Re‐Examining Sedative and Hypnotic Prescribing Following Hip Fracture

Pan and colleagues [1] provide an important and timely analysis of sedative and hypnotic use following hip fracture, offering valuable insight into real-world prescribing trajectories during a particularly vulnerable period of recovery and rehabilitation. Their finding that more than half of older adults continued a benzodiazepine (BZD) or Z-drug within 180 days of discharge highlights the persistent challenge of optimizing medication safety after major injury. While continuation is often framed as a gap in deprescribing, these patterns likely reflect the clinical realities of postfracture recovery. Anxiety, disturbed sleep, pain, and loss of confidence in mobility commonly intensify after hip fracture, and both clinicians and patients may prioritize short-term symptom relief at a time when maintaining independence is a central concern. Interpreted in this context, the authors' findings illuminate the tension between immediate symptom management and longer-term safety that characterizes geriatric care. Such complex decisions often involve competing priorities and uncertain outcomes in older adults [2]. The study also underscores the importance of sustained vigilance throughout postfracture rehabilitation. Continuation of sedative and hypnotic medicines may represent an understandable response to distressing symptoms, yet it reinforces the need for active and repeated review over time. Deprescribing in this setting is rarely a single decision point; rather, it is an iterative process requiring reassessment, communication, and shared decision making across transitions of care. Pan and colleagues' work serves as a reminder that prescribing after hip fracture is dynamic and that careful review across the recovery pathway can meaningfully support safety, mobility, and patient confidence. Several additional considerations may further inform interpretation of the authors' findings. Refill-based measures, while essential for population-level analyses, do not always equate to sustained clinical use, as dispensing does not reliably capture adherence or intermittent dosing patterns [3]. Renewals may occur for contingency or overlapping supply, particularly when dosing becomes intermittent during recovery, and refill-based estimates may therefore modestly overstate ongoing exposure in some patients, especially early after discharge. Medication governance also differs substantially between skilled nursing facilities and community settings. Pooling discharge destinations may obscure meaningful differences in prescribing oversight, monitoring, and deprescribing opportunities. Greater separation by discharge setting could help identify where interventions are most feasible and where additional support may be required to sustain medication review beyond the acute episode. A further consideration is the relative absence of structured non-pharmacological support for sleep and anxiety management following injury. Many older adults may continue sedative or hypnotic medicines when alternatives such as sleep hygiene counseling, reassurance around nocturnal pain, graded activity, or re-establishment of routine are not readily accessible. In this context, continuation may reflect unmet supportive needs rather than a firm preference for pharmacological treatment, underscoring how prescribing trajectories are shaped by the availability of alternatives as much as by clinician choice. Although this study focuses on hip fractures within a United States Medicare population, it raises broader questions about how sedative and hypnotic prescribing patterns vary across different fragility fractures and healthcare systems. Prior studies referenced by the authors include broader fracture or injury populations but do not distinguish fracture sites. Comparing hip fracture trajectories with those following vertebral, humeral, pelvic, or wrist fractures could help clarify whether observed patterns are specific to hip fracture recovery or reflect a more general postinjury phenomenon. Underlying biological heterogeneity within hip fracture populations may also contribute to variation in recovery and, consequently, prescribing trajectories [4]. Extending such comparisons across countries with differing prescribing norms and models of geriatric care would further inform the generalizability of these findings. Overall, Pan and colleagues provide a robust empirical foundation that broadens understanding of sedative and hypnotic use after hip fracture. Their work offers an important evidence base to support safer, more person-centred prescribing and highlights opportunities to strengthen medication review and supportive care during recovery in this high-risk population. B.H.L.H. and L.J.K. conceived the correspondence and prepared the initial draft. V.E.S.A. and M.B.F. contributed to the interpretation of the article findings and provided critical revisions for important intellectual content. All authors approved the final version of the manuscript. The authors have nothing to report. B.H.L.H. would like to thank the Orthogeriatric Research Fund for their support. The authors have nothing to report. The authors declare no conflicts of interest. This publication is linked to a reply article by Pan et al. To view this article, visit https://doi.org/10.1111/jgs.70503.