Medicines that increase fall risk in older adults

Falls are the leading cause of injuries for adults 65 and older. Between 30% to 40% of older adults fall every year. The consequences of falls can be serious. They may lead to a lower quality of life, a loss of independence, an increased risk of admission to a nursing home and death. Falls also can be costly.

There are many factors that can increase the risk of falls. Major risk factors include:

• Age.
• Conditions such as arthritis or Parkinson’s disease.
• One or more previous falls.
• Taking one or more medicines.
• Troubles with movement, cognition or vision.

Side effects of medicines that increase the risk of falls include:

• Confusion.
• Fatigue.
• Hyponatremia, a condition in which sodium levels in the blood are low.
• A change in heart rate or heart rhythm.
• Orthostatic hypotension (OH), a drop in blood pressure when a person stands up after sitting or lying down.
• Sedation.
• Troubles with balance.

Many medicines have side effects that may increase the risk of falls. Taking more than one of these medicines increases the risk even more. Common medicines that may increase fall risk include:

• Benzodiazepines and other hypnosedatives. Hypnosedatives are used to treat sleeping disorders and anxiety conditions. Benzodiazepines are the most common hypnosedatives. Other examples include the “Z-drugs” zolpidem (Ambien), eszopiclone (Lunesta) and zaleplon. Older adults taking hypnosedatives have an increased fall risk. This risk increases after a new prescription or with long-term use.
• Medicines used to treat depression. Also known as antidepressants, these medicines treat depression and other conditions, such as anxiety. Taking certain antidepressants increases the risk of falls due to their sedative side effects. Taking more than one makes the risk even higher.
• Medicines used to treat psychosis. Also known as antipsychotics, these medicines treat conditions such as schizophrenia and bipolar disorder. Antipsychotics carry a risk of OH, which may increase fall risk. More research is needed to fully understand how these medicines may increase the risk of falls.
• Medicines used to treat seizures. Also known as antiepileptics, these medicines are used to treat and prevent seizures. Taking antiepileptics increases fall risk because of their sedative side effects. Antiepileptics also may cause bone thinning. This increases the risk of more-serious fractures during a fall.
• Muscle relaxants. These medicines are used to treat muscle spasms and pain. Taking a muscle relaxant increases the risk of falls due to their sedative effects. Out of all muscle relaxants, baclofen has been associated with the highest risk of falls.
• Nonsteroidal anti-inflammatory drugs. Commonly known as NSAIDs, these medicines are used to treat pain and inflammation. NSAIDs increase the risk of falls in older adults because of their effect on blood pressure.
• Opioids. These medicines are used to treat pain. They may be prescribed after surgery or for ongoing pain. Opioids increase the risk of falls because they cause sedation, dizziness and trouble with thinking. The risk may be higher if you are on a strong dose of opioids or if you are taking more than one medicine.

Other medicines may increase the risk of falls. To decrease fall risk, medicines such as opioids and antidepressants may need to be slowly decreased and eventually stopped. However, stopping medicines could create a greater risk of health issues. For some people, the benefits of taking certain medicines outweigh the risks. Talk with your healthcare professional before stopping any medicines. Your healthcare professional should review your medicines once a year to be sure that they fit your needs.