Study Reveals Concerning Trend in Benzodiazepine Prescriptions for Older Stroke Survivors

A recent study published in Stroke, the scientific journal of the American Stroke Association, has uncovered a worrying pattern in the prescription of benzodiazepines to older stroke survivors. The research, which analyzed Medicare claims data over a 10-year period, found that approximately 5% of stroke survivors aged 65 and older received their first benzodiazepine prescription within 90 days of experiencing an ischemic stroke.

Benzodiazepines, commonly prescribed to alleviate anxiety and improve sleep, can pose significant risks to older adults, including an increased likelihood of falls, bone fractures, memory problems, and confusion. The study's findings are particularly concerning given that more than half of the initial prescriptions were for a 15 to 30-day supply, rather than a smaller quantity for short-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 first 90 days post-stroke 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 trends. Women were more likely than men to receive an initial benzodiazepine prescription after a stroke, with prescription rates at 5.5% and 3.8% respectively. Geographically, the highest prescription rates were observed in the Southeast (5.1%), while the Midwest had the lowest rates (4%). The study also found that lorazepam and alprazolam were the most commonly prescribed benzodiazepines.

While there has been a modest decline in initial prescriptions from 2013 to 2021 (1.6% decrease), the researchers stress that this pattern remains problematic. The potential for oversupply in these initial prescriptions raises concerns about long-term use and possible addiction among this vulnerable population.

The implications of these findings are significant for both healthcare providers and patients. The American Geriatrics Society's Beers Criteria, which provides guidance on safe medication prescribing for adults over 65, recommends avoiding benzodiazepines due to the associated risks. Alternative approaches, such as cognitive behavioral therapy for insomnia and non-pharmaceutical interventions, are suggested as safer options for managing post-stroke anxiety and sleep issues.

This research underscores the need for increased awareness among healthcare providers about the risks associated with benzodiazepine use in older stroke survivors. It also highlights the importance of exploring safer treatment alternatives and adhering to prescribing guidelines for this population.

As stroke remains a leading cause of long-term disability and mortality in the United States, addressing these prescribing practices is crucial for improving patient outcomes and quality of life. The study's authors call for further research to determine if there is a safe level for prescribing benzodiazepines to older adults and to better understand the factors influencing these prescription patterns.

For stroke survivors and their families, this research emphasizes the importance of discussing medication risks and alternatives with healthcare providers. It also serves as a reminder of the complex challenges faced during stroke recovery and the need for comprehensive, patient-centered care that considers both physical and mental health needs.

As the medical community continues to refine its approach to post-stroke care, studies like this play a vital role in identifying areas for improvement and promoting safer, more effective treatment strategies for one of our most vulnerable patient populations.