Is There an ”Epidemic” of Deaths from Falls Among Older Adults?

September 22, 2025

Did you know that, among older adults, the number of deaths from falls is more than from breast or prostate cancer and is more than from car crashes, drug overdoses, and all other unintentional injuries combined, according to the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics? Even more alarming is that the mortality rate for falls among older adults in the U.S. has more than tripled during the past 30 years, while death rates due to falls decreased during the same period in other high-income countries, according to a recent “Viewpoint” article in the Journal of the American Medical Association (JAMA) Health Forum. This alarming increase is blamed on the “soaring use” of certain prescription drugs – referred to as “fall risk–increasing drugs” (FRIDs) — and the article calls on physicians to review the medications of their older patients and stop prescribing drugs that are unnecessary or dangerous, as at least two-thirds of these deaths from falls can be prevented.

[The author of the JAMA “Viewpoint” article is Thomas A. Farley, MD, MPH, who is currently an adjunct professor at Tulane University’s Celia Scott Weatherhead School of Public Health and Tropical Medicine – where he was also the Chair of their Department of Community Health Sciences for nine years — as well as an adjunct professor at Columbia University’s Mailman School of Public Health. Dr. Farley also is a former Commissioner of New York City’s Department of Health and Mental Hygiene, and was Commissioner of Health for the City of Philadelphia.]

Dr. Farley begins by acknowledging that older adults have always been at risk for falls. As he points out, in addition to older age, risk factors for fall injuries include “physical impairment (such as muscle weakness, balance problems, or difficulty walking), vision problems, cognitive impairment, use of alcohol or drugs, living alone, and a home littered with objects that can be tripped over.” But he believes that what he describes as a “surge in deaths from falls in the U.S. reflects a new phenomenon.”

As he explains, there is no reason to think that older adults today “are much more likely to be physically frail, have dementia, have cluttered homes, or drink alcohol and use drugs than age-matched adults 30 years ago, and the percentage living alone has not changed much since 2000.” On the other hand, he stresses “there is plenty of reason to believe that the surge in fall deaths may be tied to the soaring use of certain prescription drugs,” as older adults in the U.S. are “heavily medicated. “

For example, he notes that from 2017 to 2020, 90 percent of adults older than 65 years were taking prescription drugs, 43 percent were taking multiple prescription drugs, and 45 percent were taking prescription drugs that were found by researchers to be “potentially inappropriate.” Furthermore, he says that 65 percent to 93 percent of older adults injured from falls were taking at least one drug that causes drowsiness or impaired balance or coordination — fall risk–increasing drugs (FRIDs) – and many were taking more than one FRID.

FRIDs include beta blockers (often used to treat high blood pressure when other medicines have not worked); anticholinergics (used to treat a variety of conditions, including overactive bladders, asthma, COPD, Parkinson’s disease, and certain types of poisoning); and proton pump inhibitors (a class of medications that reduce the amount of acid produced in the stomach), which Dr. Farley says may increase the risk of an injury during a fall, as high doses or long-term use of proton pump inhibitors are associated with increased risk of bone fractures.

Farley goes on to point out that four categories of central nervous system–active FRIDs are particularly concerning because of a combination of “surging use” and a strong association with falls. These include:

opioids — strong prescription pain relievers such as oxycodone, hydrocodone, and fentanyl;
benzodiazepines — a class of sedative medications used to treat a variety of conditions, including anxiety, seizures, and insomnia;
gabapentinoids –used to help prevent seizures and ease neuropathy restless legs syndrome and pain after a shingles infection; and
antidepressants.

Farley says that according to the 2023 National Survey on Drug Use and Health, at some point during the previous year 32 percent of adults older than 65 years had taken prescription pain relievers (most of which are opioids) and 17 percent had taken prescription tranquilizers or sedatives (most of which are benzodiazepines). Furthermore, he says this prescribing is occurring despite warnings from the American Geriatrics Society about the fall risks associated with these drugs. (The American Geriatrics Society strongly recommends that physicians avoid prescribing benzodiazepines and many antidepressants to older adults and strongly recommends against prescribing combinations of opioids and either benzodiazepines or gabapentinoids.}

Farley therefore says “[i]t is hard to medically justify the current levels of prescribing of central nervous system–active FRIDs to older adults.” For example, he stresses that opioids “are no more effective than the safer drugs for treatment of most types of pain,” and benzodiazepines “cannot possibly be needed by nearly 20 percent of 85-year-old individuals when experts recommend that they not be used at all.” Finally, Farley underscores that some older adults have severe depression and benefit from antidepressants, “but it is hard to imagine that is true for 1 in 5.”

Farley concludes that more research is needed to better understand the relative importance of different FRIDs in causing fall deaths. “But clinicians should not wait for this research to reduce their prescribing of risky drugs to older adults,” he emphasizes. He also calls for a “more organized, broader effort” to stop inappropriate and dangerous prescribing to older adults. For example, he notes that most physicians and other health professionals with prescribing authority are affiliated with large health systems that use electronic health records, and it therefore “should not be difficult for these health care systems to identify patients older than 65 years receiving FRIDs and provide feedback to the prescribing clinicians,” including summarizing data on their FRID prescribing, offering advice on alternative safer treatments, or adding FRID use as an incentivized quality-of-care metric.

Given the more than tripling of deaths due to falls in recent years, Farley stresses that the data suggests at least two-thirds of these deaths each year can be prevented, and that it is therefore “time for organized medicine to take this problem seriously and act to save lives.”

Writing for the New York Times (NYT), Paula Span – who has written the “New Old Age” column, about aging and caregiving, for that publication since 2009 – recently did a column on Farley’s item for the JAMA. In it, she quotes him as reiterating his view that older adults are “heavily medicated, increasingly so,” and with drugs that are “inappropriate for older people.” During the 30 years that deaths from falls among older adults in the U.S. has more than tripled, Farley stresses that this “didn’t occur in Japan or in Europe.”

Span then notes that this same 30-year period has seen a “flurry” of research and activity in the U.S. to try to reduce geriatric falls and their potentially devastating consequences. For example, she points out the American Geriatrics Society adopted updated fall prevention guidelines in 2011. The Centers for Disease Control and Prevention (CDC) also released a program called STEADI in 2019, and the United States Preventive Services Task Force recommended exercise or physical therapy for older adults at risk of falling in 2012, 2018 and again last year.

However, Dr. Donovan Maust, a geriatric psychiatrist and researcher at the University of Michigan, tells Span that these studies and interventions and investments “haven’t been particularly successful.” He said, “It’s a bad problem that seems to be getting worse.”

Therefore, Span asks, “Are prescription drugs driving that increase?” In response, she notes at the outset that geriatricians and others who research falls and prescribing practices “question that conclusion.”

Why? Dr. Thomas Gill, a geriatrician and epidemiologist at Yale University and a longtime falls researcher, told Span FRID medications can play a major role, but he said, “there are alternative explanations” for the increase in death rates.

For example, he cited changes in reporting the causes of death. That is, he told the NYT reporter that “[y]ears ago, falls were considered a natural consequence of aging and no big deal.” Accordingly, he said death certificates often attributed fatalities among older people to ailments like heart failure instead of falls, making fall mortality appear lower in the 1980s and 1990s. Gill also said today’s over-85 cohort may also be frailer and sicker than the oldest-old were 30 years ago, “because contemporary medicine can keep people alive for longer,” he pointed out, and their “accumulating impairments, more than the drugs they take, could make them more likely to die after a fall,” he explained to Span.

Also, Span noted that Dr. Neil Alexander, a geriatrician and falls expert at the University of Michigan and V.A. Ann Arbor Healthcare System — another “skeptic” of Farley’s views — argues that most doctors have come to understand the dangers of FRIDs and prescribe them less often. Indeed, Span points out that prescriptions for some fall-related drugs have already declined or hit plateaus, even as death rates because of falls have risen. For example, Medicare data shows lower prescription opioid use beginning a decade ago, and benzodiazepine prescriptions for older patients have reportedly slowed.

But she also emphasizes that, on the other hand, the use of antidepressants and of gabapentin has increased. Also — whether or not medication use outweighs all other factors — “nobody disputes that these agents are overused and inappropriately used” and contribute to the troubling increase in fall death rates among seniors, Yales’s Dr. Gill told her.

This, she says, explains the ongoing campaign for “de-prescribing” — stopping the medications whose potential harms outweigh their benefits or reducing their dosage. She goes on to explore why this effort is such a challenge, quoting Dr. Michael Steinman, a geriatrician at the University of California, San Francisco, and co-director of the U.S. Deprescribing Research Network, established in 2019, as explaining that even though “[w]e know a lot of these drugs can increase falls by 50 to 75 percent” in older patients, “it’s easy to start meds, but it often takes a lot of time and effort to have patients stop taking them.” This can be particularly true if patients think these medications seem to help with pain, insomnia, reflux and other common age-related complaints. Also, Span notes that busy doctors “may pay less attention to drug regimens than to health issues that seem more pressing.”

Dr. Steinman, who is also co-chair of the Beers panel on alternatives, urges older patients to therefore ask their doctor if any of their medications increase the risk of falls, and is there an alternative treatment. “Being an informed patient or caregiver can put this on the agenda. Otherwise, it might not come up,” he warned.

[The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults is a list developed by the American Geriatrics Society to identify potentially inappropriate medications for adults aged 65 and older. It serves as an educational and clinical tool to help healthcare providers and patients make informed decisions about medication use, with the goal of reducing adverse drug events and improving medication selection. The criteria specify medications to avoid or use with caution, with recent updates incorporating new evidence and providing guidance for specific health conditions. The Beers panel on alternatives refers to a group of interprofessional experts who are charged with developing a list of alternative treatments for medications identified in the Beers Criteria. This panel focuses on providing clinicians with safer, evidence-based options for older adults when certain high-risk medications on the Beers Criteria list might be considered.]

NCTR believes true retirement security is not possible without adequate, reliable, sensible healthcare. And cost may not always be the most important factor. Therefore, NCTR hopes this information might be shared with our plan members’ participants, both active and retired, so that they understand the implications of “fall risk–increasing drugs” (FRIDs) and consider raising this issue with their doctors themselves, if their doctors have not.