Rx for Disaster: Why Common Meds Are Silently Killing Older Americans!

Americans are dying from an invisible killer far faster than their counterparts in rest of the developed world. These deaths are mostly unreported and ignored by the healthcare system. I am referring to falls due to commonly prescribed medications. An article published in JAMA Health Forum, Aug. 8, 2025 is titled “Risky Prescribing and the Epidemic of Deaths From Falls.” Compared to other countries, we are taking way more medications that are silently killing older Americans. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2837039

How Dangerous Are Falls?

Falls are deadly for people over 65. That’s not to say they are safe for younger people, but the numbers are startling for senior citizens. When an older person falls and breaks a hip, the downward spiral is often lethal.

Here is how the author of the JAMA Health Forum article introduces his article:

“In 2023, more than 41, 000 individuals older than 65 years died from falls. 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. More importantly, the mortality rate for falls among older adults in the US has more than tripled during the past 30 years. In contrast, death rates due to falls decreased during the past 30 years in other high-income countries.”

Those numbers are shocking. Physicians encourage Americans to be tested regularly to detect breast or prostate cancer early. Consider the headlines you see about drug overdoses and car crashes.

Now think about falls. When was the last time a doctor devoted time to warning you about medications that could cause a fall? If someone falls and breaks a hip or experiences a head injury, it can lead to a long recovery. People are often left impaired.

Not infrequently, older people die prematurely from the consequences of such falls. The cause of death is almost always attributed to the complications from the fall. Rarely, if ever, are the medications that led to the fall blamed for the death.

Why Are Common Meds Silently Killing Older Adults in the US but NOT in Other Countries?

According to the “viewpoint” article in JAMA Health Forum:

“The surge in deaths from falls in the US reflects a new phenomenon.

The author points out that the surge is likely due to the:

“…soaring use of certain prescription drugs that were ‘potentially inappropriate.’”

“Older adults in the US are heavily medicated. From 2017 to 2020, 90% of adults older than 65 years were taking prescription drugs, 43% were taking multiple prescription drugs, and 45% were taking prescription drugs that were ‘potentially inappropriate.’”

All you have to do is turn on an electronic device or television to see the difference between the United States and the rest of the world. Our airwaves are filled with commercials for prescription drugs. That is not permitted in most other countries (except for New Zealand). Not surprisingly, our older citizens are taking far more medicines than their counterparts in comparable countries. We are not living longer, however!

FRIDs Are Silently Killing Older Americans!

What’s a FRID? you are asking. That’s the term that doctors use for “Fall Risk-Increasing Drugs.” There are medications that “cause drowsiness or impaired balance or coordination.” Such drugs are not always obvious. You will be surprised to learn how many commonly prescribed pharmaceuticals could be considered FRIDs.

The author of the JAMA Health Forum article (Aug. 8, 2025) points out:

“The list of FRIDs is long and includes drugs such as β-blockers and anticholinergics, as well as proton pump inhibitors that may increase the risk of an injury during a fall. A systematic review found that 65% to 93% of older adults injured from falls were taking at least 1 FRID at the time, and many were taking more than 1 FRID.”

What Drugs Are Contributing to Silently Killing Older Americans?

We always like to alert people to the BEERS Criteria for Medications. This list was originally developed by Mark Beers in 1991. Today, the list of drugs is maintained by the American Geriatrics Society (AGS).

Here is how the list is characterized:

“The AGS Beers Criteria® serves as a comprehensive list of medications that older people should potentially avoid or consider using with caution because they often present unnecessary risks for this population.”

Here is a link to the 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults.

Sadly, it is hard to use because the online list is difficult to read. We created a free Graedons’ Guide to Drugs & Older people some time ago that includes a list of drugs that are potentially inappropriate. You can access this free Guide at this link.

The article in JAMA Health Forum (Aug. 8, 2025) mentions a few FRIDs (fall risk-increasing drugs) that will surprise many physicians:

• β-blockers (for hypertension) 
• Anticholinergics
• Proton Pump Inhibitors (PPIs “may increase the risk of an injury during a fall”)
• Opioids (this category should be less surprising to health care professionals)
• Benzodiazepines (should also be recognized as problematic)
• Antidepressants
• Gabapentinoids (gabapentin and pregabalin may not be appreciated as problematic)

Many Healthcare Professionals Don’t Realize Which Drugs Have Anticholinergic Activity:

We have written extensively about anticholinergic drugs. We know that the word anticholinergic is a mouthful, but it represents a category of medicines that interfere with a critical neurochemical called acetylcholine. This neurotransmitter is essential for memory and brain function. When it is blocked, a lot of mischief can result.

Here is an article about this problem and a way to learn which drugs have anticholinergic action.

Are Anticholinergic Drugs Bad for Your Brain?
Are you taking a medicine that could affect your memory? New research confirms that anticholinergic drugs have negative impacts on the brain.

and

Where Can I Find a List of Anticholinergic Drugs?
People taking anticholinergic drugs over a long period of time may be at greater risk of developing dementia.

Are Antidepressants Silently Killing Older Americans?

I was somewhat surprised to see that the article in JAMA Health Forum (Aug. 8, 2025) listed antidepressants as a potential problem for older people.

The author notes that:

“…between 1999 and just before the COVID-19 pandemic, the percentage of older adults (>65 years of age) taking antidepressants increased from 8% to 20%.

“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.”

I fear that most clinicians are not aware that some antidepressant medications may make people more vulnerable to falls. What’s even scarier is that people often feel dizzy when they stop taking antidepressants! That was known as far back as 1959. You can read about that story of woe and intrigue at this link.

Here is an article about how antidepressants may create the conditions for older people to fall:

Are Older People More Likely to Fall on Antidepressants?
A Swedish study finds, as previous research has, that older people are more likely to fall on antidepressants. Anti-anxiety drugs also pose a fall risk.

When clinicians prescribe an antidepressant to an older person, what is the likelihood that they warn about the risk of falling?

Are Too Many High Blood Pressure Medicines Silently Killing Older Americans?

In recent years there has been a strong push to get everyone’s blood pressure around 120/80 or lower. That includes older people as well as those who are younger. Physicians are well meaning. They are trying to prevent heart attacks and strokes.

On August 14, 2025, the American Heart Association (AHA) and the American College of Cardiology (ACC) along with other organizations updated the national guideline for hypertension treatment (MEDPAGE Today, Aug. 14, 2025). It “encourages earlier intervention on high blood pressure, when patients are still at low cardiovascular risk” .

The “Top Take-Home Messages” from the new update were published in the Journal of the American College of Cardiology (JACC), August 14, 2025.

When you see this symbol < it means “less than.”

• “The overarching blood pressure treatment goal is <130/80 mm Hg for all adults, with additional considerations for those who require institutional care, have a limited predicted lifespan, or are pregnant.
• “Blood pressure is classified by the following framework: normal blood pressure is defined as <120 mm Hg systolic and <80 mm Hg diastolic; elevated blood pressure as 120 to 129 mm Hg systolic and <80 mm Hg diastolic.

In other words, normal is less than 120/80. Anything over 120/80 is not normal…regardless of age. That is more than half the population of the US.

There is a problem, however. Aggressive treatment of hypertension can lead to some unwanted consequences.

When BP treatment is too aggressive:

Here is a message we received several years ago about excessive BP medications:

Q. My elderly mom had started falling so often that my siblings and I were seriously considering nursing home care. My brother gathered all her medications and took them to her doctor.

A review of the meds showed that mom was on six different blood pressure medications. Every time the medications were changed, the old one was not discontinued. Neither her doctor nor the pharmacist had caught this.

It has now been over a year since mom’s medications were corrected, and she is 92 years old. She has not fallen even once since the adjustment to her meds. As a result, she is still living at home. Why didn’t anyone catch this earlier?

Avoiding Falls Due to Excess Medicines:

A. Falls are a leading cause of fractures, disability and death, especially in older people. Drugs that cause dizziness are especially troublesome. Six blood pressure meds are excessive and would likely cause such complications.

If you would like to learn more about the problem of aggressive blood pressure treatment and the risk of falls, please check out this article:

Diabolical Dilemma: High Blood Pressure or Risk of Falls?

The dilemma is not to ignore hypertension. There is a delicate balance between good pressure control and adverse drug reactions. Physicians who prescribe BP medications to older adults must balance the risk for falling against the risk of cardiovascular complications. It requires careful adjustment of drugs and doses. Anyone experiencing dizziness, especially when standing, should alert the physician to this potentially risky complication.

Final Words:

Dr. Thomas Farley is the author of the article in JAMA Health Forum (Aug. 8, 2025) titled:

“Risky Prescribing and the Epidemic of Deaths From Falls”

Dr. Farley’s final words are:

“The more than tripling of deaths due to falls in recent years suggests that at least two-thirds of these deaths (>25 000 each year) can be prevented. It is time for organized medicine to take this problem seriously and act to save lives.”

I could not agree more. Balancing drug benefits and risks requires a clinician to listen attentively to the concerns of patients. Dizziness or unsteadiness is a red flag that something is not right. Anything that increases a patient’s risk for a fall requires immediate attention.

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