Medicines and Falls: What Older Aucklanders Should Know About “FRIDs”

Falls are one of the biggest threats to independence as we age. In Aotearoa, about 1 in 3 people over 65 will have a fall each year, and the impact can be serious — from sprains and fractures through to hospital stays and a loss of confidence that makes it harder to stay active.

What many people don’t realise is that falls aren’t only about slippery paths or weak legs. Medicines (or combinations of medicines) can also increase the chance of falling.

These medicines are sometimes called FRIDs — Fall-Risk Increasing Drugs. It doesn’t mean the medicine is “bad” or that you should stop taking it. It simply means it can increase falls risk for some people, especially when other factors are also present (like balance changes, low blood pressure, poor sleep, or illness).

⚠  Important: Do not stop any medicine suddenly without speaking to a doctor or pharmacist first.

Stopping medicines abruptly can be unsafe. If you have concerns about a medicine and falls, the right step is to book a medicines review — not to stop taking it on your own.

What are FRIDs?

FRIDs are medicines that can raise falls risk by causing side effects such as:

•       dizziness or light-headedness
•       sleepiness or slowed reaction time
•       blurred vision (particularly with medicines that have anticholinergic effects)
•       low blood pressure, especially when standing up
•       confusion or reduced concentration
•       unsteadiness

This is why regular medicines reviews are a key part of falls prevention for older people.

Common medicine types that can increase falls risk

Different people react differently, but the following groups commonly come up in falls-risk conversations:

Medicines that affect alertness or coordination

These can make people drowsy, slower to react, or unsteady:

•      some sleeping tablets and sedatives
•       some anti-anxiety medicines
•       some strong pain medicines (especially opioids)
•       some antidepressants
•       some antipsychotic medicines

(Your pharmacist or GP can tell you whether your specific medication has these risks.)

Medicines that can drop blood pressure (especially on standing)

Some medicines can increase the likelihood of feeling faint or wobbly when you stand up quickly, particularly after a dose change:

•       some blood pressure medicines
•       some medicines that affect fluid balance (for example, certain diuretics)

This doesn’t mean you shouldn’t take them. It means it’s worth monitoring symptoms and discussing them early.

Medicines with “anticholinergic” effects

Some medicines have anticholinergic activity, which can build up when several are used together (sometimes called anticholinergic burden). In older people, higher anticholinergic burden may be associated with cognitive impairment and falls, particularly when multiple anticholinergic medicines are used in combination. The risk is most significant at moderate to high burden levels.

This category includes some medicines that many people wouldn’t expect, including:

     

• certain bladder and bowel medicines (such as oxybutynin for urinary incontinence)
•       some older antihistamines found in over-the-counter hay fever and sleep products —
        many people don’t realise these carry anticholinergic risk
•       some antidepressants and antipsychotics

If you’re unsure whether something you take — including over-the-counter products — has anticholinergic effects, it’s worth asking your pharmacist.

Why FRIDs matter more as we age

Two people can take the same medicine and have very different experiences. As we get older, several things change:

•       our bodies process medicines differently
•       we’re more likely to be on multiple medicines
•       balance, eyesight and strength can shift
•       sleep, hydration, and blood pressure fluctuations become more common

That means a medicine that once felt “fine” can become risky over time, especially after a new prescription, a dose increase, or a hospital admission.

A simple “falls + medicines” checklist

If any of these feel familiar, it may be worth asking for a medicines review:

•       you’ve had a fall, near-fall, or sudden loss of confidence
•       you feel dizzy when standing
•       you feel unusually sleepy during the day
•       you’ve started a new medicine or changed a dose recently
•       you’ve been unwell or in hospital
•       you’re taking multiple medicines, including over-the-counter products

Talk to your healthcare provider about whether any medicines can be reduced or changed to lower falls risk.

What to do next (without making risky changes)

Do not stop medicines suddenly unless a clinician tells you to — that can be unsafe.

Instead:

      Book a medicines review with your GP or pharmacist

      Bring everything you take (prescriptions, supplements, over-the-counter medicines)

      Ask directly:

      “Could any of these increase my risk of falls?”

      “Are any combinations making me drowsy or dizzy?”

      “Is the dose still right for me?”

      “Are there safer alternatives?”

      If you’ve recently had a fall, mention it clearly — it’s clinically important.

New Zealand falls guidance emphasises that regular review and optimisation of medicines can reduce falls risk as health, routine, and physiology change over time.

Falls prevention is bigger than one factor

Medicines are one piece of the puzzle. Falls prevention works best when it’s multifactorial — looking at strength and balance, home hazards, eyesight, footwear, health conditions, and medicines together.

If you want to take practical steps beyond medicines, ACC’s Live Stronger for Longer programme offers approved community group strength and balance classes across Aotearoa, designed specifically to help older adults reduce falls risk and stay independent. Find classes near you at livestronger.org.nz. or through our own Age Concern Auckland Steady As You Go classes which are ACC approved.

The takeaway

If you’re over 65, a medicines review isn’t a sign something has “gone wrong”. It’s good prevention — and it can be one of the simplest ways to reduce falls risk, protect confidence, and stay independent.

If you’re concerned about falls, talk to your GP or pharmacist, and reach out to Age Concern Auckland for support and connection.

Sources

      Healthify NZ: “Medicines and falls risk” (reviewed Sep 2024). healthify.govt.nz

      Health Quality & Safety Commission: Topic 8 – Medicines and falls risk (Falls programme). hqsc.govt.nz

      bpacnz: Anticholinergic burden in older people (includes falls risk discussion). bpac.org.nz

      Medsafe: Anticholinergic burden and adverse reactions in older patients. medsafe.govt.nz

      ACC: Preventing falls for people over 65 (Live Stronger for Longer). acc.co.nz / livestronger.org.nz

      Age Concern NZ: Falls prevention. ageconcern.org.nz

      HQSC Frailty Care Guides: Falls | Ngā hinga (multifactorial falls prevention). hqsc.govt.nz

      Stewart et al. (2021): Anticholinergic burden measures and older people’s falls risk: a systematic prognostic review. Therapeutic Advances in Drug Safety.