Some of the most common medications prescribed to older adults make falling more likely. Most people taking them have never been told.
This is the risk factor that requires no exercise, no equipment, and no home renovation to address. It requires one conversation. It is also the one most often skipped — by patients who assume their prescriptions are settled, and by clinicians who are managing the condition the drug was prescribed for rather than the side effect it produces.
The Scale of It
Medication is one of the few fall risk factors that is genuinely modifiable — you cannot subtract twenty years from your age, but a prescription can be reduced, switched, or stopped.
The exposure is also growing. Over a fifteen-year period, opioid use among older adults in the United States rose from roughly 15% to 35%. Anticonvulsant use tripled, from about 4% to 14%. These are not small shifts in a small population.
Layered on top of that is polypharmacy. Taking four or more medications has been consistently associated with increased fall risk, independent of which particular drugs they are. The count itself matters, because interactions multiply in ways that are difficult to predict from any single prescription.
What These Drugs Are Actually Doing
The phrase “increases fall risk” is vague enough to be dismissed. What these medications do is specific.
Some produce sedation — a measurable slowing of reaction time. When your foot catches an edge, staying upright depends on a correction that happens in a fraction of a second. Sedation lengthens that fraction.
Some lower blood pressure more than intended when you stand up, producing a brief drop in blood flow to the brain. That is orthostatic hypotension, and it is why the dangerous moment is often the first three seconds after rising from a chair or a bed rather than anything that happens while walking.
Some blur vision, produce dizziness, or cause mild confusion that the person experiences as ordinary tiredness rather than as a drug effect.
The important point: none of these are signs of frailty. They are pharmacological effects. Which means they can often be undone.
The Classes to Review
The CDC’s STEADI program identifies the medication classes that affect cognition and physical function in ways that contribute to falls. In plain terms:
- Benzodiazepines — prescribed for anxiety or sleep. Among the most consistently implicated drugs in the research.
- Sedative-hypnotics — the newer sleep medications, including zolpidem, eszopiclone, and zaleplon.
- Antidepressants — both older tricyclics and modern SSRIs.
- Antipsychotics
- Opioid pain medications
- Anticonvulsants — often prescribed for nerve pain rather than seizures.
- Muscle relaxants
- Antihypertensives — blood pressure medications, particularly around a dose change.
- Antihistamines — including the sedating ones sold without a prescription.
Seeing a medication on this list does not mean it is wrong for you. Many of these treat conditions that are themselves dangerous, and untreated depression, uncontrolled blood pressure, and unmanaged pain all carry their own risks — including fall risk. The list is a prompt for a conversation, not a verdict.
The Over-the-Counter Blind Spot
People tend to answer “what medications do you take?” with the prescription list. The things bought off a shelf get left out, and some of them belong in the conversation.
Anticholinergic drugs block a neurotransmitter involved in both memory and muscle control. They turn up in more places than most people realize:
- Sedating antihistamines such as diphenhydramine
- The “PM” or “nighttime” versions of ordinary pain relievers — the ingredient that makes them PM is usually a sedating antihistamine
- Overactive bladder medications such as oxybutynin and tolterodine
- Motion sickness and vertigo drugs such as meclizine and scopolamine
An older adult taking a nighttime pain reliever, a bladder medication, and something for dizziness may be carrying a substantial anticholinergic load without a single one of those appearing on a prescription list. Clinicians sometimes call this the anticholinergic burden, and it accumulates across drugs rather than residing in any one of them.
What the Evidence Actually Shows
This deserves an honest account, because the picture is more complicated than most articles on this subject admit.
The consensus is strong on reviewing. The 2022 World Guidelines for Falls Prevention and Management — a global initiative involving experts across dozens of countries — make several strong, graded recommendations: assess fall history and fall risk before prescribing a fall-risk-increasing drug; use a validated screening tool such as STOPPFall or STEADI when performing a medication review; and include medication review and appropriate deprescribing as part of any multifactorial fall prevention effort.
The evidence is weaker on deprescribing alone. Systematic reviews and meta-analyses examining medication withdrawal as a single, standalone intervention have produced inconsistent results. Reviews have generally found a trend toward fewer falls without reaching consistent statistical significance.
That inconsistency is worth understanding rather than hiding. It does not mean medication does not matter — the association between these drug classes and falls is well established. It reflects something more specific: falls are multifactorial, and pulling one thread out of a multifactorial problem rarely produces a dramatic result on its own. Trials that changed a medication list without also addressing strength, balance, blood pressure, and vision were testing one intervention against a problem with six causes.
The practical conclusion is the one the guidelines reach. Review medications as part of a broader effort, not instead of one.
The Conversation That Works
The most encouraging research on this subject is not about a drug. It is about telling people the truth.
The EMPOWER trial gave community-dwelling older adults on long-term benzodiazepines a plain-language brochure explaining the risks of the medication they were taking. No clinician was involved in the intervention. Participants simply received accurate information.
Within six months, 27% had discontinued the medication entirely, compared with 5% in the control group. Another 11% reduced their dose. Roughly six in ten started a conversation with their doctor or pharmacist about stopping.
The finding underneath that result is the reason this page exists: most long-term users had never been told there was anything to be concerned about. Given the information, a substantial number acted on it.
What NOT to Do
Do not stop any medication on your own. This is not a caution added out of legal habit — abrupt withdrawal from several of the drugs on this page is genuinely dangerous.
- Stopping benzodiazepines suddenly after long-term use can cause severe withdrawal, including seizures.
- Stopping anticonvulsants abruptly can trigger seizures.
- Stopping certain blood pressure medications abruptly can cause a rebound spike.
- Stopping antidepressants suddenly can produce a difficult discontinuation syndrome.
Deprescribing done properly is a supervised taper, often over weeks or months. The goal is a plan, not a decision made at the medicine cabinet.
Also avoid the opposite error — assuming that because a drug appears on a risk list, it must go. Some of these medications are preventing something worse. That judgment requires someone who knows your full history.
Why This Connects to Staying Active
There is a second cost to these medications that rarely gets counted.
A person who feels foggy, unsteady, or dizzy moves less. Moving less costs leg strength and balance — and lower body weakness is the single strongest risk factor for falling that researchers have identified. The sedating prescription does not only make the next stumble harder to correct. Over months, it makes the person weaker, which makes stumbles more frequent in the first place.
Which reframes what a good medication review is for. It is not a defensive act of subtracting things. Done well, it gives someone back the alertness and steadiness to be active again — and activity is what actually preserves independence.
What to Do With This
- Build one complete list. Every prescription, every over-the-counter product, every vitamin and supplement, with doses. The simplest reliable method is to put every bottle in a bag and bring the bag.
- Mark anything that appears on the classes above, including the over-the-counter items.
- Note what changed recently. New prescriptions and dose increases matter disproportionately — risk is often highest in the period right after a change.
- Ask your pharmacist first if that is easier. Pharmacists are trained in exactly this, the consultation is usually free, and no appointment is required.
- Ask the question directly: “Are any of these making me more likely to fall, and is there a safer alternative or a lower dose?”
- Ask to have your blood pressure taken lying down and again after standing. This is how orthostatic hypotension is detected, and it is often skipped in a routine visit.
- Mention any fall or near-fall from the past year. Under the guidelines, that history should change how a clinician thinks about your prescriptions.
Topics in This Section
- How to build a complete medication list before an appointment — with a printable worksheet
- Benzodiazepines, sleep medication, and what a taper looks like — with a printable review sheet
- Orthostatic hypotension: why standing up is the dangerous moment — with a printable blood pressure log
- Anticholinergic burden and the over-the-counter drugs that carry it
- Polypharmacy: what happens when the list passes four
- Talking to your pharmacist about deprescribing
- Blood pressure medication and the period after a dose change
- The Beers Criteria explained in plain language
Related Guides
- Why People Fall — how medication fits alongside the other risk factors
- Balance & Strength Training — the intervention with the strongest evidence behind it
- Footwear & Foot Health — one of the most overlooked contributors
When to Speak to a Doctor
Schedule a medication review if you take four or more medications, take anything from the classes listed above, have started a new prescription or changed a dose recently, have fallen or nearly fallen in the past year, or regularly feel dizzy, foggy, or unsteady.
Seek care promptly if you feel faint or nearly black out when standing, if dizziness is new or worsening, or if you have fallen after starting a new medication.
Seek care immediately for a fall involving a head injury, a fall while taking a blood thinner, an inability to bear weight afterward, or a fall preceded by fainting or loss of awareness.
Sources
- Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing, 2022. Age and Ageing
- van der Velde N, Seppala LJ, Hartikainen S, et al. European position paper on polypharmacy and fall-risk-increasing drugs recommendations in the World Guidelines for Falls Prevention and Management. European Geriatric Medicine, 2023. Springer
- Lee J, Negm A, Peters R, et al. Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis. BMJ Open, 2021. PubMed
- Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis. Age and Ageing, 2022. Age and Ageing
- Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Internal Medicine, 2014. PubMed
- Centers for Disease Control and Prevention. STEADI: Medications Linked to Falls. CDC
Senior Health News publishes free educational guides on fall prevention, home safety, and healthy aging. This page is for general information only and is not medical advice. It does not replace evaluation by a qualified healthcare professional, and no product is sold or recommended on this site. Never start, stop, or change a medication without speaking to your doctor or pharmacist.
Last reviewed: September 8, 2026.