Increase in mortality among seniors due to falls
In recent years, there has been a concerning trend in the United States - the death rates from fall injuries among Americans over the age of 65 have more than tripled over the past 30 years. This alarming statistic has sparked debate and research into the potential causes, with many experts pointing towards the increasing use of prescription drugs as a key factor.
One opinion article published in JAMA Health Forum in 2025 attributed this increase in fall-related mortality to Americans' reliance on prescription drugs. Farley, the author of the article, believes that medications like benzodiazepines, opioids, antidepressants, gabapentin, and certain cardiac medications are contributing to this trend.
Similarly, Thomas Gill, a geriatrician and epidemiologist at Yale University, agrees that medication use plays a major role in the increase in fall-related mortality. However, he also suggests alternative explanations such as changes in reporting the causes of death and the frailty and sickness of contemporary older adults.
The Beers Criteria, a directory of drugs often deemed inadvisable for older adults, recently published recommendations for alternative medications and nonpharmacological treatments for frequent problems such as sleeplessness and pain. This move is a step towards addressing the issue of inappropriate medication use in older adults.
Neil Alexander, a geriatrician and falls expert at the University of Michigan, argues that most doctors have come to understand the dangers of fall-risk-increasing drugs (FRIDs) and prescribe them less often. This is supported by data showing a slowdown in benzodiazepine prescriptions for older patients and a decrease in prescription opioid use beginning a decade ago.
However, the use of antidepressants and gabapentin has increased, and these medications have been linked to higher rates of falls and fractures among patients who took them, compared with those given a placebo. Earl Vickers, a retired electrical engineer, stopped taking the cancer drug enzalutamide (sold as Xtandi) in 2022 after experiencing frequent falls, and has not had a single fall since.
The American Geriatrics Society adopted updated fall prevention guidelines in 2011, 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 in 2023. These recommendations emphasize the importance of proactive measures in reducing fall-related injuries among older adults.
It's important to note that falls among older adults are not solely due to medication use. Factors such as physical impairments, deteriorating eyesight, alcohol abuse, and tripping hazards in people's homes also contribute to this problem.
Studies show declines in fall-related mortality in high-income countries other than the United States. This suggests that while the issue is significant in the US, there are successful strategies being implemented in other countries that could potentially be applied here.
The CDC unveiled a program called STEADI in 2012, which aims to prevent falls in older adults by encouraging healthcare providers to assess their patients' fall risk and take appropriate action. The New Old Age, produced through a partnership with The New York Times, continues to cover this important issue and provides a platform for discussions on fall prevention strategies.
Michael Steinman, a geriatrician at the University of California-San Francisco and co-director of the US Deprescribing Research Network, stated that certain medications can increase falls by 50 to 75% in older patients and emphasized the importance of deprescribing these medications. As the issue of fall-related mortality among older adults continues to be a pressing concern, it's crucial that we continue to explore and implement effective solutions.
