Falling in seniors can significantly worsen medication side effects, creating a complex and dangerous cycle that increases health risks and complicates treatment. This relationship is multifaceted, involving how certain medications affect balance, cognition, and blood pressure, and how falls themselves can exacerbate these effects or lead to new complications.
Many medications commonly prescribed to older adults, known as Fall Risk Increasing Drugs (FRIDs), have side effects that directly contribute to falls. These side effects include sleepiness, mental fog, loss of coordination or balance, and low blood pressure. Seniors are particularly vulnerable because aging changes how drugs are metabolized and how the body responds to them. For example, a dose of a medication like Valium that was appropriate in middle age may be effectively doubled in impact by the time a person reaches their 70s, increasing the risk of falls[1].
When a senior falls, the consequences can worsen medication side effects in several ways. First, falls often lead to injuries such as fractures, which may require additional medications like painkillers or sedatives. These new medications can further increase the risk of side effects such as dizziness or sedation, creating a feedback loop that raises the chance of subsequent falls[4]. Additionally, the trauma and stress from a fall can impair physical function and cognition, making it harder for seniors to manage their medications properly, potentially leading to overdosing or missed doses.
Polypharmacy—the use of multiple medications—is common among older adults and is strongly linked to both falls and adverse drug events. Studies show that seniors taking several medications, especially those including tricyclic antidepressants, diuretics, and narcotics, have a significantly higher risk of falling. For instance, elderly patients on tricyclic antidepressants have over a threefold increased risk of falls during hospitalization[2]. Polypharmacy complicates the clinical picture because interactions between drugs can amplify side effects like dizziness, confusion, and blood pressure drops, all of which increase fall risk.
Moreover, falls can lead to a decline in activities of daily living (ADL) and overall functional status, which in turn affects how medications impact the body. Research indicates that among seniors recovering from fractures, those with polypharmacy had worse functional outcomes at discharge, especially in the 75–89 age group. This suggests that falls and medication side effects are intertwined with the patient’s ability to recover and maintain independence[2].
Central nervous system (CNS) acting drugs—such as benzodiazepines, opioids, antidepressants, and gabapentin—are particularly implicated in increasing fall risk and related mortality. A recent report found that in 2023, 41,000 adults over 65 died from falls, a number exceeding deaths from breast or prostate cancer, car crashes, and drug overdoses combined. The overuse or inappropriate use of CNS medications contributes to oversedation and impaired balance, which are major factors in these fatal falls[3].
Physiological changes in seniors, such as reduced intrinsic capacity (a composite of physical and mental abilities), also play a role. Conditions like osteoarthritis and previous joint replacements can cause pain, stiffness, and muscle weakness, increasing fall risk. These conditions often require analgesic or anti-inflammatory medications, which themselves may have side effects that worsen balance and alertness[4].
In practical terms, falls can cause sudden drops in blood pressure or faintness due to injury or stress, which may be exacerbated by medications that affect cardiovascular function. Drowsiness, fatigue, dizziness, and vertigo caused by medications can be intensified after a fall, especially if the fall leads to hospitalization or changes in medication regimens[5].
To mitigate these risks, healthcare providers recommend regular medication reviews for seniors, especially those who have experienced falls or are on multiple medications. Adjusting dosages, discontinuing unnecessary FRIDs, or substituting safer alternatives can reduce side effects and fall risk. The CDC advises patients and caregiver
