A Literature Review of Psychotropic Medications and Alcohol as Risk Factors for Falls in Community Dwelling Older Adults

  • Sarah Laberge
  • Alexander M. Crizzle
Review Article


Psychotropic medications and alcohol are potential risk factors for falls in older adults. However, there has been no appraisal of the literature on whether these medications, both singly and in combination with alcohol, are associated with falls in community dwelling older adults (those aged 60 years and older living independently without care). Four databases (PubMed, EMBASE, CINAHL and SCOPUS) and the grey literature (i.e. WHO, Public Health Agency of Canada) were searched using the following terms: benzodiazepine, anti-psychotics, anti-depressants, anti-epileptic, lithium, memantine, anti-hypertensives: drug or medication, aged or elderly or older adult or senior, accidental falls or falls or falling, and alcohol. Studies were included if (1) they were primary studies; (2) included community dwelling persons aged 60 years and older; (3) alcohol use was an independent variable; (4) studied medications of interest; (5) falls was the outcome variable; and (6) published in English. Articles published until July 2018 were included. The search yielded 29 studies. The findings show that both benzodiazepines and antidepressants (particularly SSRIs) are associated with fall risk while antipsychotics, anti-hypertensives, anti-epileptics and alcohol are not. No statements were made about lithium or memantine due to a lack of research studies. Future studies with adequate power to detect significant associations between psychotropic medications and falls are needed, especially among individual benzodiazepine and antidepressant medications.



The authors would like to acknowledge the contributions of Jackie Stapleton, Librarian at the University of Waterloo for assisting with the database search.

Compliance with Ethical Standards


This project is funded by the University of Waterloo International Research and Partnership Grant (Principle investigator: A. Crizzle).

Conflict of interest

The authors have no conflicts of interest relevant to the content of this review.


  1. 1.
    Rotermann M, Sanmartin C, Hennessy D, Arthur M. Prescription medication use by Canadians aged 6 to 79. (No. 6).Health Analysis Division of Statistics Canada; 2015.Google Scholar
  2. 2.
    National Center for Health Statistics. Health, united states, 2016: With chartbook on long-term trends in health. 2016. Accessed 10 Jan 2018.
  3. 3.
    Scholes S, Faulding S, Mindell J. Chapter 5: use of prescribed medicines. In: Health Survey for England 2013. Health, Social Care and Lifestyles, ed. Joint Health Surveys Unit, NatCen, and Department of Epidemiology and Public Health, University College London. Leeds: The Health and Social Care Information Centre. 2015. Accessed 1 Aug 2017.
  4. 4.
    Moncrieff J, Cohen D, Porter S. the psychoactive effects of psychiatric medication: the elephant in the room. J Psychoact Drugs. 2013;45(5):409–15.CrossRefGoogle Scholar
  5. 5.
    Canadian Institute for Health Information. Drug use among seniors on public drug programs in canada. Ottawa, ON: CIHI; 2014. 2012. Accessed 8 Jan 2017.
  6. 6.
    Du Y, Wolf I-K, Knopf H. Psychotropic drug use and alcohol consumption among older adults in Germany: results of the German health interview and examination survey for adults 2008–2011. BMJ Open. 2016;6(10):e012182.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Merel SE, Paauw DS. Common drug side effects and drug-drug interactions in elderly adults in primary care. J Am Geriatr Soc. 2017;65(7):1578–85.PubMedCrossRefGoogle Scholar
  8. 8.
    Canadian Institute for Health Information. The use of selected psychotropic drugs among seniors on public drug programs in Canada, 2001 to 2010. Ottawa, ON: CIHI; 2016. 2012. Accessed 17 Jan 2017.
  9. 9.
    World Health Organization. WHO global report on falls prevention in older age. (No. 1). 2007. Accessed 20 Dec 2016.
  10. 10.
    Public Health Agency of Canada. Seniors fall report in Canada: second report. 2014. Accessed 13 Dec 2016.
  11. 11.
    Bloch F, Thibaud M, Dugué B, Brègue C, Rigaud A, Kemoun G. Psychotropic drugs and falls in the elderly people: updated literature review and meta-analysis. J Aging Health. 2010;23(2):329–46.PubMedCrossRefGoogle Scholar
  12. 12.
    Leipzig R, Cumming R, Tinetti M. Drugs and falls in older people: A systematic review and meta-analysis: I. Psychotropic drugs. Jags. 1999;47(1):30–9.CrossRefGoogle Scholar
  13. 13.
    Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, Marra CA. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–60.PubMedCrossRefGoogle Scholar
  14. 14.
    Leipzig R, Cumming R, Tinetti M. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. Jags. 1999;47:40–50.CrossRefGoogle Scholar
  15. 15.
    Hartikainen S, Lönnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. J Gerontol Ser A Biol Sci Med Sci. 2007;62(10):1172–81.CrossRefGoogle Scholar
  16. 16.
    Park H, Satoh H, Miki A, Urushihara H, Sawada Y. Medications associated with falls in older people: systematic review of publications from a recent 5-year period. Eur J Clin Pharmacol. 2015;71(12):1429–40.PubMedCrossRefGoogle Scholar
  17. 17.
    Chang V, Do M. Risk factors for falls among seniors: implications of gender. Am J Epidemiol. 2015;181(7):521–31.PubMedCrossRefGoogle Scholar
  18. 18.
    Gill T, Taylor AW, Pengelly A. A population-based survey of factors relating to the prevalence of falls in older people. Gerontology. 2005;51(5):340–5.PubMedCrossRefGoogle Scholar
  19. 19.
    O’Loughlin JL, Robitaille Y, Boivin JF, Suissa S. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol. 1993;137(3):342–54.PubMedCrossRefGoogle Scholar
  20. 20.
    Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Rojas-Fernandez C, Dadfar F, Wong A, Brown SG. Use of fall risk increasing drugs in residents of retirement villages: a pilot study of long term. Indian J Psychiatry. 2015;51(4):324–6.Google Scholar
  22. 22.
  23. 23.
    Canadian Institute for Health Information. Use of antipsychotics among seniors living in long-term care facilities. Ottawa, ON: CIHI; 2016. 2014. Accessed 8 Dec 2016.
  24. 24.
    Campanelli C. American geriatrics society updates beers criteria for potentially inappropriate medication use in older adults the american geriatrics society 2012 beers criteria update expert panel. J Am Geriatr Soc. 2012;60(4):616–31.PubMedCentralCrossRefGoogle Scholar
  25. 25.
    Darowski A, Chambers SA, Chambers DJ. Antidepressants and falls in the elderly. Drugs Aging. 2009;26(5):381–94.PubMedCrossRefGoogle Scholar
  26. 26.
    Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348(16):1556–64.PubMedCrossRefGoogle Scholar
  27. 27.
    Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting elderly. JAMA. 2003;289(9):1107–16.PubMedCrossRefGoogle Scholar
  28. 28.
    Gray SL, Mahoney JE, Blough DK. Adverse drug events in elderly patients receiving home health services following hospital discharge. Ann Pharmacother. 1999;33(11):1147–53.PubMedCrossRefGoogle Scholar
  29. 29.
    Gray SL, Sager M, Lestico MR, Jalaluddin M. Adverse drug events in hospitalized elderly. J Gerontol Ser A Biol Sci Med Sci. 1998;53(1):M59–63.CrossRefGoogle Scholar
  30. 30.
    Field TS, Gurwitz JH, Harrold LR, Rothschild J, DeBellis KR, Seger AC, Bates DW. Risk factors for adverse drug events among older adults in the ambulatory setting. J Am Geriatr Soc. 2004;52(8):1349–54.PubMedCrossRefGoogle Scholar
  31. 31.
    Tinetti M, Han L, Lee D, McAvay GJ, Peduzzi P, Gross C, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014;174(4):588–95.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Cousins G, Galvin R, Flood M, Kennedy M, Motterlini N, Henman MC, Fahey T. Potential for alcohol and drug interactions in older adults: evidence from the irish longitudinal study on ageing. BMC Geriatr. 2014;14(1):57.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Bye EK, Rossow I. Concomitant alcohol and sedative-hypnotic drug use among the elderly in norway. Nordic Stud Alcohol Drugs. 2017;34(1):18–27.CrossRefGoogle Scholar
  34. 34.
    World Health Organization. Global status report on alcohol and health. 2014.;jsessionid=92703F01A7BECF3C9B07E9406B628DD5?sequence=1. Accessed 8 Dec 2016.
  35. 35.
    Moore AA, Whiteman EJ, Ward KT. Risks of combined alcohol-medication use in older adults. Am J Geriatr Pharmacother. 2007;5(1):64–74.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Weathermon R, Crabb D. Alcohol and medication interactions. Alcohol Res Health. 1999;23(1):40–54.PubMedGoogle Scholar
  37. 37.
    Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):264–9.CrossRefGoogle Scholar
  38. 38.
    Hanlon J, Boudreau R, Roumani Y, et al. Number and dosage of central nervous system medications on recurrent falls in community elders: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2009;64(4):492–8.CrossRefGoogle Scholar
  39. 39.
    Lord SR, Ward JA, Williams P, Anstey KJ. An epidemiological study of falls in older community-dwelling women: the randwick falls and fractures study. Aust J Public Health. 1993;17(3):240–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Lord S, Anstey K, Williams P, Ward J. Psychoactive medication use, sensorimotor function and falls in older women. Br J Clin Pharmacol. 1995;39(3):227–34.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Kurzthaler I, Wambacher M, Golser K, Sperner G, Sperner-Unterweger B, Haidekker A. Alcohol and benzodiazepines in falls: an epidemiological view. Drug Alcohol Depend. 2005;79:225–30.PubMedCrossRefGoogle Scholar
  42. 42.
    Malmivaara A, Heliövaara M, Knekt P, Reunanen A, Aromaa A. Risk factors for injurious falls leading to hospitalization or death in a cohort of 19,500 adults. Am J Epidemiol. 1993;138(6):384–94.PubMedCrossRefGoogle Scholar
  43. 43.
    Stenbacka M, Jansson B, Leifman A, Romelsjo A. Association between use of sedatives or hypnotics, alcohol consumption, or other risk factors and a single injurious fall or multiple injurious falls: a longitudinal general population study. Alcohol. 2002;28:9–16.PubMedCrossRefGoogle Scholar
  44. 44.
    Kerse N, Flicker L, Pfaff J, Draper B, Lautenschlager N, et al. Falls, depression and antidepressants in later life: a large primary care appraisal. PLoS One. 2008;3(6):e2423.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Du Y, Wolf I-K, Knopf H. Association of psychotropic drug use with falls among older adults in Germany Results of the German health interview and examination survey for adults 2008–2011 (DEGS1). PloS One. 2017;12(8):e0182432.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Gribbin J, Hubbard R, Gladman JRF, Smith C, Lewis S. Serotonin-norepinephrine reuptake inhibitor antidepressants and the risk of falls in older people: case-control and case series analysis of a large UK primary care database. Drug sand Aging. 2011;28(11):895–902.CrossRefGoogle Scholar
  47. 47.
    Cumming RG, Miller JP, Kelsey JL, Davis P, Arfken CL, Birge SJ, Peck WA. Medications and multiple falls in elderly people: the st louis OASIS study. Age Ageing. 1991;20(6):455–61.PubMedCrossRefGoogle Scholar
  48. 48.
    Neutel CI, Hirdes JP, Maxwell CJ, Patten SB. New evidence on benzodiazepine use and falls: the time factor. Age Ageing. 1996;25(4):273–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Anstey KJ, Burns R, von Sanden C, Luszcz MA. Psychological well-being is an independent predictor of falling in an 8-year follow-up of older adults. J Gerontol Ser B Psychol Sci Soc Sci. 2008;63(4):P249–57.CrossRefGoogle Scholar
  50. 50.
    Iinattiniemi S, Jokelainen J, Luukinen H. Falls risk among a very old home-dwelling population. Scand J Prim Health Care. 2009;27(1):25–30.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Ferrer A, Formiga F, Plana-Ripoll O, Tobella MA, Gil A, Pujol R. Risk of falls in 85-year-olds is associated with functional and cognitive status: the octabaix study. Arch Gerontol Geriatr. 2012;54(2):352–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Spoelstra SL, Given BA, Schutte DL, Sikorskii A, You M, Given CW. Do older adults with cancer fall more often? A comparative analysis of falls in those with and without cancer. Oncol Nurs Forum. 2013;40(2):E69.PubMedCrossRefGoogle Scholar
  53. 53.
    Masud T, Frost M, Ryg J, Matzen L, Ibsen M, Abrahamsen B, Brixen K. Central nervous system medications and falls risk in men aged 60–75 years: the study on male osteoporosis and aging (SOMA). Age Ageing. 2013;42(1):121–4.PubMedCrossRefGoogle Scholar
  54. 54.
    Wong AKW, Lord SR, Sturnieks DL, Delbaere K, Trollor JN, Close JCT. Angiotensin System-Blocking medications are associated with fewer falls over 12 months in community-dwelling older people. J Am Geriatr Soc. 2013;61(5):776–81.PubMedCrossRefGoogle Scholar
  55. 55.
    Bergland A, Wyller T. Risk factors for serious fall related injury in elderly women living at home. Injury Prevention. 2004;10(5):308–13.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Kelly KD, Pickett W, Yiannakoulias N, Rowe BH, Schopflocher DP, Svenson L, Voaklander DC. Medication use and falls in community-dwelling older persons. Age Ageing. 2003;32(5):503–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Tromp AM, Pluijm SMF, Smit JH, Deeg DJH, Bouter LM, Lips P. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol. 2001;54(8):837–44.PubMedCrossRefGoogle Scholar
  58. 58.
    Tromp AM, Smit JH, Deeg DJH, Bouter LM, Lips P. Predictors for falls and fractures in the longitudinal aging study amsterdam. J Bone Miner Res. 1998;13:1932–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Landi F, Onder G, Cesari M, Barillaro C, Russo A, Bernabei R, Silver Network Home Care Study Group. Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. J Gerontol Ser A Biol Sci Med Sci. 2005;60(5):622–6.CrossRefGoogle Scholar
  60. 60.
    Ensrud KE, Blackwell TL, Mangione CM, Bowman PJ, Whooley MA, Bauer DC, et al. Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc. 2002;50(10):1629–37.PubMedCrossRefGoogle Scholar
  61. 61.
    Hanlon JT, Landerman LR, Fillenbaum GG, Studenski S. Falls in African American and white community-dwelling elderly residents. J Gerontol A Biol Sci Med Sci. 2002;57(7):M473–8.PubMedCrossRefGoogle Scholar
  62. 62.
    de Rekeneire N, Visser M, Peila R, Nevitt MC, Cauley JA, Tylavsky FA, et al. Is a fall just a fall: Correlates of falling in healthy older persons. The health, aging and body composition study. J Am Geriatr Soc. 2003;51(6):841–6.PubMedCrossRefGoogle Scholar
  63. 63.
    Svensson M, Rundgren Å, Landahl S. Falls in 84- to 85-year-old people living at home. Accid Anal Prev. 1992;24(5):527–37.PubMedCrossRefGoogle Scholar
  64. 64.
    Blake AJ, Morgan K, Bendall MJ, Dallosso H, Ebrahim SBJ, Arie THD, Bassey EJ. Falls by elderly people at home: prevalence and associated factors. Age Ageing. 1988;17(6):365–72.PubMedCrossRefGoogle Scholar
  65. 65.
    Madhusoodanan S, Bogunovic O. Safety of benzodiazepines in the geriatric population. Expert Opin Drug Saf. 2004;3(5):485–93.PubMedCrossRefGoogle Scholar
  66. 66.
    Diem SJ, Blackwell TL, Stone KL, Yaffe K, Haney EM, Bliziotes MM, Ensrud KE. Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch Intern Med. 2007;167(12):1240–5.PubMedCrossRefGoogle Scholar
  67. 67.
    de Groot M, van Campen JPCM, Moek M, Tulner L, Beijnen J, Lamoth C. The effects of fall-risk-increasing drugs on postural control: a literature review. Drugs Aging. 2013;30:901–20.PubMedCrossRefGoogle Scholar
  68. 68.
    French J. New generation antiepileptic drugs: what do they offer in terms of improved tolerability and safety? Ther Adv Drug Saf. 2011;2:141–58.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Britton A, Ben-Shlomo Y, Benzeval M, Kuh D, Bell S. Life course trajectories of alcohol consumption in the United Kingdom using longitudinal data from nine cohort studies. BMC Med. 2015;13:47.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Babatunde OT, Outlaw KR, Forbes B, Gay T. Revisiting baby boomers and alcohol use: emerging treatment trends. J Hum Behav Soc Environ. 2014;24(5):597–611.CrossRefGoogle Scholar
  71. 71.
    Wong H, Heuberger R, Logomasino J, Hewlings S. Associations between alcohol use, polypharmacy and falls in older adults. Nursing Older People. 2016;28(1):30–6.PubMedGoogle Scholar
  72. 72.
    Han BH, Moore AA, Sherman S, Keyes KM, Palamar JJ. Demographic trends of binge alcohol use and alcohol use disorders among older adults in the United States, 2005–2014. Drug Alcohol Depend. 2017;170:198–207.PubMedCrossRefGoogle Scholar
  73. 73.
    Blow F, Barry K. Alcohol and substance misuse in older adults. Curr Psychiatry Rep. 2012;14(4):310–9.PubMedCrossRefGoogle Scholar
  74. 74.
    Ilomäki J, Gnjidic D, Hilmer SN, Le Couteur DG, Naganathan V, Cumming RG, et al. Psychotropic drug use and alcohol drinking in community-dwelling older australian men: the CHAMP study. Drug Alcohol Rev. 2012;32(2):218–22.PubMedCrossRefGoogle Scholar
  75. 75.
    Ilomäki J, Paljärvi T, Korhonen MJ, Enlund H, Alderman CP, Kauhanen J, Bell JS. Prevalence of concomitant use of alcohol and sedative-hypnotic drugs in middle and older aged persons: a systematic review. Ann Pharmacother. 2013;47(2):257–68.PubMedCrossRefGoogle Scholar
  76. 76.
    Janus SIM, Reinders GH, van Manen JG, Zuidema SU, Ijzerman MJ. Psychotropic drug-related fall incidents in nursing home residents living in the eastern part of the Netherlands. Drugs Res Dev. 2017;17:321–8.Google Scholar
  77. 77.
    Lostia AM, Mazzarini L, Pacchiarotti I, Lionetto L, De Rossi P, Sanna L, Tatarelli R. Serum levels of risperidone and its metabolite, 9-hydroxyrisperidone: correlation between drug concentration and clinical response. Ther Drug Monit. 2009;31(4):475–81.PubMedCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
  2. 2.School of Public HealthUniversity of SaskatchewanSaskatoonCanada

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