Why Seniors Fall - And Why Medications Are Often the Hidden Cause

Every year, more than 14 million older adults in the U.S. fall. About 36,000 of them die from those falls. That’s more than car crashes. And while many assume it’s just aging, weakness, or poor vision, the real culprit is often something far more preventable: the medications they’re taking. Seniors don’t fall because they’re frail - they fall because drugs are making them dizzy, slow, or confused. And most of the time, no one ever checks.

Medications That Raise Fall Risk - The Big Five

It’s not one drug. It’s classes of drugs. And they’re everywhere. If you or a loved one is 65 or older, chances are at least one of these is on the list:

• Antidepressants - Especially SSRIs like sertraline and fluoxetine, and older tricyclics like amitriptyline. These don’t just lift mood - they lower blood pressure when standing, cause drowsiness, and impair balance. A 2018 meta-analysis found people on SSRIs are over twice as likely to fall as those not taking them.
• Benzodiazepines - Drugs like diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax). These are prescribed for anxiety or sleep, but they slow reaction time, blur vision, and make coordination worse. Long-acting versions are especially dangerous. Even short-term use increases fall risk by 42%.
• Antipsychotics - Used for dementia-related agitation or psychosis, drugs like risperidone and quetiapine (Seroquel) cause dizziness, muscle stiffness, and a condition called tardive dyskinesia. These aren’t meant for long-term use in seniors - yet they’re still prescribed for months or years.
• Blood pressure meds - Beta blockers (carvedilol), ACE inhibitors (lisinopril), and diuretics (hydrochlorothiazide) are common. But when doses are too high or changed too fast, they cause orthostatic hypotension - a sudden drop in blood pressure when standing up. That’s when people feel lightheaded, stumble, and fall. It’s not the disease. It’s the treatment.
• Opioids - Painkillers like oxycodone and hydrocodone. They cause drowsiness, dizziness, and confusion. But here’s the worst part: when opioids are mixed with benzodiazepines, fall risk jumps by 150%. That’s not a small risk. That’s a red flag.

And don’t forget the over-the-counter stuff. Diphenhydramine - found in Benadryl, Tylenol PM, and sleep aids - is an anticholinergic. It dries your mouth, blurs your vision, and slows your brain. One study found that seniors taking just one anticholinergic drug had a 50% higher chance of falling. Two? The risk doubles.

Why Polypharmacy Is a Silent Killer

Taking one risky drug? Dangerous. Taking three or four? Deadly. The National Council on Aging says seniors on four or more medications have a much higher chance of falling - not because each drug is bad alone, but because they interact. One drug lowers blood pressure. Another makes you sleepy. A third messes with your balance. Together, they create a perfect storm.

It’s not just the number. It’s the duration. Many of these drugs were prescribed years ago - for anxiety, insomnia, or chronic pain - and never reviewed. Doctors assume they’re still needed. Families assume they’re safe. But the body changes with age. What worked at 60 can be dangerous at 75.

Here’s the truth: 65% to 93% of seniors who fall and get hurt were taking at least one medication known to increase fall risk. And nearly half were taking two or more.

What the Experts Say - The Beers Criteria and STOPP/START

The American Geriatrics Society doesn’t guess. They track it. Since 1991, they’ve published the Beers Criteria - a list of medications that should be avoided or used with extreme caution in older adults. The 2023 update is clearer than ever: benzodiazepines? Avoid. Tricyclic antidepressants? Avoid. Anticholinergics like diphenhydramine? Avoid. Antipsychotics for dementia? Avoid unless absolutely necessary.

Doctors also use two tools: START (Screening Tool to Alert to Right Treatment) and STOPP (Screening Tool of Older Persons’ Prescriptions). STOPP finds drugs that shouldn’t be there. START finds drugs that should be added - like vitamin D or a fall prevention program. Together, they help flip the script: from prescribing more, to prescribing less.

Dr. Michael Steinman, one of the authors of the Beers Criteria, says: “Reducing or eliminating fall-risk-increasing medications can cut fall rates by 20% to 30%.” That’s not a small win. That’s life-changing.

How to Check Your Medications - A Simple 4-Step Plan

You don’t need a PhD to protect yourself or a loved one. You just need to ask the right questions.

1. Get the full list. Write down every pill, patch, and liquid - including vitamins, supplements, and OTC drugs. Don’t trust your memory. Look in the pill bottles.
2. Take it to your doctor or pharmacist. Don’t say, “Is this safe?” Say, “Could any of these be making me dizzy or unsteady?” Ask specifically about the drugs listed above.
3. Ask about deprescribing. Can any of these be stopped? Can the dose be lowered? Is there a safer alternative? For example, instead of a benzodiazepine for sleep, try cognitive behavioral therapy. Instead of diphenhydramine, try melatonin (with doctor approval).
4. Check for orthostatic hypotension. Sit quietly for 5 minutes. Measure your blood pressure. Stand up. Wait 3 minutes. Measure again. If your systolic pressure drops 20 points or more, that’s a red flag. Tell your doctor. It’s often caused by meds - and it’s fixable.

Pharmacist-led reviews - like the HomeMeds program - have been shown to reduce falls by 22%. That’s not magic. That’s science.

What Happens When You Stop

Some people worry: “If I stop my meds, will I get worse?” The answer is often: no. You’ll get better.

One study followed seniors who stopped benzodiazepines. Within weeks, their balance improved. Their memory cleared. Their fall risk dropped. They didn’t relapse into anxiety - they learned other ways to cope.

Another found that seniors who stopped antipsychotics for dementia didn’t get more agitated - they became calmer, more alert, and more engaged. Their families noticed the difference.

Stopping doesn’t mean going cold turkey. It means working with your team to taper safely. Some drugs need weeks to come off. Others can be stopped quickly. But the key is: don’t assume you have to keep taking them forever.

The Bigger Picture - Why This Keeps Happening

Doctors aren’t careless. They’re overwhelmed. Most primary care visits last 15 minutes. Medication lists are long. There’s no time to dig into every pill.

And here’s the irony: we’ve gotten better at treating high blood pressure, depression, and pain - but worse at asking, “Is this still helping - or is it hurting?”

Only 42% of primary care doctors routinely check for medication-related fall risk. That’s not enough. We need better systems: electronic alerts when a senior is prescribed a high-risk drug. Pharmacist consultations built into routine visits. Insurance coverage for medication reviews.

But until then, you have power. You can ask. You can push. You can bring the list. You can say, “I don’t want to fall. What can we take off?”

What to Do Next

Don’t wait for a fall. Don’t wait for a hospital visit. Start today.

• Make a list of every medication you or your loved one takes.
• Bring it to your next appointment - doctor, pharmacist, or both.
• Ask: “Could any of these be causing dizziness or unsteadiness?”
• Ask: “Is there a safer option? Can we try lowering the dose?”
• Ask: “Can we stop one of these?”

Falls aren’t inevitable. They’re often preventable. And the easiest place to start? The medicine cabinet.