A Rising Tide of Harm: How Medication Overload May Be Fueling Falls In Older Americans

By Joshua Speiser | September 17, 2025

Look in any older person’s medicine cabinet or pill box and you might be surprised at the sheer number of medications to be found. Far from benign, this mix of pills, salves, and tinctures may have serious unintended consequences for patients including overmedication, oversedation, and life-threatening falls.

A new JAMA Health Forum report found that 41,000 adults over age 65 died from a fall in 2023, “more than from breast or prostate cancer…car crashes, drug overdoses, and all other unintentional injuries combined.” The New York Times highlighted how death rates from fall injuries among Americans over 65 have more than tripled over the past 30 years as it declined in other high-income countries.

According to researchers, medications that act on the central nervous system—including benzodiazepines, opioids, antidepressants, and gabapentin—may be the culprit.

The Lown Institute has long been active in the effort to reduce over-prescription and other low value health care services that may do more harm than good.

America’s “Other Drug Problem”

Our 2019 report Medication Overload: America’s Other Drug Problem showed how over the previous decade, adults aged 65 and older have been hospitalized for serious drug side effects about 2 million times, a rate of 750 older adults each day.

“It seemed like I was falling every other month. It was kind of crazy.”
— Earl Vickers, 69, retired electrical engineer, The New York Times, “Why Are More Older People Dying After Falls?”

While no single cause explains the dramatic rise in the number of medications older people are taking, we did identify three overarching aspects of our health care system contributing to the epidemic of medication overload:

Culture of Prescribing: Both patients and clinicians have been oversold on the benefits of medications, to the point where a prescription is seen as caring, and withdrawal of medication connotes giving up on the patient.
Information & Knowledge Gaps: Clinicians and patients lack critical information and skills they need to appraise the evidence and make informed decisions regarding medications.
The Fragmentation of Care: American health care suffers from a pervasive lack of coordination, or communication with a patient’s various providers—hospitals, rehab units, and long-term care facilities—prescribing additional medications with little information about the patient’s current prescriptions.

If current trends continue, the Lown Institute predicts, over the next decade there will be more than 4.5 million hospitalizations of older adults for serious side effects of medications.

A Better Prescription

To catalyze action on this critical issue, the Lown Institute convened a working group of 22 experts in medication use and polypharmacy, including patient advocates, physicians, nurses, pharmacists, and researchers, to develop a national action plan to eliminate medication overload.

“It’s easy to start meds, but it often takes a lot of time and effort to have patients stop taking them.”
-Dr. Michael Steinman, geriatrician at the University of California, San Francisco, and co-director of the US Deprescribing Research Network, The New York Times, “Why Are More Older People Dying After Falls?”

Together, the group drafted the report Eliminating Medication Overload: A National Action Plan which offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use that includes implementing prescription checkups; raising awareness among clinicians, policymakers, and the public; improving information at the point of care; and educating and training health professionals to reduce medication overload.

With this roadmap in hand, we can shift the healthcare narrative away from one that too often defaults to low-value prescribing practices that put older Americans in jeopardy for falls and other complications.

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.