Falls are the leading cause of injury and injury-related death among older adults in the United States. More than 1 in 4 people over 65 report falling each year, and many of these falls result in serious injuries like hip fractures and traumatic brain injuries.
Older adults are already at a higher risk of falling due to common issues like sensory impairment, gait and balance issues, living in environments with fall hazards, and orthostatic hypotension (a sudden drop in blood pressure when standing), says Cara McDermott, PhD, an assistant professor in medicine in geriatrics at the Duke University School of Medicine in Durham, North Carolina, and taking certain medications can make falls even more likely to happen.
The number of people age 65 and older who died due to a fall in 2023 is more than triple the number of fall-related deaths 30 years ago — and researchers suggest that this surge may be tied to the soaring use of certain prescription drugs.
Aging itself can reduce the body’s ability to mount an appropriate response to a fall so that you can catch yourself from a stumble, says Dr. McDermott. When you combine that with a drug that impacts your perception, balance, or coordination, you further increase the risk of falls, she says. Here are 10 types of drugs that can contribute to fall risk in older adults.
1. Z-Drugs
Z-drugs, including zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata), are a class of sedative-hypnotic drugs prescribed for insomnia. They can contribute to fall risk by causing orthostatic hypotension, dizziness or imbalance, sedation, muscular weakness, and ataxia (lack of muscle coordination), among other side effects.
Sleeping pills also have special risks for people over age 65, because as you age, your body absorbs, distributes, metabolizes, and excretes medications more slowly, and they stay in your body longer, says McDermott.
This means that the risk of side effects like confusion, memory issues, and unsteadiness is higher, which makes falling more likely, says Amy Shaver, PharmD, PhD, a postdoctoral research fellow at Thomas Jefferson University in Philadelphia.
The risk of falling is higher in people when they first start using Z-drugs and other sedative-hypnotic drugs or when they use them long term.
2. Benzodiazepines
This class of sedative drugs includes alprazolam (Xanax), lorazepam (Ativan), and diazepam, which are typically prescribed for anxiety, insomnia, and seizures.
Benzodiazepines can cause dose-dependent drowsiness, slowed reflexes, and impaired balance, which can lead to falls, says Dr. Shaver. “Benzodiazepines linger in the body longer in older adults and can cause confusion, which increases fall risk,” she says.
Combining these drugs with alcohol or other sedatives magnifies these effects because both substances impact the central nervous system, notes Shaver. “You definitely don’t want to drink while taking a benzo,” she says.
Specifically, a nationwide study of 558,147 older adults in Korea found that the SSRIs escitalopram (Lexapro) and paroxetine (Paxil) and the TCAs amitriptyline and imipramine were among drugs that significantly increased the risk of fall-related injuries in older adults.
There are a few reasons why SSRIs can lead to falls. First, orthostatic hypotension is a potential side effect of these medications, which can make you feel dizzy or lightheaded, and that adds to fall risk, Shaver says.
Loss of appetite and nausea are other frequent side effects of SSRIs, potentially leading to dehydration, which may contribute to orthostatic hypotension and increase fall risk. Moreover, dizziness and sleepiness are frequently reported side effects of antidepressants in general, and both can lead to falls.
As for TCAs, these drugs can also cause orthostatic hypertension as well as sleepiness, which can increase fall risk for older adults over 65, per one systematic review and meta-analysis of 18 studies conducted in Spain.
4. Antipsychotics
One study out of Ireland of 74 nursing home residents found that a regular antipsychotic prescription was associated with one or more falls.
“Antipsychotics can increase fall risk because of their sedative properties and effects on motor control,” says Shaver. These drugs also impact the central nervous system, which makes alcohol use especially risky, she adds.
5. Antihypertensives
However, sometimes blood pressure can fall too low when taking these drugs, especially when people become lightheaded when standing and lose balance. “This is especially common when people are first put on the drugs, before their body has gotten acclimated to them,” says Shaver.
One retrospective cohort study of 29,648 older adults residing in nursing homes showed that those who started new medications to treat high blood pressure had an elevated risk of fractures and falls. In fact, they were more than twice as likely to experience a fracture than those who did not start new high blood pressure medication.
6. Dopaminergic Drugs
Dopaminergic drugs, or drugs that affect the level of the neurotransmitter dopamine in the brain, are often used to treat conditions like Parkinson’s disease and have been linked to falls.
A recent case-control study out of Ontario, Canada, that looked at almost 80,000 older adults in home care and long-term care found that people using dopaminergic drugs and antidepressants had the greatest likelihood of falls compared with people taking other classes of drugs.
For example, levodopa, a type of dopaminergic drug that’s often prescribed to help with Parkinson’s disease movement symptoms, can cause side effects like lightheadedness, lowered blood pressure, and dyskinesias (extra movements), which can contribute to fall risk, says Shaver.
7. Anticonvulsants
Anticonvulsant or antiepileptic drugs like gabapentin, pregabalin, and carbamazepine are prescribed for epilepsy but are also commonly used to treat conditions like neuropathic pain.
A recent meta-analysis out of Liverpool, England, assessed 23 studies and found that using antiepileptic drugs to treat neuropathic pain is linked to a significant fall risk in older adults, with higher doses carrying greater risks.
According to the meta-analysis, these medications exert significant effects on the central nervous system, resulting in common adverse events such as dizziness, sedation, ataxia, and sleepiness or drowsiness — factors strongly associated with increased fall risk in older adults.
8. Opioids
Opioids such as oxycodone, hydrocodone, and morphine are used to block pain signals between the brain and the body.
Side effects of opioids include drowsiness, orthostatic hypotension, dizziness, and cognitive impairment, all of which can contribute to fall risk, says Shaver.
These drugs can be particularly risky when combined with other drugs, especially benzodiazepines, sedatives, anticonvulsants, and muscle relaxers, adds Shaver.
9. Muscle Relaxants (Muscle Relaxers)
These drugs, such as cyclobenzaprine, tizanidine, baclofen, and carisoprodol, are typically prescribed for muscle spasms and chronic pain.
However, muscle relaxants 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 in part because the benefit you’re getting with their effect on your muscles could then also impair your ability to move and the way you’re expecting to move,” says Shaver.
One study out of Korea found that muscle relaxants were among medications associated with the highest risk of fall-related injuries in people age 65 and older.
10. Anticholinergics
These drugs, such as benztropine and trihexyphenidyl, diphenhydramine (Benadryl), and oxybutynin, are used to treat conditions such as Parkinson’s disease, allergies, depression, and overactive bladder. They work by blocking acetylcholine, a neurotransmitter that plays a role in muscle movement.
Side effects of anticholinergics include blurry vision and diminished muscle contraction, which may impair walking and increase the risk of falls, says Shaver.
If you’re currently taking an anticholinergic drug — either prescription or over the counter — talk to your healthcare provider about switching medications, as there are alternatives that don’t typically cause falls, says Shaver.
How to Lower Your Fall Risk if You’re Taking These Drugs
To reduce your risk of medication-related falls, the following tips can help, from talking to your doctor to avoiding drugs and alcohol.
Talk to your doctor about all the drugs you’re taking. Discuss all the drugs you’re taking with your doctor and whether any of them are known to cause falls or have interactions with other drugs that may cause falls. “Check in with your doctor regularly to make sure the medicine list is correct and always ask if they are all necessary,” says John Batsis, MD, an associate professor of medicine and geriatrician at the University of North Carolina School of Medicine in Chapel Hill. You can also ask your doctor about changing or reducing the dosage of your medications to reduce your fall risk, Dr. Batsis adds.
Be wary of drugs that make you feel dizzy or sleepy. Anything that causes these side effects raises your fall risk, says Katherine Ward, MD, a geriatrician with Stanford Senior Care in Palo Alto, California.
Avoid using recreational drugs or alcohol when you’re taking prescription medications. This is especially true when you’re taking medications known to cause falls, says Dr. Ward. “When a medication goes through the approval process, they don’t test the medication on a person on recreational drugs or alcohol. So you’re venturing into a no-man’s-land,” she says.
Make sure your home is clean, clear, and well lit. This can help further reduce your risk of falls, says Batsis.
Know your personal fall risk. Before starting any new medication, talk to your doctor about your personal fall risk. “Decisions about medications should be made in conjunction with your prescriber, taking into account personal preferences, comorbidities, and past history of falling,” says McDermott.
The Takeaway
Falls are a serious and growing health risk for older adults, and many commonly used medications can make that risk worse by causing side effects like dizziness, drowsiness, or slower reflexes.
Sedatives, muscle relaxers, and antidepressants can increase your risk of falling because of side effects such as 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.
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