Every year, more than 36,000 older adults in the U.S. die from falls. That’s more than car crashes or gun violence. And here’s the hard truth: many of these falls aren’t just bad luck-they’re caused by medications. Not one or two, but often a mix of pills that seniors have been taking for years without a second thought. The problem isn’t that these drugs are dangerous on their own. It’s that they’re given out like candy, and nobody checks if they’re still needed.

What Medications Are Most Likely to Cause Falls?

It’s not just one drug. It’s entire categories. The American Geriatrics Society’s Beers Criteria-updated every two years-is the gold standard for identifying risky medications in older adults. Here’s what they say: if you’re over 65 and taking any of these, your fall risk goes up.

• Antidepressants-especially tricyclics like amitriptyline and SSRIs like sertraline. These don’t just lift your mood; they mess with your balance. Studies show they double the chance of falling. Why? They cause dizziness, low blood pressure when standing, and slow reaction times.
• Benzodiazepines-drugs like diazepam (Valium) and lorazepam (Ativan). These are prescribed for anxiety or sleep, but they make you groggy, unsteady, and slow to react. Long-acting ones are worse. Even short-acting versions aren’t safe long-term.
• Antipsychotics-used for dementia-related agitation. Medications like risperidone and haloperidol can cause stiffness, tremors, and sudden drops in blood pressure. The FDA has black box warnings for these in older adults with dementia because they increase stroke and death risk-and falls are part of that.
• Blood pressure meds-ACE inhibitors like lisinopril, beta blockers like carvedilol, and diuretics like hydrochlorothiazide. These are meant to protect your heart, but if the dose is too high or you’ve just started them, your blood pressure can crash when you stand up. That’s orthostatic hypotension-and it’s a top reason seniors end up on the floor.
• Opioids-oxycodone, hydrocodone, tramadol. These aren’t just addictive. They make you dizzy, confused, and slow. When combined with benzodiazepines, fall risk jumps by 150%.
• Antihistamines-especially diphenhydramine (Benadryl). Found in sleep aids and allergy pills, these are loaded with anticholinergic effects. They dry out your mouth, blur your vision, fog your brain, and make you wobbly. Yet they’re still sold over the counter like candy.
• Muscle relaxants-cyclobenzaprine, carisoprodol. These are often prescribed for back pain, but they knock you out. One study found seniors on these were 2.5 times more likely to fall.
• Anticholinergics for bladder control-oxybutynin, tolterodine. These help with frequent urination, but they also impair memory and coordination. The Beers Criteria says they should be avoided in older adults entirely.

And here’s the kicker: most seniors aren’t on just one of these. They’re on three, four, or more. That’s called polypharmacy. And it’s not just a number-it’s a multiplier. Each drug adds its own risk. Together, they create a perfect storm.

Why Do These Drugs Cause Falls?

It’s not magic. It’s physiology.

As we age, our bodies change. Our kidneys and liver don’t clear drugs as fast. Our brains become more sensitive to sedatives. Our blood vessels don’t adjust quickly to standing up. So a dose that was fine at 50 becomes dangerous at 75.

Take orthostatic hypotension. When you stand up, gravity pulls blood down. Your body normally responds by tightening blood vessels and speeding up your heart. But if you’re on a blood pressure pill or an antidepressant, that response is blunted. Your brain doesn’t get enough blood for a few seconds. You feel lightheaded. You sway. You fall.

Or consider sedation. Benzodiazepines and opioids slow down your central nervous system. Your reaction time drops. Your balance gets shaky. Your eyes don’t track movement as well. You miss a step. You don’t catch yourself. That’s how a simple stumble turns into a hip fracture.

And then there’s cognition. Anticholinergics-found in many OTC sleep aids and bladder meds-block acetylcholine, a brain chemical critical for memory and attention. Seniors on these meds often report feeling “foggy.” That fog makes it harder to notice slippery floors, uneven steps, or cluttered hallways. It’s not that they’re clumsy. It’s that their brain isn’t processing the world the way it should.

How Many Seniors Are Affected?

More than you think.

A 2023 study in JAMA Health Forum found that between 65% and 93% of older adults hospitalized for fall injuries were taking at least one medication known to increase fall risk. Nearly half were taking three or more. And here’s the most alarming part: the rise in fall deaths since 2018 didn’t match any increase in frailty, dementia, or home hazards. It matched a sharp rise in prescriptions for CNS-active drugs.

Between 1991 and 2013, opioid prescriptions in the U.S. tripled. Benzodiazepine prescriptions for seniors rose by over 40% in the last decade. Antidepressant use in older adults has doubled since 2000. And most of these were never reviewed.

Many seniors have been on these meds for years-since a doctor prescribed them for anxiety after their spouse died, or for sleep after retirement, or for pain after a minor injury. No one ever asked if they still needed them. No one checked if the risks outweighed the benefits.

What Can Be Done? The Power of Deprescribing

The good news? You can fix this.

Dr. Cara Cassino, a geriatrician with the CDC’s STEADI program, says this plainly: “Reviewing medications with all patients 65 and older is the single most effective clinical intervention for reducing fall risk.”

Deprescribing isn’t about stopping meds cold. It’s about asking: “Do you still need this? Is the benefit still worth the risk?”

Studies show that when pharmacists or doctors systematically review senior medication lists, fall rates drop by 20% to 30%. One program called HomeMeds, run by the University of South Florida, found that pharmacist-led reviews reduced falls by 22% in community-dwelling seniors.

Here’s how it works:

1. Make a full list-every pill, patch, and OTC drug. Include vitamins, herbal supplements, and sleep aids. Don’t forget the Benadryl you take for allergies.
2. Bring it to your doctor or pharmacist-ask: “Which of these could be making me dizzy or unsteady?”
3. Ask about alternatives-for sleep, try cognitive behavioral therapy instead of benzodiazepines. For bladder issues, pelvic floor exercises might work better than oxybutynin.
4. Look for dose reductions-sometimes lowering the dose reduces side effects without losing benefit.
5. Track your balance-if you feel wobbly after starting a new med, tell your provider. Don’t wait for a fall.

Doctors aren’t always trained to do this. A 2022 study found only 42% of primary care physicians routinely check for medication-related fall risk. So you have to lead the conversation.

What Should Seniors and Families Ask?

Don’t wait for your doctor to bring it up. Ask these questions:

• “Is this medication still necessary?”
• “Could it be causing my dizziness or unsteadiness?”
• “Are there safer alternatives?”
• “Can we try lowering the dose?”
• “What happens if I stop this?”

If your loved one is taking four or more medications, especially if they’ve had a fall or near-fall, request a full medication review. Ask for a referral to a geriatrician or clinical pharmacist. Many hospitals and clinics now have medication management programs specifically for seniors.

And if you’re taking any of these drugs-stop taking them on your own. That’s dangerous. But do talk to your provider. Together, you can make a plan to taper off safely.

What About Over-the-Counter Drugs?

They’re not harmless.

Many seniors don’t think of Benadryl, Unisom, or NyQuil as “medications.” But they’re full of anticholinergics. One pill can last 8-12 hours and leave you foggy, wobbly, and confused. The Beers Criteria says these should be avoided entirely in older adults.

Same with melatonin supplements. While they’re natural, they can interact with blood pressure meds and cause drowsiness. Don’t assume “natural” means “safe.”

Check every bottle. If it says “drowsiness may occur,” it’s a red flag.

What’s the Future?

Change is coming-but slowly.

By 2025, 75% of academic medical centers plan to have formal deprescribing protocols. Right now, only 35% do. Electronic health records are starting to flag high-risk combinations. Pharmacists are becoming key players in senior care.

But until then, the power is in your hands. If you or someone you love is over 65 and taking multiple medications, don’t assume they’re all necessary. Don’t assume they’re safe. Ask. Review. Challenge. You might just prevent the next fall-and save a life.