Every year, more than 36 million older adults in the U.S. fall-and nearly 32,000 of them die from it. Falls aren’t just accidents. For many, they’re the direct result of medications meant to help but quietly increasing the risk of injury. Sedating drugs like benzodiazepines, antidepressants, opioids, and muscle relaxants are among the most common culprits. These medications don’t just make you drowsy. They slow your reactions, blur your balance, and cloud your judgment-all while you’re trying to get out of bed, walk to the bathroom, or step off a curb. The good news? Many of these falls can be prevented with simple, proven steps.

What Makes a Medication a Fall Risk?

Not all sedating drugs are the same, but they all share one dangerous trait: they affect your central nervous system. Medications classified as Fall Risk Increasing Drugs (FRIDs) include antipsychotics, antidepressants, antihypertensives, benzodiazepines, opioids, anticonvulsants, and muscle relaxants like baclofen. Baclofen, in particular, has one of the highest documented risks among its class. Opioids, even at moderate doses, can cause dizziness and confusion. Antidepressants, especially tricyclics and SSRIs with sedating properties, double the fall risk when taken with other sedatives.

The real danger comes from polypharmacy-taking three or more medications at once. Each additional drug multiplies the risk. A 75-year-old on a sleep aid, a blood pressure pill, an antidepressant, and a painkiller isn’t just managing four conditions. They’re managing four separate ways their body could lose balance. Studies show that people taking five or more medications are more than twice as likely to fall as those on one or none.

The STEADI-Rx Approach: A Proven System

The CDC’s STEADI-Rx program (Stopping Elderly Accidents, Deaths & Injuries-Rx) is the most widely adopted framework for tackling medication-related falls. It’s not a checklist. It’s a process built around three steps: screen, assess, intervene.

Screen: Every older adult should be asked if they’ve fallen in the past year. If yes, or if they feel unsteady, a medication review is non-negotiable. Tools like the Timed Up and Go test-timing how long it takes to stand from a chair, walk 10 feet, turn, and sit back down-can reveal hidden instability.

Assess: Pharmacists and doctors review every medication for FRID status using the Beers Criteria, updated by the American Geriatrics Society every three years. This list flags drugs that are risky for older adults, even if they’re prescribed legally. The review isn’t just about names-it’s about dose, timing, and interactions. A low-dose sleeping pill taken with a blood pressure med at night? That’s a recipe for a fall when getting up to use the bathroom.

Intervene: This is where real change happens. About 75% of STEADI-Rx interventions involve switching to a safer alternative. For example, replacing diazepam with cognitive behavioral therapy for insomnia, or swapping an antipsychotic like quetiapine for non-drug behavioral strategies for agitation. The goal isn’t to stop all meds-it’s to stop the ones that do more harm than good.

Medication Review Works-But Only If Done Right

A 2021 study found that structured medication reviews could prevent over 42,000 medically treated falls each year in the U.S. and save $418 million in healthcare costs. But here’s the catch: most reviews aren’t structured. In a 2022 survey, only 45% of pharmacists said they had enough time to do a full medication review. Primary care doctors are stretched thin. Patients often don’t know which meds are risky. And many fear that stopping a drug will make their symptoms worse.

Real success comes from collaboration. Pharmacists document each medication’s name, dose, frequency, and refill status. They then send a Provider Consult Form to the prescribing doctor with three key questions: Is this drug still needed? Can it be lowered? Is there a safer option? If the doctor doesn’t respond within seven days, the pharmacist follows up. This simple protocol cuts through the noise.

One Reddit user, u/SeniorSafetyFirst, shared how switching from diazepam to therapy eliminated their nighttime falls-from two or three per month to zero in six months. That’s not luck. That’s a targeted intervention.

Pharmacist and patient reviewing medications as a mechanical arm displays Beers Criteria icons, with a risky pill dissolving into a tree symbol.

Medication Changes Alone Aren’t Enough

Cutting a sedating drug helps-but pairing it with movement makes it stick. The Cochrane Review found that exercise programs combining balance, strength, and gait training reduced the number of fallers by 15% to 29%. Programs lasting 12 weeks or more, with sessions of 30 to 90 minutes one to three times a week, cut fractures by 61% and medical visits for falls by 43%.

Exercise doesn’t mean running marathons. It means standing on one foot while brushing teeth. Walking backward in a safe space. Rising from a chair without using your hands. These are simple, doable, and powerful. Vitamin D supplementation (1,000 IU daily) is also recommended by the American Geriatrics Society, though evidence is mixed. Some studies show benefit; others don’t. But movement? The data is clear.

Barriers to Change-And How to Overcome Them

Changing meds isn’t easy. Patients worry about withdrawal. Doctors fear relapse. Pharmacies lack time. Systems lack reimbursement.

Many older adults believe their sleeping pill or anxiety med is essential. Stopping it feels like losing control. But research shows that with proper tapering and support, most can reduce or eliminate sedating drugs safely. The National Council on Aging found 63% of older adults struggled to reduce these meds-not because they didn’t want to, but because no one showed them how.

Health systems can help. Electronic health records can flag high-risk combinations. Pharmacies can offer free medication reviews. Medicare now covers medication therapy management for certain patients, but many providers don’t know how to bill for it. Training programs like the one from the University of North Carolina teach pharmacists how to do this in 8 to 10 hours. It’s doable. It’s just not widespread.

Older man balancing on one foot in a biomechanical dojo, floating training modules and a light-based Tai Chi instructor beside him.

What You Can Do Today

If you or someone you care for is over 65 and taking any sedating medication, here’s what to do:

  1. Make a full list of every medication, including over-the-counter pills, supplements, and creams.
  2. Ask the pharmacist: “Are any of these linked to falls?”
  3. Ask the doctor: “Can we review these meds? Is there a safer alternative?”
  4. Start a simple balance routine: stand on one foot for 20 seconds, three times a day.
  5. Remove tripping hazards: loose rugs, cluttered floors, poor lighting.

You don’t need a grand plan. You just need to start. One less sedating pill. One more minute of standing on one foot. That’s how falls are prevented-not with alarms or hip protectors, but with smart choices and small, consistent actions.

The Bigger Picture

By 2040, more than 80 million Americans will be over 65. Falls will only rise unless we fix this. The CDC’s STEADI initiative is now used by 78% of state health departments and 65% of major health systems. The global fall prevention market is projected to hit $31 billion by 2028. But money and tools aren’t the barrier. Awareness is.

Sedating medications aren’t evil. They help people sleep, manage pain, and control anxiety. But when they’re not reviewed, adjusted, or replaced, they become silent hazards. The solution isn’t to avoid all meds. It’s to use them wisely-with eyes wide open.

Which medications are most likely to cause falls in older adults?

The highest-risk medications include benzodiazepines (like diazepam and lorazepam), antidepressants (especially tricyclics), opioids (like oxycodone and hydrocodone), antipsychotics (such as quetiapine), muscle relaxants (like baclofen), and antihypertensives (especially when taken at night). These drugs cause dizziness, slowed reflexes, confusion, and low blood pressure upon standing-all leading to falls. The Beers Criteria, updated every three years by the American Geriatrics Society, lists these and other potentially inappropriate medications for older adults.

Can stopping a sedating medication really reduce fall risk?

Yes, and often dramatically. A 2021 study found that switching from a sedating medication to a safer alternative prevented an estimated 42,735 medically treated falls annually in the U.S. One Reddit user reported going from 2-3 nighttime falls per month to zero after switching from diazepam to cognitive behavioral therapy for insomnia. The key is tapering slowly under medical supervision to avoid withdrawal symptoms, which can also increase fall risk if done too quickly.

How often should older adults have their medications reviewed?

At least once a year, and always after a fall or hospital stay. For those taking three or more medications, especially sedating ones, a review every six months is ideal. Many pharmacies offer free medication therapy management services covered by Medicare Part D. Ask your pharmacist if you qualify. Don’t wait for a crisis-proactive reviews are the best defense.

Is vitamin D helpful for preventing falls?

The evidence is mixed. The U.S. Preventive Services Task Force recommends 800 IU daily for older adults at risk of falls, while the American Geriatrics Society suggests 1,000 IU. However, a Cochrane review found no significant reduction in falls from vitamin D alone. It’s not a magic fix, but it’s safe and may help if levels are low. A blood test can confirm deficiency. Combining vitamin D with exercise is more effective than either alone.

What’s the best exercise to prevent falls from sedating meds?

Balance, strength, and gait training are the most effective. Examples include standing on one foot, heel-to-toe walking, sit-to-stand without using hands, and walking backward in a safe space. Programs that last at least 12 weeks, with sessions 2-3 times per week, reduce fall risk by up to 29%. Tai Chi is also proven effective. The goal isn’t intensity-it’s consistency. Even 10 minutes a day of balance work makes a difference over time.

Can pharmacists help reduce fall risk from medications?

Absolutely. Pharmacists are trained in geriatric pharmacotherapy and are often the first to spot dangerous combinations. Through programs like STEADI-Rx, they review all medications, identify fall risks, and communicate with prescribers using a standardized form. In one study, 75% of pharmacist recommendations led to a safer medication change. Many pharmacies now offer free medication reviews-ask if yours does.

What should I do if my doctor won’t change my medication?

Ask for a referral to a geriatrician or a pharmacist specializing in older adults. Bring the CDC’s STEADI-Rx guide or the Beers Criteria list to your appointment. Explain your concerns clearly: “I’ve had two falls in the last six months, and I’m worried my meds might be contributing.” If your doctor dismisses you, seek a second opinion. Your safety matters more than sticking with the status quo.

Are there tools to help track fall risk medications?

Yes. The CDC’s STEADI website offers free tools, including a medication checklist and a fall risk assessment. Apps like Medisafe or MyTherapy can track medications and flag potential risks. The Beers Criteria is available online through the American Geriatrics Society. Pharmacies often print lists of high-risk drugs for patients. Keep a printed copy in your wallet or on your fridge.