A recent study published in the American Stroke Association's journal Stroke has uncovered worrying trends in the prescription of benzodiazepines to older stroke survivors. The research analyzed Medicare claims data for over 120,000 patients aged 65 and older who were hospitalized for ischemic stroke, finding that nearly 5% received their first benzodiazepine prescription within 90 days of their stroke. Benzodiazepines, which are used to treat anxiety, muscle spasms, and seizures, can pose significant risks to older adults, including an increased likelihood of falls, fractures, and cognitive impairment. The study's findings raise concerns about potential oversupply and the risk of long-term use or addiction among this vulnerable population.
According to the research, more than half of the initial benzodiazepine prescriptions were for a 15 to 30-day supply, rather than the recommended shorter-term, as-needed use. This pattern of prescribing could lead to dependence and other adverse outcomes in older stroke survivors. The study also revealed notable demographic and regional differences in prescription rates. Women were more likely than men to receive an initial benzodiazepine prescription after a stroke, with rates of 5.5% and 3.8% respectively. Hispanic adults had the highest prescription fill rates at 5.8%, although they represented a small portion of the overall sample. Geographically, the Southeast United States, known as the 'stroke belt,' had the highest prescription rates at 5.1%.
While there has been a modest decline in initial benzodiazepine prescriptions from 2013 to 2021, dropping by 1.6%, researchers emphasize that the current prescription patterns remain problematic. The study's co-author, Julianne Brooks, M.P.H., stressed the importance of the 90-day post-stroke period for rehabilitation and recovery, noting that benzodiazepines may hinder this crucial process. The findings underscore the need for healthcare providers to adhere more closely to guidelines such as the American Geriatrics Society Beers Criteria, which recommends avoiding benzodiazepines in adults over 65 due to various risks. Experts suggest exploring alternative interventions, including cognitive behavioral therapy for insomnia and non-pharmaceutical approaches, before resorting to benzodiazepines.
This research highlights the ongoing challenges in managing post-stroke care for older adults and the importance of balancing symptom relief with patient safety. As stroke remains a leading cause of long-term disability and mortality in the United States, these findings call for increased vigilance in medication management and a more tailored approach to post-stroke care for older patients. The study's limitations include the lack of information on why benzodiazepines were prescribed in each case. Researchers emphasize the need for further studies to determine if there is a safe level of benzodiazepine prescription for older adults and to better understand the factors influencing prescribing patterns.
As the medical community continues to grapple with these issues, the research serves as a crucial reminder of the need for careful consideration of medication risks and benefits in the treatment of older stroke survivors. It also underscores the importance of ongoing education for healthcare providers and patients alike about the potential dangers of benzodiazepine use in this population. The study's implications extend beyond individual patient care to broader systemic issues in geriatric medicine and post-stroke rehabilitation protocols.
