If you’re an older adult, falling is one of the top ways you could get hurt or need to be hospitalized. Issues with your balance or mobility can cause falls but the medications you take could also play a role.
Some prescription and over-the-counter (OTC) drugs can affect your alertness, coordination or blood pressure and increase fall risk in older adults. Understanding how medications and falls are connected can help you take steps to stay safe.
How medications impact fall risk in older adults
“Medications can impact balance and safety in several ways,” said Paul Thompson, a pharmacist with Banner Pharmacy Services. “Drugs that affect the central nervous system, blood pressure or the way your body processes and gets rid of drugs can significantly increase fall risk in older adults.”
Common medication side effects include:
- Dizziness or lightheadedness
- Drowsiness
- Slowed reaction time
- Blurred vision
- Changes in blood pressure, especially when standing up
Taking several different medications at the same time, known as polypharmacy, can raise your risk even more. The more medications you take, the greater the chance of side effects and interactions. “Polypharmacy can increase sedation, confusion or low blood pressure,” Dr. Thompson said.
Plus, age-related changes in how your body absorbs and clears medicine can also make you more sensitive to these effects.
If you feel unsteady or think you might have dizziness from medicine, you should talk to your health care provider. Don’t make any changes to the medications you take without discussing them with your provider.
Medications most often linked to falls
“Many medications are associated with an increased risk of falls, particularly in older adults,” Dr. Thompson said. Not everyone who takes these drugs will fall but it’s important to know how they could affect you.
1. Pain medications (opioids)
You may take prescription opioids for moderate to severe pain. They can cause drowsiness, slower reflexes and confusion, especially when you’re starting the medication or changing doses. These effects can increase the risk of losing balance.
2. Antidepressants
Some antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and older tricyclic antidepressants, may cause dizziness, sedation or drops in your blood pressure. You may notice these effects more when you’re standing up or walking.
3. Sleep medications and sedatives
Drugs used to help you sleep can cause grogginess, confusion or poor coordination the next day. They can also make nighttime trips to the bathroom risky, since you could lose your balance.
4. Anti-anxiety medications (benzodiazepines)
Medications like benzodiazepines can slow your thinking and reaction time. They may also affect your balance and increase your chance of falls, especially if you take them regularly.
5. Blood pressure medications
Medications that lower blood pressure are important for your heart health but they can sometimes cause orthostatic hypotension. This is a sudden drop in blood pressure when you stand up, which can lead to dizziness or fainting.
6. Diabetes medications
Insulin and some oral diabetes medications can lower blood sugar too much. Low blood sugar may cause shakiness, weakness, confusion or fainting, which increases your fall risk.
7. Antipsychotics
Antipsychotic medications prescribed for certain mental health or neurologic conditions can cause sedation, muscle stiffness or difficulty with movement, which may raise your risk of falls.
Remember that medications that cause dizziness or drugs that increase fall risk can be more dangerous when they are combined or taken at higher doses.
The American Geriatrics Society has a detailed list of medications older adults should avoid, adjust or use with caution. Keep in mind that even some OTC medications, like antihistamines, sleep aids and cold remedies, can sedate you and increase your fall risk.
Reducing fall risk while taking medication
These fall prevention tips can lower your fall risk when you’re taking medications you need:
- Ask your doctor or pharmacist for a safe medication review regularly, including prescriptions, OTC medications and supplements. “You can usually have this done free of charge by your local pharmacy or primary care team,” Dr. Thompson said.
- Don’t stop or change a prescription without medical guidance.
- Ask whether you can adjust doses or timing to reduce side effects.
- See if you can switch to safer alternatives, like using cognitive behavioral therapy for insomnia instead of sedatives. “Non-drug approaches like exercise, therapy, hydration and home safety improvements can be equally effective and safer for managing issues such as insomnia, anxiety and pain,” Dr. Thompson said.
- Stay physically active and include balance and strength exercises as recommended.
- Make your home safer with changes like better lighting and removing trip hazards.
- Use mobility aids like canes or walkers if you need to.
- Have your vision checked regularly, since poor vision can increase your fall risk.
“Give strong consideration to these changes, even if making them feels inconvenient,” Dr. Thompson said.
When to see your doctor
You should talk with your provider if:
- You’ve had a recent fall or near fall
- You notice new dizziness, lightheadedness, weakness, sedation, confusion, blurred vision or other vision changes.
- You feel unsteady walking or you need support after starting a new medication.
- You’re taking two or more high risk medications, such as a benzodiazepine plus an opioid.
- You have concerns about medication side effects or interactions.
- It’s time for an annual medication or safety review.
An older adult medication checkup is a good opportunity to talk about your fall concerns and review all your prescriptions and supplements.
“Proactive communication can prevent harm and improve your health outcomes. It’s better to be safe than sorry. Always ask your pharmacist or provider about your medications. Don’t let a lack of knowledge or the number of medications put you in jeopardy of preventable risks,” Dr. Thompson said.
“Fall risk is modifiable. Medication is one of the most changeable risk factors and you can lower your risk by working with your health care team. Regular medication reviews are critical, because what is appropriate today may not be tomorrow,” he said.
Taking the next step
Falls don’t have to be part of aging and you can lower many of your fall risks. If you or a loved one is worried about fall risk, reach out to a Banner Health provider who can help review your medications, identify side effects and recommend safety steps to keep you healthy and independent.
