Medication and Fall Risk in Older Adults

Medication is one of the most significant and most overlooked contributors to fall risk in older adults. Unlike muscle weakness or poor balance, which develop gradually and visibly, medication-related fall risk is often invisible until a fall happens. Understanding which medications carry the highest risk, and what can be done about it, is an important part of a comprehensive fall prevention approach.

Which medications increase fall risk?

Several classes of medication are consistently identified in the research as fall risk factors. Sedatives and sleep medications, including benzodiazepines such as diazepam (Valium), cause drowsiness, slowed reaction time, and impaired coordination that persist well into the following day. Research has linked benzodiazepine use to a 44 percent increased risk of hip fracture.

Blood pressure medications can cause orthostatic hypotension, a drop in blood pressure when standing up from a sitting or lying position, that produces momentary dizziness and loss of stability. This is most likely first thing in the morning or after prolonged sitting. Diuretics, often used alongside blood pressure medications, also contribute through dehydration and electrolyte imbalance.

Antidepressants, including both older tricyclic antidepressants and newer SSRIs, are associated with increased fall risk through effects on balance, blood pressure, and reaction time. Antidepressants have one of the strongest single-drug associations with falls in the research literature.

Antipsychotic medications carry significant fall risk through sedation and postural instability.

The polypharmacy problem

Polypharmacy, the use of four or more medications simultaneously, is common in older adults with multiple chronic conditions. The risk from polypharmacy is not simply additive. Medications interact with each other in ways that can amplify side effects. Taking more than four medications daily raises fall risk significantly, and the risk increases with each additional medication added.

What to do about it

The right response to medication-related fall risk is a conversation with your doctor, not stopping medication independently. Many of the medications associated with fall risk are important for managing serious conditions. The goal is a medication review, not medication elimination.

Ask your GP or specialist to review your full medication list with fall risk in mind. Specifically ask whether any of your medications are contributing to dizziness, drowsiness, or balance problems, whether the dose can be reduced while still achieving the therapeutic goal, and whether any medication can be replaced with one that carries lower fall risk.

Where the biokineticist fits in

A biokineticist cannot review your medication, but can work alongside your medical team to address the physical consequences of medication side effects. If your blood pressure medication causes morning dizziness, a supervised exercise programme can improve your cardiovascular conditioning and muscle tone in ways that reduce the severity of postural hypotension over time. If sedation is reducing your physical activity, a structured programme can help maintain the muscle strength and balance capacity that would otherwise decline.

Need a hand?

Contact JW Bio at https://jwbio.co.za/contact or call 011 880 4719.