We summarize existing knowledge on the risk of opioid-related falls in older adults, including aspects of pharmacokinetics and pharmacodynamics, and assist clinicians in (de-) prescribing opioids.

Opioid use increases the risk of falls in older adults due to sedation, orthostatic hypotension and also hyponatremia caused by weak opioids.

Decisions regarding both opioid prescribing and deprescribing in fall-prone older persons need to be individualized as adverse drug events may lead to falls, but adequate pain treatment is also warranted. Clinical decision tools can support prescribers in rational (de-) prescribing decision making.