Fall deaths among older adults have tripled, prescription drugs under scrutiny

Editor's Note

Deaths from falls among Americans over 65 have more than tripled in the past 3 decades, raising alarm among geriatric experts and fueling debate about the role of prescription drugs, HealthLeaders September 15 reports. The Centers for Disease Control and Prevention (CDC) recorded more than 41,000 fall-related deaths in this age group in 2023, with the highest rates among adults over 85. For that cohort, mortality rose from 92 per 100,000 in 1990 to 339 per 100,000 in 2023.

Epidemiologist Thomas Farley, writing in JAMA Health Forum, attributed much of this surge to the growing use of fall-risk-increasing drugs (FRIDs). These include benzodiazepines, opioids, antidepressants, gabapentin, certain cardiac drugs, and early antihistamines like Benadryl. Such medications can cause dizziness, drowsiness, or impaired balance. Farley argued while aging, impaired vision, and home hazards all contribute to falls, these risks have not worsened threefold over 30 years. Other high-income countries have not seen similar increases.

Some experts agree that FRIDs are a major factor but caution against assigning all blame to medication. Thomas Gill of Yale University pointed to shifts in how deaths are recorded: in the past, fatalities after falls were often attributed to heart failure or other conditions. He also noted today’s oldest patients may be frailer due to advances that keep people alive longer with multiple chronic illnesses.

Skeptics such as Neil Alexander of the University of Michigan argue that awareness of FRIDs has already led to more cautious prescribing. Medicare data show opioid use declining over the past decade, though prescriptions for antidepressants and gabapentin have risen. Regardless, geriatricians agree that inappropriate prescribing remains common and fuels fall risk.

The article highlighted deprescribing efforts, including the US Deprescribing Research Network and updated Beers Criteria, which recommend safer alternatives and non-drug interventions such as cognitive behavioral therapy for insomnia or physical therapy for pain. Michael Steinman, co-chair of the Beers panel, emphasized while medications are easy to start, tapering them requires time and persistence. Patients, he said, should proactively ask their clinicians whether their prescriptions may raise fall risk and discuss alternatives.