Fall Prevention Strategies for Sedating Medications in Older Adults

Every year, more than 36 million older adults in the U.S. fall-many because of medications meant to help them sleep, calm down, or manage pain. These drugs, while helpful in the short term, can make walking unsteady, blur vision, or slow reaction time. The result? A trip down the stairs, a slip in the bathroom, or a collapse after standing up too fast. And for someone over 65, a fall isn’t just a bruise-it’s a broken hip, a hospital stay, or worse. The good news? Many of these falls can be prevented by looking closely at what’s in the medicine cabinet.

What Medications Raise Fall Risk?

Not all medications are created equal when it comes to fall risk. The ones most likely to cause problems are called Fall Risk Increasing Drugs, or FRIDs. These include:

• Benzodiazepines like diazepam (Valium) or lorazepam (Ativan)-often prescribed for anxiety or insomnia, but they linger in the body and cause drowsiness.
• Antidepressants, especially tricyclics like amitriptyline, which can cause dizziness and low blood pressure when standing.
• Opioids such as oxycodone or hydrocodone-painkillers that slow reflexes and cloud thinking, especially at higher doses.
• Antipsychotics like quetiapine or risperidone, sometimes used for dementia-related agitation, but they can make people unsteady and confused.
• Muscle relaxants like baclofen, which has one of the highest documented risks among its class.
• Antihypertensives, particularly when blood pressure drops too low after standing.

It’s not just one drug-it’s the combination. Taking three or more of these at once multiplies the risk. A person on an antidepressant, a sleep pill, and a painkiller might feel fine sitting down. But stand up? Their body doesn’t adjust fast enough. Blood pressure plummets. Their legs give out. That’s when the fall happens.

The STEADI-Rx Approach: A Proven System

The CDC’s STEADI-Rx program-short for Stopping Elderly Accidents, Deaths & Injuries-Rx-is the most structured way to tackle this problem. It’s not just a checklist. It’s a team effort between doctors, pharmacists, and patients.

Here’s how it works in three steps:

1. Screen: Ask every older adult if they’ve fallen in the past year. If yes, or if they feel unsteady, it’s time to review medications.
2. Assess: Look at every pill they take. Which ones are sedating? Are any duplicates? Are they still needed? Pharmacists use tools like the Beers Criteria-a list of medications best avoided in older adults-to spot trouble.
3. Intervene: This is where real change happens. Instead of just stopping a drug cold, the goal is to replace it with something safer, reduce the dose, or eliminate it entirely.

Studies show that 75% of the changes made through STEADI-Rx involve switching a high-risk drug for a lower-risk alternative. For example, replacing a benzodiazepine with cognitive behavioral therapy for insomnia cuts nighttime falls dramatically. One Reddit user shared that after switching from diazepam to therapy, their monthly falls dropped from 2-3 to zero over six months.

Medication Review Isn’t Enough Alone

Looking at pills is powerful-but it’s not the whole answer. The strongest results come when medication review is paired with physical activity.

Cochrane reviews show that exercise programs focused on balance, strength, and walking reduce the number of people who fall by 15-29%. Programs that meet 3-4 times a week for at least 12 weeks cut falls requiring medical care by 43% and fractures by 61%. It’s not about lifting heavy weights. It’s about standing on one foot, stepping over lines, moving slowly with control. Simple, daily movements make a huge difference.

Even something as basic as vitamin D-1,000 IU daily-can help, though evidence is mixed. The U.S. Preventive Services Task Force recommends 800 IU, while some studies find no benefit. Still, many older adults are deficient, and it’s low-risk. So it’s often included.

But here’s the key: if you only do one thing, do the medication review. Research from the University of Colorado says it’s the single most impactful intervention for fall prevention in older adults. Why? Because it removes the root cause. No sedating drug means no dizziness. No dizziness means no fall.

Why Do People Keep Taking Risky Medications?

You’d think once people know a drug is dangerous, they’d stop. But it’s not that simple.

A 2021 survey by the National Council on Aging found that 63% of older adults struggled to reduce sedating meds because they feared withdrawal-panic attacks from stopping a sleep pill, worsening pain without an opioid, or feeling worse without an antidepressant. Many believe the drug is helping them, even if it’s slowly hurting them.

Doctors and pharmacists face hurdles too. Time is tight. Most primary care visits last 15 minutes. Pharmacists want to help, but only 45% say they have enough time to do full medication reviews. And not all prescribers welcome suggestions from pharmacists, even when backed by data.

That’s why communication matters. STEADI-Rx uses a simple form-called a Provider Consult Form-that pharmacists fill out and send to the doctor. It includes the patient’s three key questions: What’s the goal of this drug? Is it still working? Can we try something safer? If the doctor doesn’t respond within 7 days, the pharmacist follows up. This structure turns a good idea into real action.

What Can You Do Right Now?

You don’t need a fancy program to start. Here’s what anyone can do:

• Make a list of every medication, supplement, and over-the-counter drug you take-including sleep aids, pain relievers, and antihistamines.
• Ask your pharmacist: “Which of these could make me unsteady or increase my fall risk?” They’re trained to spot this.
• Ask your doctor: “Is this still necessary? Can we try lowering the dose or switching to something less sedating?”
• Start moving. Even 10 minutes a day of heel-to-toe walking or standing on one foot improves balance. Look for a local senior exercise class-many are free.
• Remove home hazards. Install grab bars, remove loose rugs, add nightlights. But don’t stop there. Fixing your home won’t help if your meds are making you fall.

Don’t wait for a fall to happen. If you’re over 65 and taking any sedating medication, it’s time to have this conversation. The goal isn’t to stop everything. It’s to find the right balance-enough relief, without the risk.

What’s Changing in 2025?

The field is evolving fast. In 2023, the CDC updated its STEADI toolkit with new guidance on safely stopping benzodiazepines. More pharmacists are getting certified as Geriatric Pharmacotherapy Specialists-over 1,200 now hold the credential. Some states are expanding pharmacists’ authority to adjust certain medications without a doctor’s note, especially for blood pressure or sleep aids.

Artificial intelligence is starting to help too. New tools in electronic health records now flag high-risk combinations automatically-like when a patient is prescribed an opioid and a benzodiazepine together. These alerts don’t replace judgment, but they make sure the conversation happens.

The big driver? Numbers. By 2040, 80 million Americans will be over 65. Falls will keep rising unless we act. And the cost? $418 million in medical expenses each year could be saved just by fixing medication-related fall risks. That’s not just money-it’s independence, dignity, and life.

Next Steps: What to Do Today

If you or someone you care for is over 65 and taking any sedating medication:

1. Write down every pill, patch, or supplement they take.
2. Call your pharmacist and ask: “Which of these could increase fall risk?”
3. Schedule a 15-minute appointment with the doctor to ask: “Can we reduce or replace any of these?”
4. Sign up for a balance class at your local senior center or YMCA.
5. Install grab bars in the bathroom and remove throw rugs.

Small steps, done now, prevent big tragedies later. Falls aren’t inevitable. With the right approach, they’re entirely avoidable.