Pills & Spills
4 types of medication that may increase your chance of falling
Harvard Health Publishing
Among people over 65, falls are a leading cause of unintentional injuries. Even more concerning: deaths from falls more than tripled over the past 30 years in the United States.
Too often, a broken hip or serious head injury from a fall triggers a downward health spiral. The soaring use of prescription drugs that affect the brain may be to blame for this lethal trend, according to an opinion piece in a recent issue of JAMA Health Forum.
Many medications can make people feel drowsy or impair their balance or coordination. Known as fall risk-increasing drugs — or FRIDs — they include a wide range of medications. But the most worrisome are four classes that have been heavily prescribed to older adults in recent decades: opioids, benzodiazepines, gabapentinoids and antidepressants.
“Despite recent efforts to reduce the use of these drugs in older people, it’s still a serious problem,” says Dr. Sarah Berry, chief of gerontology at Harvard-affi liated Beth Israel Deaconess Medical Center. Unfortunately, when doctors stop prescribing one class of medications, they may substitute newer medications that aren’t necessarily any safer in terms of fall risks, she adds.
Drugs for pain and anxiety
For example, doctors prescribed fewer opioids due to the serious risks of addiction and overdose from these powerful pain relievers. Examples include oxycodone (Oxycontin) and hydromorphone (Dilaudid). That fueled a rise in prescriptions for gabapentinoids, which include gabapentin (Neurontin, Horizant, Gralise) and pregabalin (Lyrica). Originally developed to treat seizure disorders, these drugs are now commonly prescribed off -label for chronic pain. But gabapentinoids probably pose just as much fall risk as opioids, Berry says.
For treating anxiety and sleep problems, the American Geriatric Society recommends antidepressants instead of benzodiazepines. The latter, which include diazepam (Valium) and alprazolam (Xanax), can lead to cognitive impairment and other serious risks as well as falls. But all antidepressants, including those recommended by the AGS — citalopram (Celexa) and sertraline (Zoloft) — also can leave older people more prone to falls, Berry says.
How might medications cause falls?
The four highlighted drug classes aff ect brain function and can make you feel sleepy, dizzy or confused — all of which can leave you vulnerable to falling.
“But we don’t actually understand the mechanism for a lot of medication side effects, and their links to falls are probably the result of multiple factors,” Berry says.
For example, gabapentin makes people sleepy, but it also can cause swelling in the legs that can impair mobility. If both of those side eff ects occur in someone with arthritis and a mild visual impairment, that combination of factors could literally tip them over, Berry explains.
What you can do
If you’re currently taking a medication from any of these classes, don’t stop taking it abruptly, as doing so may cause withdrawal symptoms. Talk to your doctor for advice about possibly tapering off the medication. Have your primary care clinician review all of your medicines (including prescription and nonprescription medications) as well as all supplements at least once a year. Make sure you understand why you take each drug and whether you still need it. If you’re taking a FRID, ask if a less risky alternative might be an option for you.
For people coping with chronic pain, the latest guidelines on opioids recommend a range of other options.
“There’s no magic bullet for chronic pain. Often, the best option is to use multiple strategies together,” Berry says. For example, you might take a low dose of acetaminophen (Tylenol) with a topical treatment like a lidocaine patch or diclofenac gel (Voltaren).
For people who take benzodiazepines, nondrug alternatives for anxiety include therapy and relaxation techniques. For those who struggle with sleep, practicing better sleep hygiene can help.
The scope of the problem
The JAMA Health Forum piece presents statistics that highlight the problem of risky prescribing:
32% Percentage of adults older than 65 who took prescription pain relievers (most of which were opioids) at some point during 2022; 17% took tranquilizers or sedatives (most of which were benzodiazepines) during that year.
4x Prescriptions for gabapentin and combinations of gabapentin and opioids increased about fourfold between 2006 and 2018.
12% Percentage increase of people over 65 who take antidepressants from 1999 to 2020. Usage rose from 8% to 20% of people over 65.
New COVID-19 subvariant has health officials on alert
Rong-Gong Lin II
Los Angeles Times
A highly mutated COVID-19 strain is circulating in California, raising concerns that disease activity could rise heading into the summer.
The emergence of the BA.3.2 strain, nicknamed “cicada,” comes amid broader uneasiness about COVID vaccination rates among seniors — who are especially susceptible to the virus — and whether complacency after back-to-back relatively quiet winters has left the elderly vulnerable.
The “cicada” nickname refers to this subvariant’s apparent dormancy before it reemerged in 2025, akin to some periodically active insects of the same name.
COVID timing changing
The timing of the spread of the cicada subvariant also underscores that, at least in California, COVID has morphed into more of a summer disease. In fact, the summer peaks of COVID in 2024 and 2025 were worse than their respective winter peaks, according to the California Department of Public Health — a stark departure from the earlier years of the pandemic, when winter surges occurred with devastating regularity.
Instead it was the flu that was the dominant respiratory virus the last two winters, with this past season considered moderately severe.
“This cicada variant may be increasing just in time for what for COVID is more of a summer hit,” said Dr. Neil Silverman, director of the Infections in Pregnancy Program at the David Geffen School of Medicine at the University of California, Los Angeles. “COVID doesn’t seem to play by the same rules that influenza tends to play by, where its cycle is predictable.”
Dr. Peter Chin-Hong, a UC San Francisco infectious diseases expert, said cicada is “a different kind of variant that’s increasing. It looks so different from the other ones that have been circling since JN.1 came on board” in late 2023.
“My ears are perking up,” he said.
Public health impact ‘considerable’
In lab studies, the cicada subvariant efficiently evades immunity from a prior vaccination or infection, according to a report published by the U.S. Centers for Disease Control and Prevention. That raises the possibility of a seasonal increase in COVID-19, the researchers said.
“Although widespread infection and vaccine-conferred immunity have decreased rates of severe COVID-19 over time, the public health impact of COVID-19 is still considerable,” scientists recently wrote in the CDC’s Morbidity and Mortality Weekly Report.
During the 2024-25 respiratory virus season, there were an estimated 45,000 to 64,000 COVID deaths and 390,000 to 550,000 hospitalizations.
A potential uptick is concerning as recent COVID vaccine coverage remains scant — even among the most vulnerable.
“To me, the biggest threat ... is the low vaccination rate in seniors,” Chin-Hong said. “The landscape of divisiveness around vaccines is leading people to be confused and to think of COVID as being political when it’s not.”
The cicada subvariant was initially detected in South Africa in November 2024 and first found in the U.S. in a sample given at San Francisco International Airport in June 2025 by an international traveler from the Netherlands.
By that September, detection of the subvariant was increasing. In November, BA.3.2 was identified in a wastewater sample in Rhode Island, and among patients, the first detections of the new subvariant were found in three states in December and early January.
Cicada seen around the world
As of February, the cicada subvariant was reported in 23 countries and has also been seen among airline passengers to the U.S. traveling from the United Kingdom, Japan and Kenya. Over the autumn and winter, about 30% of coronavirus samples analyzed in three European countries — Germany, the Netherlands and Denmark — were the Cicada subvariant, according to the Morbidity and Mortality Weekly Report.
It’s not a sure fire bet the cicada subvariant will bring a summer of misery, however. COVID wasn’t appreciably worse this past winter than in previous years in central Europe.
According to the California Department of Public Health, the cicada subvariant remains at low levels in the state’s wastewater, and there have been no reports of increased severity of illness among those who were infected. It’s also not projected to be a particularly fast-growing subvariant, nor a dominant one.
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