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Preventing Falls in Older Adults Who Take High-Risk Medicines

Topic Overview

What does "high-risk" mean?

High-risk means that a medicine can cause serious health problems or accidents. High-risk doesn't always mean "do not use." It can mean "use with care" when a medicine is more likely to help you than harm you.

If you take a medicine that may make you feel confused, drowsy, or dizzy, pay attention to how it affects your balance and how it makes you feel. Take extra care to prevent a fall. A fall can lead to serious problems that can change your ability to function and quality of life.

Examples of high-risk medicines include:

  • Antipsychotics, such as haloperidol, quetiapine, and risperidone.
  • Muscle relaxants, such as cyclobenzaprine and methocarbamol.
  • Anxiety medicine, such as alprazolam, lorazepam, and oxazepam.
  • Sleep medicine, such as zolpidem.
  • Antidepressants, such as amitriptyline and paroxetine.
  • Over-the-counter allergy and cold medicines that contain ingredients that may cause drowsiness, such as chlorpheniramine or diphenhydramine. These are antihistamines. Some medicines for sleep or pain also use diphenhydramine.

How can you prevent falls when you take high-risk medicine?

Be prepared for side effects

As you age, your body changes. When you take a medicine, you may get a stronger effect now than when you were younger. For example, you may get more dizzy or drowsy. And you may be more likely to have dangerous side effects when you take more than one medicine.

To help avoid serious side effects, talk to your doctor or pharmacist about your medicines.

  • Make a list of everything you take. Include the dose and when you take it. Keep a copy with you, and take it to each doctor visit. Ask if there are any medicines that you don't need or shouldn't take. And ask if you could lower your dose of any of the medicines.
  • Find out if a treatment without medicine might work for you.
  • Use one drugstore, if possible. Before filling a new prescription, give the pharmacist your list of medicines. Ask about possible interactions with anything you are taking. If you use more than one drugstore, make sure each one has your list.
  • Talk to your doctor about all side effects you have. Your doctor may want to change your dose or your medicine. Be sure to tell your doctor that you only want to take medicines that you really need, and at the lowest possible dose.

Learn to move wisely

  • Stand up slowly. After you stand up, stay still for a few seconds before you move. If you feel dizzy, don't try to walk.
  • If you have a problem with balance, walk carefully. Consider seeing a physical or occupational therapist to help with your balance. Wear low-heeled shoes that fit well and give your feet good support. Use footwear with non-skid soles.
  • If you are very weak, seek help from a physical or occupational therapist. Take steps to become active and increase your strength. You may need someone to help you get up, walk, and bathe.
  • If one of your legs is stronger than the other, get into a tub or shower with your weaker leg first. Get out with your stronger side first. Consider grab bars in your bathroom to help you get in and out of the tub or shower.
  • Use extra care if you use a cane, a walker, or crutches. They can slip out from under you on smooth, wet surfaces. Consider seeing a physical or occupational therapist to make sure you are using them correctly.
  • If you have glasses, hearing aids, or both, be sure to use them.

Make changes to stay independent at home

  • Keep walking paths clear. Remove throw rugs and clutter. Place furniture and electrical cords out of the way.
  • Repair loose carpet or uneven flooring.
  • Keep your living space well lit. At night, use night-lights. Keep a cordless phone and a flashlight by your bed.
  • Install sturdy handrails on stairways. Put grab bars and non-skid mats in your shower or tub and near the toilet. Use a shower chair or bath bench when you bathe.
  • Store items within easy reach. Avoid reaching overhead.
  • If you have ice and snow during the winter, have a family member or friend sprinkle salt or sand on slippery steps and sidewalks.

Take care of yourself

  • Before you take any prescription or over-the-counter medicine, ask your doctor or pharmacist if it might make you sleepy, less alert, or less aware of how you're moving. It's important to know ahead of time if you're going to be at risk for losing your balance and falling.
  • When you are alone at home or outdoors, carry a phone or personal medical alert device with you. Then you can quickly call for help if you need it.
  • Have your vision and hearing checked each year, or anytime you notice a change. Sight or hearing problems can cause falls.
  • Talk to your doctor or physiotherapist about exercises for improving your strength and balance. Exercise regularly.

When should you call your doctor?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You cannot get up after a fall.
  • You believe you have serious or life-threatening injuries.
  • You are having chest pain or trouble breathing.
  • You are having trouble speaking, or you have new weakness or numbness on one side of your body.

Call your doctor now or seek medical care right away if:

  • You feel faint.
  • You develop severe pain.
  • You think you may have passed out but aren't sure.
  • You hit your head or think you may have hit your head but aren't sure.
  • You think your medicine may have caused you to fall.

Watch closely for changes in your health, and be sure to contact your doctor if you have fallen, even if you aren't hurt.

Don't feel embarrassed to let your doctor know that you have fallen. Your doctor may be able to adjust your medicine or give other advice so you can prevent more falls.


Other Works Consulted

  • American Geriatrics Society 2015 Beers Criteria Update Expert Panel (2015). American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 63(4): 2227–2246. DOI: 10.1111/jgs.13702. Accessed March 31, 2016.
  • Hartikainen S, et al. (2007). Medication as a risk factor for falls: Critical systematic review. Journal of Gerontology, 62(10): 1172–1181.


Adaptation Date: 2/28/2022

Adapted By: Alberta Health Services

Adaptation Reviewed By: Alberta Health Services

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