Medications and Increased Fall Risk

Polypharmacy has been linked to increased fall risk and recurrent falls in older adults, though it is not solely responsible for falls.

Helpful Highlights

  • Polypharmacy is the use of five or more prescription medications daily. The use of ten or more medications is referred to as hyper-, heightened-, or excessive polypharmacy.

  • Polypharmacy is common among the elderly and makes them 1.5-2 times more likely to fall and is related to recurrent falls (2 or more in 12 months).

  • There appears to be a stronger link between falls and the types of medications taken rather than polypharmacy on its own.

  • Medications are a key modifiable (controllable) risk factor for falls, though they are not the sole reason falls occur.

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Multiple studies, dating back two decades, have linked the number of medications taken and the risk of falls in older adults. In recent years, greater definition has been given to this link and it appears that the types of medications taken are more influential than mere polypharmacy alone. However, it stands to reason that the more medications prescribed, the more likely they are to include those medications that most increase fall risk.

Definitions of fall risk-increasing drugs (FRIDs) vary, but those classes identified as consistently associated with a higher risk of falls are:

  • benzodiazepines (anti-anxiety)

  • antidepressants (mainly tricyclic class)

  • psychotropics (antipsychotics)

  • non-benzodiazepine sedative-hypnotics (sleep aids)

As well, though not as consistently associated with a higher risk of falls are:

  • diphenhydramine (Benadryl)

  • opioids (narcotics)

  • prescription drugs for overactive bladder

Reducing FRID use as a stand-alone intervention may not be effective in reducing falls, though as part of a larger strategy that includes deprescribing and other non-pharmaceutical approaches, it could reduce fall risk.

If you are concerned about your loved one falling, and they are taking one or more FRIDs, talk with their primary healthcare provider and their other specialists about the association with fall risk and discuss ways to possibly reduce or eliminate FRIDs from your loved one's daily drug regimen.

RESOURCES

Dhalwani, N.N., Fahami, R., Sathanapally, H., Seidu, S., Davies, M.J., & Khunti, K. (2017). Association between polypharmacy and falls in older adults: a longitudinal study from England. BMJ Open, 2017, 7, e016358. doi: 10.1136/bmjopen-2017-016358

Haddad, Y.K., Karani, M.V., Bergen, G., & Marcum, Z.A. (2019). Willingness to change medications linked to increased fall risk: A comparison between age groups. Journal of the American Geriatric Society, 67(3), 527-533. doi: 10.1111/jgs.15696

Hammond, T., & Wilson, A. (2013). Polypharmacy and falls in the elderly: A literature review. Nursing and Midwifery Studies, 2(2), 171-175. doi: 10.5812/nms.10709

Harvard Medical School. (2021, November 15). Medications that increase your risk of falling. Harvard Health Publishing. Link

Le, K., Chou, E., Boyce, R.D., & Albert, S.M. (2021). Fall risk-increasing drugs, polypharmacy, and falls among low-income community-dwelling older adults. Innovation in Aging, 5(1), igab001. DOI

Milos, V., Bondesson, A., Magnusson, M., Jakobsson, U., Westerland, T., & Midlov, P. (2014). Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC Geriatrics, 14, 40. DOI

Ming, Y., & Zecevic, A. (2018). Medications & polypharmacy influence on recurrent fallers in community: A systematic review. Canadian Geriatrics Journal, 21(1), 14-25. doi: 10.5770/cgj.21.268

Wollcott, J.C., Richardson, K.J., Wiens, M.O., Patel, B., Marin, J., Khan, K.M., & Marra, C.A. (2009). Meta-analysis of the impact of 9 medication classes on falls in elderly persons. JAMA Archives of Internal Medicine, 169(21), 1952-1960. doi: 10.1001/archinternmed.2009.357

Zaninotto, P., Huang, Y.T., Di Gessa, G., Abell, J., Lassale, C., & Steptoe, A. (2020). Polypharmacy is a risk factor for hospital admission due to a fall: Evidence from the English Longitudinal Study of Ageing. BMC Public Health, 20, 1804. DOI

No content in this app, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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