Initial prescriptions of benzodiazepines, a type of medication often used to address anxiety and sleep issues following a stroke, may be excessively high for adults aged 65 and older, according to a new study.
Despite a slight decline in the prescription of benzodiazepines (depressants that alleviate anxiety, relax muscles, induce sedation, and reduce seizures) to elderly patients over the past decade, the number of first-time prescriptions for these drugs after an ischemic (caused by a clot) stroke remains significant. This conclusion comes from research published today in Stroke, a peer-reviewed scientific journal associated with the American Stroke Association, part of the American Heart Association.
Post-stroke, benzodiazepines are often prescribed to help alleviate anxiety and enhance sleep. However, for older adults, the use of these drugs can heighten risks of falls, fractures, memory issues, confusion, and other adverse effects. The U.S. Drug Enforcement Agency classifies benzodiazepines as a schedule IV-controlled substance due to possible abuse, addiction, withdrawal symptoms, and illegal distribution.
Researchers analyzed data from Medicare claims in the U.S. and examined 10 years’ worth of first-time benzodiazepine prescriptions among over 120,000 individuals aged 65 and older who were hospitalized for an ischemic stroke. They specifically looked at the prescribing rates within the first three months following the stroke while adjusting for factors like race, sex, and ethnicity. Yearly patterns of prescriptions were also assessed to determine the number of possibly excessive new benzodiazepine prescriptions given to stroke survivors.
“We focused on stroke survivors 90 days post-stroke because this timeframe is crucial for the rehabilitation of physical, speech, and cognitive abilities, as well as mental health. It is often a challenging period for patients who are dealing with decreased mobility and independence. The use of benzodiazepines may hinder recovery and rehabilitation,” explained study co-author Julianne Brooks, M.P.H., a data analytics manager at the Center for Value-based Healthcare and Sciences at Massachusetts General Brigham in Boston. “For older patients, guidelines suggest avoiding benzodiazepine prescriptions whenever possible. However, there may be occasions where a doctor prescribes them on an as-needed basis. For instance, a few pills might be given to manage sudden anxiety, accompanied by advice to use the medication sparingly. It’s crucial to discuss the potential risks of dependence, falls, and other negative effects with the patient.”
Key findings from the study include:
- Within 90 days of experiencing a stroke, 6,127 individuals (4.9%) were prescribed a benzodiazepine for the first time.
- The most frequently prescribed benzodiazepines were lorazepam (40%) and alprazolam (33%).
- Approximately 75% of these initial benzodiazepine prescriptions were for more than a week, with over 50% covering a period between 15 to 30 days.
- Women had higher prescription rates (5.5%) compared to men (3.8%).
- Hispanic adults also showed higher prescription fill rates (5.8%), although this group was limited by a small participant size, making up only 1.9% of the overall sample.
- Prescription rates were highest in the Southeast (5.1%) and lowest in the Midwest (4%) of the U.S. “The Southeast is often referred to as the ‘stroke belt’ due to a higher prevalence of strokes, which may contribute to different care patterns in that area,” noted Brooks.
- There was a modest nationwide reduction in initial prescriptions from 2013 to 2021, totaling 1.6%.
“We observed a trend indicating potential oversupply with these initial benzodiazepine prescriptions, which could lead to long-term usage or even addiction. These prescriptions could promote dependence,” Brooks pointed out. “It’s essential to heighten awareness and improve guidance regarding the risks associated with these medications for older stroke survivors.”
“While the overall rate of prescriptions dropped slightly over the last decade, this pattern remains concerning. Older adults are particularly susceptible to overprescribing and negative outcomes. Previous studies show that vulnerable and marginalized groups tend to have worse recovery results following a stroke, so it’s vital to understand the contributing factors to enhance care,” Brooks added.
The American Geriatrics Society Beers Criteria from 2019 provides a reference for healthcare providers to prescribe medications safely for those aged 65 and older. The criteria advise avoiding benzodiazepines entirely for older adults due to risks of cognitive decline, confusion, falls, fractures, and car accidents.
“Alternative guidelines also propose behavioral strategies like cognitive behavioral therapy for insomnia, using antidepressants for anxiety disorders, and prioritizing non-medication approaches first,” Brooks suggested.
The researchers emphasize the need for further studies to determine a safe level for prescribing benzodiazepines that would be suitable for older adults. A limitation of this study was its reliance on a large national dataset that did not capture the specific reasons for benzodiazepine prescriptions.
According to the 2024 Update of the American Heart Association’s Heart Disease and Stroke Statistics, strokes are a leading cause of severe long-term disability in the United States, accounting for roughly 1 out of every 21 deaths in the country in 2021.
Study details, background, and methodology:
- The analysis encompassed data from 126,050 adults sourced from U.S. Medicare claims for all individuals aged 65 and older who were discharged from the hospital due to an ischemic stroke between 2013 and 2021.
- The average age of participants was 78; 54% identified as female, and 82% as white.
- The analysis focused on new benzodiazepine prescriptions within 90 days post-discharge after an ischemic stroke, including only those without prior benzodiazepine prescriptions.
