How to Request a Medication Review for Fall Risk in Elderly Parents

About 41% of falls in older adults are linked to medication side effects. That's not a secondary factor — it's the leading modifiable cause of falls that most families never address. Grab bars and non-slip mats are visible. The benzodiazepine your parent takes every night for sleep is invisible, and it's arguably more dangerous than a loose rug.

Getting a proper medication review done is one of the highest-impact actions you can take. Here's how to make it happen.

What a Medication Review Actually Involves

A fall-risk medication review isn't your parent's doctor scanning a prescription list for 30 seconds. It's a systematic evaluation of every medication — prescription, over-the-counter, and supplement — against two clinical tools designed specifically to identify drugs that increase fall risk in older adults:

The AGS Beers Criteria: Published by the American Geriatrics Society, this is the gold standard in the US. It lists medications that are potentially inappropriate for adults 65 and older, categorized by risk type. For fall risk specifically, it flags:

• Benzodiazepines (alprazolam, diazepam, lorazepam)
• Non-benzodiazepine sleep aids (zolpidem, eszopiclone)
• First-generation antihistamines (diphenhydramine — sold as Benadryl, Tylenol PM, ZzzQuil)
• Tricyclic antidepressants (amitriptyline, nortriptyline)
• Antipsychotics
• Opioids
• Skeletal muscle relaxants (cyclobenzaprine, methocarbamol)

The STOPPFall Tool: A European-developed screening tool specifically focused on fall-risk-increasing drugs (FRIDs). It's more targeted than the Beers Criteria and includes medications Beers doesn't flag for fall risk specifically, like:

• Blood pressure medications that cause orthostatic hypotension (standing up makes you dizzy)
• Long-acting sulfonylureas (diabetes drugs that can cause hypoglycemia-induced unsteadiness)
• Alpha-blockers prescribed for enlarged prostate (tamsulosin)

Over 53% of older adults take at least one FRID. Many take three or more. The cumulative effect compounds the risk — polypharmacy (typically defined as taking five or more medications) is itself an independent fall risk factor.

How to Get the Review

Your parent's primary care physician can do this, but you may need to push for it. Here's the approach:

Before the appointment:

1. Collect every medication bottle in the house — prescriptions, OTC pills, supplements, vitamins, eye drops, inhalers. Put them in a bag and bring them to the appointment.
2. Include anything your parent takes intermittently ("just when I can't sleep" or "only when my back hurts")
3. Write down any falls, near-misses, or episodes of dizziness in the past 6 months, noting time of day and what they were doing

At the appointment, ask these questions:

• "Can we do a comprehensive medication review using the Beers Criteria to check for fall risk?"
• "Are any of these medications on the STOPPFall list?"
• "Which of these can be safely reduced in dose or discontinued?"
• "Are there safer alternatives for the medications that increase fall risk?"
• "Is there a clinical pharmacist available for a full medication reconciliation?"

The clinical pharmacist route: Many health systems now have clinical pharmacists who specialize in geriatric medication reviews. If your parent's doctor brushes off the request, ask specifically for a referral to a clinical pharmacist. Ask the pharmacist or Medicare plan whether any Medication Therapy Management (MTM) benefit applies and what eligibility rules govern it.

What Deprescribing Looks Like

Deprescribing isn't stopping medications cold turkey. It's a systematic, supervised reduction process:

1. The clinician identifies which FRIDs can be tapered or switched
2. Changes happen one medication at a time, at intervals the clinician sets to monitor effects
3. Some medications require gradual dose reduction; abrupt discontinuation can cause withdrawal symptoms or rebound effects, so do not stop or change a medication without the prescriber's instructions

The goal isn't necessarily zero medications. It's eliminating or reducing the ones where the fall risk outweighs the therapeutic benefit — particularly drugs that cause sedation, orthostatic hypotension, or impaired balance.

The OTC Problem

The medications your parent buys without a prescription are often the worst offenders. Diphenhydramine (Benadryl) carries a high anticholinergic burden score and is present in dozens of products your parent may not realize contain it — Tylenol PM, Advil PM, ZzzQuil, and many allergy medications. First-generation antihistamines cause drowsiness that persists well into the next morning, impairing balance and reaction time.

Ask your parent's doctor about safer sleep alternatives and an appropriate dose rather than changing medication or starting a supplement on your own. Sleep-hygiene changes may also reduce reliance on sedating antihistamines.

Track and Follow Up

After a medication review, track the results. A simple log noting which medications were changed, when, and any observed effects on balance, alertness, and falls gives you objective data for follow-up visits. The Home Safety and Fall Prevention Audit includes a medication tracking worksheet designed specifically for this — documenting current medications, flagging known FRIDs, and recording changes over time alongside fall incident data.