Study Reveals Concerning Trend in Benzodiazepine Prescriptions for Older Stroke Survivors

A new study published in the American Stroke Association's journal Stroke has uncovered a concerning trend in the prescription of benzodiazepines to older stroke survivors. The research, which analyzed Medicare claims data for over 120,000 patients aged 65 and older who were hospitalized for ischemic stroke, found that approximately 5% received their first prescription for benzodiazepines within 90 days of their stroke.

Benzodiazepines, which are commonly prescribed to relieve anxiety, muscle spasms, and seizures, can pose significant risks to older adults, including an increased likelihood of falls, fractures, memory problems, and confusion. The study's findings are particularly alarming given that more than half of the new prescriptions were for a 15 to 30-day supply, rather than the recommended shorter-term, as-needed use.

Julianne Brooks, M.P.H., a co-author of the study and data analytics manager at the Center for Value-based Healthcare and Sciences at Massachusetts General Brigham in Boston, emphasized the critical nature of the 90-day post-stroke period for rehabilitation. "It's often a very difficult time for patients who experience loss of mobility and independence. Benzodiazepines may inhibit recovery and rehabilitation," Brooks stated.

The research revealed several notable patterns in benzodiazepine prescriptions. Women were more likely than men to receive initial prescriptions, with rates of 5.5% and 3.8% respectively. Geographically, prescription rates were highest in the Southeast (5.1%) and lowest in the Midwest (4%) of the United States. The study also found that lorazepam and alprazolam were the most commonly prescribed benzodiazepines, accounting for 40% and 33% of prescriptions respectively.

While there has been a modest nationwide decline in initial prescriptions from 2013 to 2021 of 1.6%, the researchers stress that the current prescription patterns remain problematic. The potential for oversupply and long-term dependence is a significant concern, particularly given the vulnerability of older adults to adverse outcomes from these medications.

The findings of this study underscore the need for increased awareness among healthcare providers about the risks associated with prescribing benzodiazepines to older stroke survivors. The American Geriatrics Society's Beers Criteria, which provides guidelines for safe medication prescribing in adults over 65, recommends avoiding benzodiazepines due to the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents.

Experts suggest that alternative approaches, such as cognitive behavioral therapy for insomnia and non-pharmaceutical interventions, should be considered before resorting to benzodiazepine prescriptions. The study's authors call for more research to determine if there is a safe level for prescribing benzodiazepines that may be most appropriate for older adults.

This research highlights the importance of careful medication management in the care of older stroke survivors. As stroke remains a leading cause of long-term disability and mortality in the United States, addressing potential issues in post-stroke care, including medication prescribing practices, is crucial for improving patient outcomes and quality of life.

The study's findings serve as a call to action for healthcare providers to reassess their prescribing practices and for policymakers to consider implementing stricter guidelines for the use of benzodiazepines in vulnerable populations. By raising awareness of these issues, the research contributes to the ongoing effort to enhance the safety and effectiveness of post-stroke care for older adults.