Falls in older people: medicines that increase the risk

Which medicines increase fall risk according to the Spanish Ministry of Health, which signs to watch for and how to ask for a review without stopping anything yourself.

The medicines that most increase the risk of falls in older people are sedatives and other psychotropic drugs, those with anticholinergic effects and some cardiovascular drugs such as diuretics and blood pressure medicines. Taking many medicines at once also multiplies the risk.

We explain which groups of medicines the Spanish Ministry of Health lists, which signs should make you suspicious and what the family can do, always together with the doctor.

How much do medicines contribute to falls?

A great deal, and it is one of the factors that can be corrected most easily. The Spanish Ministry of Health consensus document (2026) considers polypharmacy one of the most easily modifiable risk factors for falls and calls for a review especially in anyone taking 5 or more medicines.

Falls are a serious problem: according to the same document, about 30% of people over 65 living at home fall at least once a year, and between 5% and 10% of falls end in a fracture. The World Health Organization notes that falls are the second leading cause of unintentional injury deaths worldwide and that around 71% of those deaths occur in people aged 60 or over.

Which medicines increase the risk of falls?

So-called FRIDs (fall risk increasing drugs) are mainly psychotropic medicines, those with anticholinergic effects and some cardiovascular medicines. They act by causing drowsiness, dizziness, a drop in blood pressure on standing up or confusion.

The table summarises the groups listed by the Spanish Ministry of Health based on the STOPPFall and STOPP/START criteria. Taking one of them does not mean it should be stopped: it is often essential, and the decision to change it always lies with the doctor.

Why does taking many medicines increase the risk even further?

Because the effects add up: two drugs that each cause slight dizziness can cause a lot of dizziness together. And the more medicines there are, the more likely interactions, duplicates and mistakes in taking them become.

The STOPP/START 3 criteria advise against, for example, benzodiazepines, Z-hypnotics, antipsychotics or opioids in people with recurrent falls, and against using two or more drugs with anticholinergic effects at the same time. The Ministry of Health adds that frailty makes a person more sensitive to side effects, and that polypharmacy is in turn linked to greater frailty.

Which signs should make you suspect a medicine?

Suspect the medication when dizziness, unsteadiness or drowsiness appear shortly after starting a treatment, increasing a dose or adding a drug. Also when the person feels dizzy getting out of bed or a chair, which is typical of orthostatic hypotension.

• Dizziness or blurred vision on standing up.
• Daytime drowsiness or difficulty waking up in the morning.
• Confusion, new forgetfulness or slower reflexes.
• An urgent need to pass urine at night, getting up in the dark.
• A fall or a near miss with no clear cause.

If dizziness is frequent, you may find our article on what causes dizziness in an older person useful.

What can the family do to reduce the risk?

The first step is to ask the GP for a medication review focused on fall risk, without stopping anything on your own, because suddenly stopping some drugs (such as benzodiazepines or antidepressants) can cause withdrawal effects. The Ministry of Health states that stopping drugs on its own does not significantly reduce falls, but it does help when combined with other measures.

1. Take the full medication list to the appointment, including over the counter products.
2. Ask whether any of the drugs is on the list of those that increase fall risk and whether there is an alternative.
3. Make sure medication is taken at the right time: a missed dose followed by a double one can also cause dizziness.
4. Combine the review with strength and balance exercise, good lighting at night and removing rugs and obstacles.
5. Have a plan in case it happens: learn how to help an older person up from the floor and consider telecare.

A practical example: José and his nights

Take the case of José, 83, who takes a benzodiazepine to sleep, a diuretic for his blood pressure and an alpha blocker for his prostate. He gets up two or three times every night to go to the toilet and one early morning he falls on the way there.

His daughter could book a GP appointment, explain the fall and bring the medication list, ask whether the timing of the diuretic or the need for the benzodiazepine can be reviewed, fit a night light in the hallway and, in the meantime, check that José is not repeating doses because he forgets. Any change to his treatment is decided by the doctor.

How can IMA Health help?

At IMA Health we coordinate with a specialised pharmacy so that medication is prepared by day and time of each dose, with home delivery and personalised follow-up. This makes it easier to avoid missed and repeated doses, and when the doctor adjusts a treatment to reduce fall risk, the change reaches the prepared medication.

Sources

• Spanish Ministry of Health: updated consensus document on preventing frailty and falls in older people (2026)
• World Health Organization: falls fact sheet
• Spanish version of the STOPP/START 3 criteria (Rev Esp Geriatr Gerontol, 2023)

This article is for information only and does not replace advice from your doctor or pharmacist.