When people think about why someone falls, they think about legs.
Weak muscles. Poor balance. A trip hazard. Perhaps eyesight.
They rarely think about the medicine cabinet, and yet medication is one of the recognised contributors to falls in older adults, and it is one of the few that can be addressed with a conversation rather than months of work.
A boundary first. We are a physiotherapy service. We do not prescribe and we do not advise anyone to change their medication. This article is background for a conversation with your GP or pharmacist, who knows your full history.
And please do not stop or alter anything on the basis of what follows. Several of the medicines discussed require gradual reduction under supervision, and stopping abruptly can be considerably more dangerous than continuing.
What the Guidance Says
UK guidance on falls recommends that older people who present for medical attention because of a fall, who report recurrent falls in the past year, or who show abnormalities of gait or balance, should be offered a multifactorial falls risk assessment.
That assessment may include gait, balance and mobility, muscle weakness, osteoporosis risk, visual impairment, home hazards, cardiovascular examination, and medication review.
And among the interventions recommended are strength and balance training, home hazard assessment, vision assessment and referral, and medication review with modification or withdrawal.
More recent NICE guidance on falls assessment and prevention, which extends consideration to people aged 50 and over at higher risk, similarly emphasises medicines optimisation as part of a comprehensive assessment.
So medication review is not a fringe idea. It appears in national guidance as a core component.
The Term Worth Knowing
Clinicians use the phrase falls risk increasing drugs, sometimes shortened to FRIDs.
These are not bad medicines. They are medicines that, as a recognised side effect, can contribute to falls, usually through effects on blood pressure, alertness, balance or coordination.
The broad categories identified in the literature include:
Medicines affecting the brain and alertness, including sedatives, sleeping tablets, certain antidepressants and antipsychotics.
Blood pressure medicines, which can contribute to light headedness on standing.
Medicines with anticholinergic effects, where the cumulative burden across several drugs matters as much as any individual one.
And medicines affecting blood sugar, where episodes of low blood sugar can cause dizziness and falls.
There is a specific validated tool, known as STOPPFall, developed to help clinicians identify these medicines during a review, and its use is endorsed in European guidance for medication review in older adults with a fall history.
Which means your GP or pharmacist has a structured framework for this, if the question is raised.
The Number That Matters
Polypharmacy, meaning the use of multiple medicines, is recognised as an important risk factor for falls in itself.
A major review identified the use of four or more prescription medications among the established risk factors for falling, alongside things like impairment in balance, gait, vision, cognition or muscle strength, and depressive symptoms.
And the same review noted that the risk of falling increases consistently as the number of risk factors rises.
Which gives you a practical prompt. If you are taking four or more prescription medicines and you have had a fall or feel unsteady, a review is a reasonable thing to request.
The Honest Caveat
This is where accuracy matters, because it would be easy to oversell this.
A systematic review and meta-analysis examining deprescribing of falls risk increasing drugs as a single falls prevention strategy found limited evidence of effectiveness.
Read that carefully, because it does not say what people sometimes assume.
It does not mean medicines are irrelevant to falls. The association between certain drug classes and fall risk is reasonably well established.
What it means is that removing medicines on its own, without addressing everything else, has not been shown to reliably reduce falls.
Which is why guidance places medication review inside a multifactorial approach rather than offering it as a standalone solution. Strength and balance training, home hazards, vision and the rest all sit alongside it, and the combination is what the evidence supports.
So the honest framing: reviewing your medicines is a sensible component of reducing your falls risk. It is unlikely to be the whole answer, and anybody presenting it as such is overstating it.
How to Raise It
Practical, because the conversation goes better when prepared.
Book a medicines review specifically. Not a passing mention at the end of an appointment about something else. Ask for a review, and say it is because of falls or unsteadiness.
Bring everything. Prescriptions, over the counter medicines, supplements and anything bought online. The cumulative picture matters, and over the counter items including some antihistamines and sleep aids carry relevant effects.
Mention the falls explicitly, including ones where you were not hurt and ones you did not report at the time. These go unreported constantly, usually out of embarrassment or concern about the consequences.
Describe the circumstances. Did you feel light headed? Did it happen on standing, or after a meal, or at night? Was it a trip, or did your legs simply go?
That detail matters enormously, because a fall with light headedness on standing points somewhere quite different from a trip over a rug.
And ask directly: are any of these medicines likely to be contributing, and is there anything that could be reviewed?
Your pharmacist is also a good route, and in the UK pharmacists conduct medicines reviews routinely.
What Not to Do
Do not stop anything yourself. Several of these medicines require gradual withdrawal, and abrupt cessation carries real risks including rebound effects.
Do not assume the medicine is the whole problem, given the evidence above.
And do not let a review replace the other work. Strength and balance training is the intervention with the strongest evidence in this area, and it is the one most people have never actually received.
The Falls Worth Reporting
Report every fall, including ones where you were not injured.
And flag these specifically:
Falls where you felt light headed or faint beforehand.
Falls you cannot explain, as opposed to tripping over something identifiable.
Falls associated with palpitations or chest symptoms.
Any loss of consciousness.
Unexplained falls in particular warrant further cardiovascular assessment according to international guidance, since they are approached similarly to blackouts.
Seek Urgent Medical Attention For
A fall involving a head injury, particularly if you take blood thinning medication, even if you feel fine.
Any loss of consciousness.
A suspected fracture, inability to weight bear, or obvious deformity.
Confusion, drowsiness, repeated vomiting or worsening headache after a fall.
Chest pain, palpitations or breathlessness.
And contact your GP promptly for recurrent falls, new unsteadiness, or dizziness on standing.
Let Us Handle the Other Half
Medicines are one piece. The strength, balance and walking side is the piece with the strongest evidence behind it, and it is the piece we can address directly.
Ravenscroft Health offers a free discovery visit at no cost and no obligation. You will get a thorough assessment of your balance, strength, walking and falls risk, a clear explanation of what is contributing, and a programme built around it.
With GP input available where a medicines review or further investigation is warranted.
