Could Your Medications Be Increasing Your Fall Risk?
Updated: 8/30/26
Essential Points:
The Beers Criteria and FRID frameworks can help flag medications worth reviewing, but neither should be treated as a list of drugs everyone must stop. They help identify drugs that may affect alertness, blood pressure, coordination, or the ability to recover from a loss of balance.
The combination of medications may matter more than the total number taken. Several drugs with overlapping effects such as sleepiness, dizziness, confusion, or low blood pressure, can collectively reduce a person’s margin for error.
Medication review is one part of a complete fall assessment. Never stop or reduce a prescription without professional guidance. A physician or pharmacist should weigh each medication’s benefits and risks alongside strength, balance, vision, health conditions, and environmental hazards.
I work primarily with older adults who have balance problems and recurrent falls. That means I spend a lot of time looking at strength, walking, reaction time, assistive devices, and the environments where people live.
But there’s another part of my evaluation that can be just as revealing.
Their medication list.
I’ve worked with plenty of people who take 10 or more medications every day. I even saw one person on 25+ medications once. There might be one for pain, another for sleep, two for blood pressure, one for anxiety, and another for nerve pain. Then we discover an over-the-counter nighttime medication that isn’t even included on the official list.
No single medication provides a perfect explanation for the person’s falls. However, several of them may cause sleepiness, dizziness, confusion, lower blood pressure, or slower reactions.
What if the problem isn’t one obviously dangerous medication?
What if it’s several reasonable medications quietly pushing the same person in the same direction?
That doesn’t mean the medications were prescribed irresponsibly. Each one may have had a legitimate purpose when it was started.
The question is whether the complete medication list still makes sense for this particular person today.
Falls Are Increasing, and Medications May Be Part of the Story
Falls are the leading cause of injury among adults 65 and older in the United States. More than 14 million older adults report falling each year, and fall-related death rates have continued to rise.
Between 2018 and 2024, the age-adjusted fall death rate among older adults increased by 21%. (1) Because this rate is age-adjusted, population aging alone doesn’t fully explain the change.
Researchers are still trying to understand what’s happening. Changes in chronic disease, physical function, frailty, medication use, survival after serious illness, and how falls are documented may all play a role.
A 2025 Viewpoint published in JAMA Health Forum raised concern about the increasing use of several medications associated with falls, particularly opioids, benzodiazepines, gabapentinoids, and antidepressants. (2)
The article proposed that medication use could be contributing to rising fall mortality. However, it didn’t establish that these medications caused the increase.
Falls are far too complicated for a single explanation.
It does suggest that medication use deserves much more attention when someone begins falling.
What Are the Beers Criteria?
The American Geriatrics Society Beers Criteria is a clinical guide designed to improve medication safety in adults 65 and older. It was developed primarily for use in the United States and applies across outpatient, hospital, and institutional settings, with the exception of hospice and end-of-life care.
It identifies medications that may be potentially inappropriate in older adults. Some are generally best avoided. Others become concerning only when a person has a particular medical condition, takes certain other medications, or has reduced kidney function. The criteria also identifies medications that can remain appropriate but require cautious dosing or monitoring. (3)
The key word is potentially.
A medication appearing in the Beers Criteria doesn’t automatically mean:
The medication is dangerous for everyone
The prescriber made a mistake
Everyone over 65 should stop taking it
The medication caused a particular fall
The risks always outweigh the benefits
It means there’s enough concern to justify taking a closer look.
I like to think of the Beers Criteria as a red flag asking us to pause and investigate, not an automatic stop sign. It essentially just perks my ears up when I see any of them in a medication list.
The criteria specifically states that it should support rather than replace shared clinical decision-making. (3) A list can identify potential concerns, but it can’t account for the person’s medical history, symptoms, treatment goals, previous responses, or available alternatives.
What Are Fall-Risk-Increasing Drugs (FRIDs)?
Another useful concept is the fall-risk-increasing drugs, commonly shortened to FRIDs.
FRIDs are medications associated with increased fall risk through possible effects such as:
Sedation
Dizziness
Confusion
Changes in vision
Impaired coordination
Muscle weakness
Lower blood pressure
Orthostatic reactions
Slower reaction time
Not every FRID causes every one of these effects. The relevant side effects depend on the medication, dosage, person, medical condition, and other substances being taken. (4, 5, 7)
The Beers Criteria and FRIDs overlap, but they aren’t the same thing.
The Beers Criteria asks whether a medication may be inappropriate or require additional caution in an older adult. The FRID framework asks whether a medication could contribute to a fall.
A medically necessary medication can still be a FRID. It may provide an important benefit while also producing a side effect that needs to be recognized and managed.
That’s an important factor to remember.
The goal isn’t to label medications as good or bad. The goal is to understand how each medication affects the person taking it.
Medications Can Reduce Your Margin for Error
When people think about medications and falls, they often picture someone becoming extremely dizzy and collapsing.
That can happen, but medication-related falls aren’t always that obvious.
A medication may not cause the initial trip or loss of balance. It might simply make the person less capable of recovering from it, which in itself might be just as dangerous.
If someone catches a foot on a rug, their nervous system has to recognize the problem, move the opposite leg forward, control the trunk, and find a safe place to step. That entire sequence happens incredibly quickly, and usually before you even consciously know what’s happening.
Now imagine trying to complete it while sleepy, mentally foggy, lightheaded, or poorly coordinated.
The original mistake may be the same, but the person has less room to recover.
This is one reason medication effects can be difficult to recognize. The medication might not create an obvious medical emergency, instead it might just turn a recoverable balance error into a fall.
Most fall-related medication effects fit into three overlapping categories.
1. Medications That Slow the Brain and Protective Reactions
A loss of balance is a race between the body and gravity.
Sedating medications can slow your performance during that race. They can reduce alertness, coordination, judgment, and the speed of a protective step or reach.
A person can still appear strong during an examination. But having enough strength to perform an exercise isn’t the same as accessing that strength quickly during an unexpected loss of balance.
Several medication groups deserve attention here.
Benzodiazepines and sleep medications include drugs such as lorazepam, alprazolam, and diazepam, as well as nonbenzodiazepine sleep medications such as zolpidem, zaleplon, and eszopiclone.
These medications can impair coordination, thinking, and reaction time. The Beers Criteria recommends avoiding benzodiazepines and these “Z-drugs” in most older adults because of their association with cognitive impairment, delirium, falls, fractures, and other adverse events. (3)
That doesn’t mean they’re never appropriate. Benzodiazepines may still be used for conditions such as seizure disorders, severe generalized anxiety disorder, rapid eye movement sleep behavior disorder, withdrawal management, and anesthesia.
They also shouldn’t be stopped suddenly in someone who may be physically dependent on them. Abrupt discontinuation or reducing the dosage too quickly can cause serious withdrawal reactions, including potentially life-threatening seizures. When discontinuation is appropriate, the medication generally requires an individualized, medically supervised taper. (8)
Opioids, used primarily to treat pain, can also cause sedation, dizziness, confusion, and impaired coordination. Their effects may be especially concerning when treatment is first started, the dosage is increased, or the opioid is combined with another medication that slows the central nervous system.
But pain itself can affect balance too.
Someone in severe pain might walk differently, move less, lose strength, become distracted, or rush through a painful movement. The answer isn’t always to eliminate pain medication. The goal is to manage pain effectively while minimizing unnecessary risk.
Gabapentin and pregabalin are anticonvulsant medications that are also used for certain forms of nerve pain and other conditions. Depending on the dosage, kidney function, and other medications being taken, they can cause dizziness, drowsiness, blurred vision, or other central nervous system effects.
Kidney function is particularly important because these medications are primarily eliminated through the kidneys. The Beers Criteria recommends reducing the dosage of gabapentin when kidney function is reduced because of the risk of central nervous system adverse effects. (3)
The combinations may be more concerning than any single medication.
The Beers Criteria recommends avoiding opioids combined with benzodiazepines because of the increased risk of overdose and other serious adverse events. It also recommends generally avoiding opioids combined with gabapentin or pregabalin because of the risk of severe sedation-related events, respiratory depression, and death, although limited clinical exceptions exist. (3)
Antipsychotic medications may also affect alertness, movement, blood pressure, and cognition. They require particular caution in people with dementia.
The Beers Criteria recommends avoiding antipsychotics for behavioral symptoms of dementia or delirium unless non-drug approaches have failed, aren’t possible, or the person threatens substantial harm to themselves or others. If an antipsychotic is necessary, clinicians are advised to use the lowest effective dose and occasionally reconsider whether it is still needed. (3)
This warning is specifically about using antipsychotics to manage behavioral symptoms of dementia or delirium. It doesn’t mean antipsychotics are inappropriate for every condition. They may remain appropriate for established indications such as schizophrenia, bipolar disorder, or other situations in which the benefits justify the risks.
2. Medications That Make Standing and Walking Less Stable
Some medication-related falls begin before the person takes their first step.
Orthostatic hypotension is a drop in blood pressure that occurs after standing. It can cause lightheadedness, blurred vision, weakness, unsteadiness, or fainting.
A common story sounds something like this:
Someone gets out of bed during the night. They sit up, stand quickly, and immediately begin walking toward the bathroom. Before their blood pressure and awareness have fully adjusted, they become lightheaded and lose their balance.
The risk can increase during sickness, dehydration, weight loss, or after a medication change.
Blood-pressure medications are often essential and shouldn’t be treated as universally inappropriate or dangerous. Treating high blood pressure can prevent strokes, heart attacks, and other serious problems.
However, the Beers Criteria specifically flags certain medications, including nonselective peripheral alpha-1 blockers when used for hypertension, centrally acting alpha agonists, and immediate-release nifedipine. Depending on the medication, concerns may include orthostatic hypotension, bradycardia, central nervous system effects, or excessive hypotension. (3)
Other antihypertensives and diuretics aren’t automatically inappropriate. They should be reviewed when someone develops:
Dizziness or weakness after standing
Falls following a dosage increase
Unusually low blood-pressure readings
Dehydration or recent illness
Electrolyte abnormalities
Several medications affecting blood pressure at once
Diuretics may also increase urinary frequency. That can create hurried trips to the bathroom, more walking at night, or attempts to stand before the person is fully alert.
A medication can consequently contribute to the situation in which a fall occurs without directly impairing balance.
Some antidepressants and antipsychotics can also contribute to orthostatic hypotension. The important question isn’t simply whether someone takes “a blood-pressure medication.” It’s whether the complete medication plan produces symptoms that affect standing and walking.
A medication that worked well for years may need to be reconsidered after weight loss, illness, changes in activity, worsening kidney function, or the addition of another medication.
The goal isn’t to stop treating high blood pressure. It’s to determine whether the current medication, dosage, timing, and combination still fit the person’s present health.
3. Medications That Affect Thinking, Vision, and Awareness
Balance depends on more than muscles and reflexes. A person also needs to see the environment, recognize hazards, remember safety instructions, and make appropriate decisions.
Medications that affect thinking or vision can interfere with that process.
A person may forget to use their walker, misjudge the edge of a chair, fail to notice an object on the floor, or attempt to walk when they’re unusually groggy. I see this scenario daily.
We sometimes describe these events as carelessness. But the person’s awareness or judgment may be temporarily altered.
Anticholinergic medications are particularly important here.
Anticholinergic effects can come from prescription drugs, bladder medications, older antidepressants, antihistamines, and common over-the-counter nighttime products.
Possible effects include:
Confusion
Drowsiness
Blurred vision
Constipation
Urinary retention
Cognitive impairment
One anticholinergic medication may cause only mild symptoms. The bigger problem may be anticholinergic burden, which occurs when several medications with anticholinergic properties are taken together.
The Beers Criteria reports that cumulative exposure to anticholinergic drugs is associated with increased risks of falls, delirium, and dementia. It also recommends minimizing the number of anticholinergic medications used at the same time. (3)
Diphenhydramine, the active ingredient in Benadryl and many “PM” products, is an important example.
People might not think of an over-the-counter allergy or sleep medication as part of their fall risk, but it absolutely belongs in the medication review.
That doesn’t mean diphenhydramine is never appropriate. The Beers Criteria acknowledges that it may be appropriate in situations such as the acute treatment of a severe allergic reaction. (3)
Selected antidepressants may also affect sedation, attention, blood pressure, or coordination.
The Beers Criteria recommends caution with serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, and tricyclic antidepressants in people with a history of falls or fractures. It also acknowledges that the evidence is mixed, although newer evidence suggests that serotonin-norepinephrine reuptake inhibitors may increase fall risk. (3)
This is another situation where the condition being treated matters.
Untreated depression can affect physical activity, concentration, motivation, self-care, and social participation. Depression itself has also been associated with increased fall risk. (5)
The question isn’t simply whether an antidepressant can increase fall risk. The question is whether its benefits outweigh its risks for the individual and whether those risks can be reduced.
One Medication May Not Be the Problem
This is what makes the medication list so difficult to interpret during a fall evaluation.
My patient may not be taking one medication that obviously explains everything. They may be taking one that makes them slightly sleepy, another that lowers their blood pressure, and another that slows their reactions.
None causes a dramatic problem alone.
Together, they leave less room to recover when something goes wrong.
Polypharmacy generally means taking multiple medications. Five or more is the most commonly used numerical definition, although researchers and clinicians don’t use one universal threshold. (9)
More importantly, the number alone doesn’t determine whether a medication plan is appropriate or how much fall risk it creates.
Depending on what the medications are, why they’re needed, and how they’re managed, 10 necessary medications could be safer than three medications that all cause sedation, dizziness, or low blood pressure.
More useful questions include:
Are several medications sedating?
Do multiple medications lower blood pressure?
Do several have anticholinergic effects?
Are three or more central nervous system medications being combined?
Was anything recently added or increased?
Are all the medications treating active problems?
Has kidney or liver function changed?
Are alcohol, cannabis, supplements, or over-the-counter products involved?
The Beers Criteria specifically recommends avoiding the simultaneous use of three or more central nervous system-active drugs from certain categories because of the increased risk of falls and fractures. These categories include anticonvulsants, antidepressants, antipsychotics, benzodiazepines, Z-drugs, opioids, and skeletal muscle relaxants. (3)
That’s the stacking effect.
The medications don’t need to have the same name or treat the same condition. They only need to push the nervous system in the same direction.
What Does the Research Say About Multiple FRIDs?
A 2024 observational analysis followed 2,157 generally healthy, community-dwelling adults 70 and older for three years.
In the study’s primary adjusted models, taking at least one FRID at baseline was associated with higher rates of total, injurious, and recurrent falls. The associations were generally stronger among people taking two or more FRIDs. (4)
However, the results require an important note.
After the researchers additionally adjusted for the number of medical conditions, the associations between taking at least one FRID and the three fall outcomes weakened and were no longer statistically significant.
Among people taking two or more FRIDs, the associations with total and injurious falls remained statistically significant. The association with recurrent falls was borderline. (4)
This doesn’t prove that multiple FRIDs caused the falls.
People taking these medications may differ in other important ways from people who aren’t taking them. The medical conditions requiring the medications may also contribute to fall risk.
The findings do strengthen the argument for examining medication combinations rather than looking only at the total number of prescriptions.
When Every Prescription Makes Sense, but the Complete List Doesn’t
Medication management becomes especially difficult when several clinicians are involved.
A cardiologist treats the heart. A pain specialist treats chronic pain. A psychiatrist treats depression or anxiety. A neurologist treats nerve symptoms. A medication is added during a hospital stay. Over-the-counter products are purchased without appearing in the medical record.
Each decision may be reasonable when viewed on its own, but the complete list may tell a different story.
No one may be evaluating how the entire combination affects walking, alertness, blood pressure, reaction time, or nighttime mobility.
This is why medication reviews matter. It’s also why pharmacists can be so valuable.
A physician can have the most complete understanding of the person’s medical conditions. A pharmacist can identify interactions, duplicate effects, dosing concerns, and medications that are no longer necessary.
Current international fall-prevention guidance recommends using a structured medication review to identify FRIDs and incorporating appropriate deprescribing into a personalized, multifactorial fall-prevention plan. (5)
Medication Timing Can Reveal Important Clues
If someone is falling, don’t just ask what medications they take. Ask when they take them and when the falls occur.
Look for patterns such as falls or near-falls:
Shortly after taking a medication
During the night
First thing in the morning
Immediately after standing
After a dosage increase
After starting a new medication
During an illness
When dehydrated
After taking an “as needed” medication
After combining a medication with alcohol or cannabis
A simple diary can help.
Record the medication, dosage, time taken, symptoms, blood-pressure readings if available, and any falls or near-falls. Also record what the person was doing when the symptoms appeared.
This won’t establish medical causation, but it can give a physician or pharmacist much more useful information than simply saying, “I’ve been dizzy lately.”
Will Stopping FRIDs Prevent Falls?
This is where the evidence becomes uncomfortable, but important.
Observational research consistently connects FRID use with falls. However, trials testing FRID deprescribing as a standalone intervention haven’t consistently reduced falls.
A 2021 systematic review identified five randomized trials involving 1,305 adults 65 and older. Compared with usual care, deprescribing FRIDs as a standalone intervention didn’t significantly change fall rates, the proportion of people who fell, or fall-related injury rates over six to 12 months. None of the trials evaluated fall-related fractures or hospitalizations. (6)
The authors didn’t conclude that medication review is ineffective. Instead, they concluded that there wasn’t enough robust, high-quality evidence to support or reject FRID deprescribing as a standalone fall-prevention strategy.
That nuance is useful to know.
A medication review may fail to reduce falls if the recommended changes are never implemented. A medication may also be necessary and impossible to discontinue safely.
Even when deprescribing is successful, the person may still have:
Leg weakness
Poor balance
Neuropathy
Vision loss
Unsafe footwear
Environmental hazards
Fear of falling
Poor use of an assistive device
Slow protective reactions
Changing a medication won’t automatically correct those problems.
Medication review should be part of fall prevention, but it shouldn’t replace strength and balance training, vision care, environmental changes, medical assessment, or the appropriate use of an assistive device.
What Should You Do if a Medication May Be Affecting Your Balance?
Don’t Stop It on Your Own
Some medications can cause serious withdrawal or rebound symptoms when stopped cold turkey. Other medications may be treating conditions that become dangerous when treatment is suddenly interrupted.
Even if a medication appears in the Beers Criteria, talk with the prescribing clinician or pharmacist before changing it.
Request a Complete Medication Review
Bring a complete list that includes:
Prescription medications
Over-the-counter medications
Vitamins and supplements
Sleep aids
Allergy medications
Medications taken only as needed
Alcohol use
Cannabis or CBD products
If possible, bring the actual bottles. Medication lists in medical records aren’t always complete or current.
Ask Better Questions
Questions worth asking include:
Is every medication still necessary?
Could any of these medications cause dizziness, sedation, confusion, vision changes, or low blood pressure?
Am I taking several medications with similar side effects?
Did anything change around the time my falls began?
Could changes in my kidney or liver function affect the dosage?
Could the dosage be safely reduced?
Is there a safer alternative?
Could changing the time I take it reduce symptoms?
Do my over-the-counter products interact with my prescriptions?
If we discontinue something, how should it be tapered and monitored?
A Medication Review Is Not the Same as Medication Removal
A good medication review doesn’t always end with fewer medications, but that doesn’t mean it is a waste of time.
It may lead to:
Keeping the medication unchanged
Lowering the dosage
Changing when it is taken
Substituting a safer option
Gradually tapering it
Monitoring blood pressure or laboratory values
Treating the underlying condition differently
Adding mobility precautions while the medication remains necessary
The goal isn’t to create the shortest medication list possible.
The goal is to create the safest and most effective plan for that person.
Final Thoughts: The Medication List Is Part of the Fall Assessment
When I evaluate someone with recurrent falls, I rarely find one dramatic explanation. Life is unfortunately never that cut and dry.
Instead, I find several smaller problems working together.
The person might have weak legs, reduced balance, and a tendency to rush to the bathroom. Their blood pressure might drop when they stand. Several medications might cause overlapping sedation or dizziness. They might be especially groggy at a particular time of day.
Addressing only one of those problems probably won’t eliminate every fall.
But ignoring the medication list means ignoring a potentially modifiable part of the larger picture.
Falls are often blamed on age, weakness, or carelessness. Sometimes those factors matter, but medications can change alertness, coordination, blood pressure, vision, and the ability to recover from a loss of balance without you even realizing it.
The Beers Criteria and FRID frameworks can help identify concerns, but neither can determine what’s right for an individual. That requires a thoughtful review of the person, the medication, why it was prescribed, how it affects them, and everything else they’re taking.
If you or someone you care for has started falling, don’t simply accept it as part of aging. Bring the complete medication list to a physician or pharmacist and ask whether it could be part of the problem.
A medication list should be treated as part of the fall assessment, not as background paperwork.
What’s My Fall Risk Score?
Most people don’t notice their balance declining until something goes wrong.
This 10-minute self-assessment will show you:
• How stable your balance really is
• Where you're most at risk (strength, coordination, or falling ability)
• What to focus on first
No equipment. No guesswork. Just clear answers.
References
Centers for Disease Control and Prevention. Older adult falls data. Updated February 26, 2026. Accessed August 29, 2026. https://www.cdc.gov/falls/data-research/index.html
Farley TA. Risky prescribing and the epidemic of deaths from falls. JAMA Health Forum. 2025;6(8):e253031. doi:10.1001/jamahealthforum.2025.3031
By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372
Molino CDGRC, Forster CK, Wieczorek M, et al. Association of fall risk-increasing drugs with falls in generally healthy older adults: a 3-year prospective observational study of the DO-HEALTH trial. BMC Geriatr. 2024;24(1):980. doi:10.1186/s12877-024-05557-2
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: implications and implementation. Eur Geriatr Med. 2023;14(4):649-658. doi:10.1007/s41999-023-00824-8
Lee J, Negm A, Peters R, Wong EKC, Holbrook A. Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis. BMJ Open. 2021;11(2):e035978. doi:10.1136/bmjopen-2019-035978
Centers for Disease Control and Prevention. Pharmacy care (STEADI-Rx). Updated August 4, 2025. Accessed August 29, 2026. https://www.cdc.gov/steadi/hcp/clinical-resources/pharmacy-care.html
US Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Published September 23, 2020. Accessed August 29, 2026. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. doi:10.1186/s12877-017-0621-2
