Fall Prevention Strategies for Sedating Medications in Older Adults

Every year, more than 36 million older adults in the U.S. fall-and nearly 32,000 of them die from those falls. The CDC calls this a public health crisis. But here’s the uncomfortable truth: many of these falls aren’t just bad luck. They’re often triggered by medications meant to help, not hurt. Sedating drugs like benzodiazepines, opioids, antidepressants, and muscle relaxants are commonly prescribed to manage pain, anxiety, or insomnia in older adults. But they don’t just calm the mind-they slow reaction time, blur vision, and throw off balance. And when someone’s already at risk for falling, these drugs can turn a simple trip to the bathroom into a life-changing injury.

Which Medications Are the Biggest Culprits?

Not all sedating medications carry the same risk. Some are far more dangerous than others when it comes to falls. The list of Fall Risk Increasing Drugs (FRIDs) includes anticonvulsants, antidepressants, antipsychotics, benzodiazepines, sedatives, hypnotics, opioids, and even some blood pressure pills. But among these, a few stand out as especially risky.

Benzodiazepines like diazepam (Valium) and lorazepam (Ativan) are classic offenders. They’re often prescribed for anxiety or sleep, but they linger in the body longer as we age, building up and causing drowsiness that lasts into the next day. One study found that people taking these drugs were 60% more likely to fall than those who weren’t.

Opioids-even low-dose ones like tramadol-are another major concern. They don’t just mask pain; they cloud thinking and make you feel unsteady on your feet. The risk spikes when opioids are combined with other sedatives. A 2023 Mayo Clinic analysis showed that patients taking two or more sedating medications had more than double the fall risk of those on just one.

Antidepressants, especially tricyclics like amitriptyline, are surprisingly common in older adults and carry a hidden danger. Their sedating side effects aren’t always obvious to patients or even doctors. One 2022 study found that 44% of older adults taking these drugs reported feeling dizzy or unsteady, but only 12% told their doctor.

And then there’s baclofen, a muscle relaxant often used for back pain or spasticity. It’s one of the highest-risk medications in its class, with studies showing it increases fall risk more than any other muscle relaxant. Yet it’s still frequently prescribed without proper monitoring.

How Many Medications Are Too Many?

It’s not just about which drugs you take-it’s about how many. Taking three or more medications at once is called polypharmacy, and it’s one of the strongest predictors of falling in older adults. Each additional drug adds risk, not just from its own side effects, but from how it interacts with others.

Imagine someone on a blood pressure pill, a sleep aid, an antidepressant, and a painkiller. Individually, each might be fine. Together? They create a perfect storm: low blood pressure when standing, dizziness from the sleep aid, slowed reflexes from the painkiller, and confusion from the antidepressant. The result? A stumble that leads to a hip fracture.

Research from the CDC shows that people taking five or more medications have a 50% higher chance of falling than those on one or two. And the risk doesn’t stop at the pill bottle. These drugs can interact with supplements, over-the-counter cold meds, or even grapefruit juice-making things even more unpredictable.

The STEADI-Rx Model: A Proven Way Forward

There’s a solution that’s working in pharmacies across the country: STEADI-Rx. Developed by the CDC and the University of North Carolina, it’s not a new drug or gadget. It’s a simple, three-step process designed to stop medication-related falls before they happen.

Step 1: Screen. Every older adult should be asked: Have you fallen in the past year? Do you feel unsteady? Do you worry about falling? That’s it. No fancy tests. Just a few clear questions.

Step 2: Assess. If the answer is yes, a pharmacist or clinician reviews every medication-not just prescriptions, but supplements and OTC drugs too. They look for FRIDs, check for interactions, and note dose levels. They ask: Is this still necessary? Is there a safer alternative?

Step 3: Intervene. This is where real change happens. In 75% of cases reviewed under STEADI-Rx, the solution wasn’t adding a new drug-it was switching or stopping one. Replacing a benzodiazepine with non-drug sleep therapy. Switching from an opioid to acetaminophen with physical therapy. Stopping an unnecessary antipsychotic.

Pharmacists play a key role here. They use a Provider Consult Form to clearly explain risks and suggest alternatives to the prescribing doctor. In one pilot program, 89% of prescribers accepted the pharmacist’s recommendation. And when they did, falls dropped by 30% over six months.

Exercise Isn’t Just Good for You-It’s a Shield Against Falls

Medication review alone helps. But it works even better when paired with movement. The U.S. Preventive Services Task Force and the American Geriatrics Society both agree: exercise is one of the most effective ways to prevent falls.

Balance training, strength exercises, and walking programs don’t just build muscle-they retrain the brain to react faster, stabilize the body, and recover from a stumble. A Cochrane review found that structured exercise programs reduced falls by 15-29%. Even more striking: they cut fractures by 61% and medical visits for falls by 43%.

What kind of exercise? You don’t need a gym. Tai Chi, seated leg lifts, heel-to-toe walking, and standing on one foot (with support) are all proven. The key is consistency: 30 to 90 minutes, one to three times a week, for at least 12 weeks. That’s not a lot of time-but it’s enough to make a life-saving difference.

What About Vitamin D?

You’ve probably heard that vitamin D helps prevent falls. The truth? It’s complicated. The U.S. Preventive Services Task Force recommends 800 IU daily for older adults. But a major Cochrane review found no clear benefit. Why the difference?

It likely depends on whether someone is deficient. If your vitamin D level is low (under 20 ng/mL), supplementation can help. But if you’re already getting enough sunlight or eating fortified foods, extra pills won’t make you safer. The best approach? Test the level first. Don’t just give supplements blindly.

Why Don’t More Doctors Do This?

You’d think this would be standard care by now. But it’s not. Many primary care doctors are overwhelmed. A 2022 survey by the American Society of Health-System Pharmacists found that 82% of pharmacists believe medication reviews reduce falls-but only 45% have enough time to do them properly.

Prescribers often hesitate to stop medications because they fear withdrawal, worsening symptoms, or patient pushback. One patient on Reddit shared that after switching from diazepam to CBT for insomnia, her nighttime falls stopped completely. But another said her doctor refused to reduce her opioids, saying, “I don’t want you to go back to pain.”

And reimbursement is a barrier. Medicare pays for medication therapy management-but only if the pharmacist is recognized as a provider, which varies by state. Many pharmacies don’t have the staffing or training to run these programs.

What Can You Do?

If you or a loved one is taking one or more sedating medications, here’s what to ask:

• Is this medication still necessary? Could it be stopped?
• Is there a non-sedating alternative?
• Could the dose be lowered?
• Have we checked for interactions with other drugs or supplements?
• Can we add balance exercises to our routine?

Bring a full list of everything you take-including vitamins, herbs, and OTC drugs-to your next appointment. Ask for a pharmacist consult. Most community pharmacies now offer free medication reviews. Don’t wait for a fall to happen. Prevention starts with a conversation.

What’s Next?

The future of fall prevention is getting smarter. In 2023, the CDC updated its STEADI toolkit to include specific deprescribing guides for benzodiazepines and opioids. More pharmacists are getting certified in geriatric pharmacotherapy-over 1,200 now hold the credential. AI tools are being tested to flag dangerous drug combinations before they’re even prescribed.

But none of that matters if we don’t act now. With over 80 million Americans expected to be over 65 by 2040, the need for smarter medication use isn’t coming-it’s already here.