A 2025 opinion piece in the Journal of the American Medical Association called attention to a staggering statistic: Deaths from falls in the United States have tripled over the last 30 years. One possible reason: increasing medication use.
For older adults, falls can be life altering as well as life threatening. Injuries from falls often require hospitalization, surgery and rehabilitation, and despite good care, many people never regain their previous level of function or independent living.
The good news: You can prevent many falls by understanding your risks, reviewing your medications, and working with your health care team to minimize your risks.
Understand your risks
Older adults — especially those with several risk factors — are most at risk for falls. Those falls typically result from a combination of factors:
- Intrinsic factors, such as frailty, neurologic disease and chronic illness
- Extrinsic factors, such as using certain medications (see below) or multiple medications
- Environmental hazards, such as poor lighting and unsecured rugs
In addition, people who have sustained an injury from a fall, had multiple falls in the prior year, or are unable to get up without assistance, are at high risk.
Check your risk by taking this quick quiz, from the CDC publication, “Stay Independent.”
Review your medications
Many medications increase the likelihood of falls due to their effects on the brain, blood pressure or muscle control. In the pharmacy world, we call these medications fall-risk increasing drugs, or FRIDs. FRIDs can cause side effects such as dizziness, lightheadedness or weakness, which make falls more likely. Drinking alcohol while taking them can worsen these side effects and heighten the risk of a fall.
Examples of FRIDs include (but are not limited to):
- Benzodiazepines (for anxiety/sleep): diazepam, lorazepam
- Opioids (for pain): morphine, oxycodone
- Sleep medications: zolpidem (Ambien)
- Antidepressants: sertraline (Zoloft), venlafaxine (Effexor)
- Antipsychotics: quetiapine, haloperidol
- Anticonvulsants (for seizures): phenytoin, carbamazepine
- Antihyperglycemics (for diabetes): insulin, glipizide, glimepiride
- Antihypertensives (for blood pressure): medications that end in “-pril”, “-sartan”, or “-lol”
- Loop diuretics (for fluid): furosemide
- NSAIDs (for pain/inflammation): ibuprofen
- Nonselective antihistamines (for allergies): diphenhydramine (Benadryl)
- Gabapentinoids (for pain): gabapentin, pregabalin
Work with your health care team to minimize your risks
If you’ve had a fall or are concerned about falling, please have a talk with your primary care provider. Let your provider know about any history of falls, dizziness, alcohol use or other risks. Review your medication list together, and ask about the risks and benefits of each medication. Explore whether there are safer alternatives, lower doses, or non-prescription alternatives that could work for you. Your provider can make changes to your medications and provide referrals to specialists if appropriate.
If you’ve experienced muscle weakness or balance issues, The Portland Clinic’s physical therapists are another important part of your team. They can assess your balance, gait and fall risk, and can provide individualized training to help you improve strength and stability where needed.
Finally, make sure your home isn’t tripping you up. Removing tripping hazards such as loose rugs and clutter, improving lighting, adding nonslip mats in bathtubs/showers, and installing handrails will make your home a safer place to live a long and healthy life.
For more resources, visit STEADI(Stopping Elderly Accidents, Deaths & Injuries).
