Key takeaways:

• U.S. deaths from falls in adults 65+ have more than tripled over ~30 years. Clinicians point to the soaring use of certain medications—often called fall-risk–increasing drugs (FRIDs)—as a major, modifiable contributor. Ovid
• Prospective data show that taking any FRID raises the incidence of total, injurious, and recurrent falls; taking multiple FRIDs raises the risk even more. PMC
• The CDC’s STEADI program urges routine medication reviews and coordinated deprescribing when benefits don’t clearly outweigh risks. CDC

What are FRIDs?

Fall-risk–increasing drugs (FRIDs) are medicines whose side effects—like sedation, dizziness, slowed reaction time, blurred vision, orthostatic hypotension, or impaired balance—can make a fall more likely. Clinicians watch especially for CNS-active FRIDs:

• Opioids (pain medicines)
• Benzodiazepines and “Z-drugs” (sleep aids)
• Gabapentinoids (e.g., gabapentin, pregabalin)
• Antidepressants

Other categories (e.g., strong anticholinergics) can also increase risk; meanwhile, some widely used drugs (like proton-pump inhibitors) don’t cause falls per se but may worsen fall injuries (e.g., through bone effects or bleeding). The common thread is impaired balance/alertness or compounded risk when several FRIDs are taken together. Ovid+1

How strong is the evidence?

• Population signal. In 2023, >41,000 older Americans died from fall injuries, and the mortality rate has more than tripled since the early 1990s—rising in the U.S. even as peer countries fell. A leading view in JAMA Health Forum argues that the change is unlikely to be explained by frailty alone and does align with rising FRID exposure. Ovid
• Prospective cohort (3 years, n=2,157). In generally healthy adults ≥70, baseline use of ≥1 FRID increased the incidence rate of total falls (IRR 1.13), injurious falls (1.15), and recurrent falls (1.12). Using ≥2 FRIDs amplified risk: total (1.22), injurious (1.33), recurrent (1.14). Effects were strongest in adults ≥75. PMC
• Systematic review (JAGS). Among older adults presenting with a fall injury, 65%–93% were taking at least one FRID; antidepressants and sedative-hypnotics were most common. PMC

Caveat: These are associations. Not every study proves causation, and comorbidities matter. But the pattern is consistent, and FRID exposure is one of the few fall risks clinicians can change. PMC

Why polypharmacy matters

Even modest side effects can stack. Two or three small hits to alertness, gait, or blood pressure can turn a safe step into a misstep. That’s why guidelines (e.g., AGS Beers Criteria) flag benzodiazepines and related sedatives for avoidance in most older adults, and why deprescribing programs emphasize tapering and safer alternatives rather than abrupt stops. PubMed+1

What older adults and families can do (today)

1. Bring every med (RX, OTC, supplements) to your next visit. Ask: “Which of these could raise my fall risk?” The CDC’s STEADI-Rx toolkit encourages pharmacist-led screening, med review, and follow-up with your prescriber. CDC
2. Ask about safer swaps. For chronic pain, anxiety, or insomnia, discuss non-sedating options and non-drug therapies first; if a FRID is essential, aim for lowest effective dose and shortest duration. Ovid
3. Never stop sedatives suddenly. Benzodiazepines and Z-drugs must be tapered to avoid withdrawal; deprescribing should be planned and supervised. NursingCenter
4. Stack the deck in your favor. Vision checks, strength/balance training, home safety fixes (lighting, grab bars, no loose rugs), proper footwear, and cautious alcohol use all reduce risk independently of meds. (These are core STEADI elements.) CDC

What clinicians and health systems can do

• Flag FRIDs in the EHR and prompt for reconsideration when patients are ≥65—especially if they’re on multiple FRIDs or have had a recent fall. Ovid
• Use Beers Criteria & STOPP/START to guide safer choices; document a deprescribing plan (who tapers what, how fast, and when to reassess). PubMed
• Team up with pharmacists. The STEADI-Rx algorithm lays out screening, med review, and communication workflows that practices can adopt. CDC

Bottom line

Falls aren’t inevitable—with the right medication strategy, many are preventable. Review sedating and balance-impairing drugs regularly, avoid unnecessary combinations, taper wisely, and pair medication changes with strength, vision, and home-safety interventions. The evidence says that’s where the biggest wins are for keeping older adults upright, independent, and safe. PubMed+4Ovid+4PMC+4