Accidents, Deaths & Injuries (STEADI) includes a self-questionnaire to assess your fall risk, brochures and practical tips for loved ones.
— Talk to your family and loved ones about how you feel about your fall prevention plan.
— Discuss your concerns about falling with your provider.
When you are taking medications that increase the risk of falling, a multidimensional fall prevention plan combines home safety, strength and mobility, lifestyle adjustments and your support system to ensure you stay safe and fall-free as an older adult, even if you need to take medications to manage your chronic conditions.
More from U.S. News
9 Steps to Plan Ahead for Long-Term Care
Independent Living vs. Assisted Living: What’s the Difference?
Medications That Increase Fall Risk in Older Adults originally appeared on usnews.com
Clarification 10/27/25: This article was updated to clarify which party determined that medication treatments contributed to a senior’s falls.
