Lowering Fall Risk in the Aging I/DD Population

September marks Fall Prevention Awareness Month, reminding providers of the importance of addressing fall risk among the individuals they support every day. Thanks to advances in care, individuals with intellectual and developmental disabilities (I/DD) are living longer than ever. While that progress is worth celebrating, it also brings specific health challenges providers must be ready to meet. Falls are among the most serious. For an aging individual with I/DD, a single fall can lead to injury, hospitalization, and a loss of independence.

A Growing Population Facing Earlier Fall Risk

The aging I/DD population is expanding rapidly. The number of adults aged 60 and older with developmental disabilities is expected to nearly double to 1.2 million by 2030. This demographic shift introduces fresh challenges for providers, as these individuals often develop chronic conditions earlier than the general population, including arthritis, Type 2 diabetes, cardiovascular disease, Alzheimer’s disease, and other dementias.

Fall risk also begins earlier in this population. Research shows falls tend to occur around the mid-50s, well ahead of the general population, where risk climbs after age 65. About 30% of adults with I/DD fall each year and 66% will fall again, increasing the likelihood of future falls and more serious injuries.

The Medication Connection

Much of the conversation around fall prevention focuses on the physical environment, such as grab bars, lighting, or clear walkways. But one of the most overlooked contributors to fall risk sits inside the medication cart.

The chronic conditions common in aging populations with I/DD require ongoing treatment, and certain medications used to manage them can contribute to fall risk. Sedatives, antidepressants, benzodiazepines, opioid analgesics, muscle relaxants, and blood pressure medications can cause drowsiness, dizziness, balance issues, and muscle weakness. Antipsychotics can cause sedation, tremors, and extrapyramidal symptoms that further increase fall risk.

Because individuals with I/DD are often prescribed multiple drugs by several specialists, medication management becomes a critical component of fall prevention. Pharmacists play a crucial role here, particularly those specializing in long-term care (LTC). A comprehensive medication review can identify drugs that may contribute to falls, and pharmacists can recommend adjusting dosages, switching to less sedative alternatives, or discontinuing unnecessary medications to enhance patient safety.

An LTC pharmacy can also serve as an extension of the care team, offering the clinical perspective needed to reduce medication-related fall risk. And ongoing clinical oversight allows pharmacy teams to monitor regimen changes, especially after a hospital stay or new diagnosis, keeping the care team aligned and the individual protected.

In practice, reducing medication-related fall risk requires practical strategies that providers can help reinforce across the care team.

Medication Management Strategies to Reduce Fall Risk

• Bring a comprehensive medication list to every physician’s visit
• Request a pharmacist medication regimen review to flag high fall-risk medications and make recommendations
• Look for opportunities to discontinue or reduce the dose of high fall-risk medications
• Consider lower-risk medications first
• Strive to find the lowest effective dose of high fall-risk medications
• Avoid psychotropic medications when possible
• Use opioid analgesics for the shortest time possible
• Reduce or discontinue sedative/hypnotic use when possible by improving sleep hygiene
• Avoid administering stimulating medications in the evening
• Evaluate medications taken within 1 to 2 hours of a fall

A Team-Based Approach to Fall Prevention

Fall prevention works best as a team. Alongside pharmacists, direct support professionals, nurses, physicians, and occupational therapists each play a role. When regimens are reviewed regularly, staff are equipped with reliable tools, and clinical support is accessible around the clock, fall prevention becomes an active part of daily care rather than a reactive response.

We often say age is just a number. In this case, the number that matters most is the number of falls we can prevent. Preventing falls is not just about avoiding injuries; it’s about preserving independence, dignity, and quality of life for aging individuals with I/DD. By working together, providers and care teams can make a profound difference in the lives of those they serve—and work toward making that number zero.

Curt Bicknell is the President of Guardian Pharmacy Mid-South.