Falls are the leading cause of injury-related death for adults over 65. Every year in the U.S., 36 million falls happen, leading to 3 million emergency room visits and 32,000 deaths. Many of these falls aren't accidents-they're side effects of sedating medications that cause dizziness, sleepiness, or balance problems.

Why Sedating Medications Increase Fall Risk

These medications affect your brain and body in ways that make falls more likely. Benzodiazepines for anxiety or sleep can leave you groggy and uncoordinated. Opioids for pain slow your reaction time. Even antidepressants might cause dizziness when you stand up. The problem gets worse when you take multiple sedating drugs at once-a situation called polypharmacy. It happens when older adults take three or more medications daily, and each extra drug raises fall risk significantly.

According to the CDC, seniors on just one sedating medication have a 20% higher fall risk. With two or more, that risk jumps to 50% or more. This isn't just about accidents-it can lead to broken hips, brain injuries, or even death. The good news? Many of these falls are preventable with the right strategies.

The STEADI-Rx Approach: A Three-Step Strategy

Here's how it works in practice:

1. Screen: Use the CDC's fall risk assessment tool during routine checkups. Ask simple questions like "Have you fallen in the past year?" or "Do you feel unsteady when standing?"
2. Assess: Review all medications for FRIDs (Fall Risk Increasing Drugs). This includes checking for drug interactions and whether the dose is too high.
3. Intervene: Work with pharmacists and doctors to adjust medications, suggest non-drug alternatives, and recommend exercise programs.

This approach isn't just theoretical. A 2021 study showed STEADI-Rx could prevent over 42,000 medically treated falls and save $418 million in healthcare costs each year in the U.S. It's especially effective in community pharmacies where pharmacists take the lead on medication reviews.

Key Medications That Raise Fall Risk

One real-world example: A 78-year-old man on diazepam for anxiety had three nighttime falls in a month. His pharmacist reviewed his medications and suggested switching to cognitive behavioral therapy for insomnia (CBT-I) instead. Within six months, his falls stopped completely. This isn't uncommon-75% of STEADI-Rx recommendations involve switching to safer alternatives.

How Medication Reviews Prevent Falls

Pharmacists are your secret weapon for fall prevention. They don't just count pills-they check for hidden dangers. In the STEADI-Rx model, pharmacists document medication therapy problems and share findings with doctors using a Provider Consult Form. This form includes answers to three key questions:

• Is this medication necessary?
• Is the dose too high?
• Are there safer alternatives?

For example, a pharmacist might notice a patient taking both an opioid and a benzodiazepine. These drugs together multiply fall risk. The pharmacist could recommend switching the opioid to a non-opioid pain reliever like acetaminophen, or suggest physical therapy for chronic pain. This collaborative approach cuts fall risk by up to 30% compared to medication changes alone.

Many seniors don't realize pharmacists can help with this. In fact, a 2022 survey found only 45% of pharmacists feel they have enough time to do comprehensive reviews. But when they do, the results speak for themselves. A 2023 study in the Journal of the American Geriatrics Society showed medication reviews reduced falls by 22% in older adults.

Combining Medication Management with Other Strategies

Medication reviews alone aren't enough. The best results come from combining them with other simple changes:

• Exercise: Balance training, strength exercises, and walking programs reduce falls by 15-29%. Aim for 30 minutes, three times a week. Even simple moves like standing on one foot or heel-to-toe walking help.
• Home safety: Remove tripping hazards like loose rugs, install grab bars in the bathroom, and improve lighting. A 2021 study found these changes cut home falls by 35%.
• Vitamin D: While research is mixed, the U.S. Preventive Services Task Force recommends 800 IU daily for seniors. It's especially helpful for those with low vitamin D levels.

When these strategies work together, the impact is powerful. A 2020 Cochrane review found that combining medication reviews with exercise programs reduced fall-related fractures by 61% and medical care visits by 43%. This isn't just about avoiding falls-it's about staying independent longer.

Overcoming Common Challenges in Deprescribing

Changing medications isn't always easy. Many seniors worry about withdrawal symptoms or symptom return. A 2021 National Council on Aging survey found 63% of older adults struggle to reduce sedating medications due to these fears. Doctors may also hesitate, especially if they're short on time.

But solutions exist. Electronic health record alerts can flag high-risk medication combinations. Clear communication between pharmacists and doctors ensures safe transitions. Patient education materials explain risks and benefits in plain language. For example, explaining that "stopping this medication might feel scary at first, but it could keep you from falling" helps build trust.

One success story: A 72-year-old woman on multiple sedating drugs for anxiety and sleep had frequent falls. Her pharmacist created a gradual tapering plan with her doctor, replacing one medication at a time. After three months, she was on safer alternatives and had zero falls. This shows that with patience and teamwork, deprescribing works.