Séverine Henrard

Background: Various factors hinder older adults from discontinuing benzodiazepine receptor agonists (BZRAs). Identifying and prioritising these barriers is essential for designing effective interventions to discontinue BZRAs. Objective: To identify barriers to BZRA discontinuation among older adults and factors associated with their willingness to reduce or stop use. Methods: A cross-sectional survey was conducted among adults 65+ using BZRA for sleep problems, recruited from hospitals across six European countries. Barriers were identified via a 27-item questionnaire grounded in the Theoretical Domains Framework (TDF), which systematically identifies individual and contextual determinants of behaviour. Responses were analysed using descriptive statistics. Multivariable logistic regressions identified factors associated with patients’ willingness to reduce or stop BZRA. Results: Among 183 participants, 59.1% were willing to reduce and 42.7% to stop BZRA if recommended by their doctor. Half understood why discontinuation is necessary. Barriers were present for most participants across multiple TDF domains. They included: high satisfaction with BZRA, perceived low risk of side effects, limited coping skills or ability to stop, fear of discontinuation and lack of support from physicians or social networks. Higher scores in the TDF domains of Goals, Emotion and Social Influences were associated with greater willingness to reduce BZRA. These domains and Reinforcement, Environmental context and resources were also linked to a greater willingness to stop. Conclusions: These findings highlight the opportunities and challenges of discontinuing BZRA in older adults. While half know the need to discontinue and are willing to try, future interventions must address pervasive barriers across many behavioural domains.

Complex regional pain syndrome (CRPS) is a challenging condition with unpredictable clinical evolution. Identifying early prognostic factors could transform patient management and improve outcomes. This prospective study followed 113 patients with early CRPS (<6 months) over 1 year to assess clinical evolution and investigate key predictors of chronification. Participants underwent repeated clinical assessments, quantitative sensory testing, and self-reported evaluations at 4 time points over 1 year. Multivariable mixed-effect models were used to identify independent early prognostic factors. Despite some improvement, 35% of the participants still met Budapest criteria at 1 year, with persistent pain, disability, and impaired quality of life. Sensory profiles appeared to stabilize after a few months, while body perception disturbance scores did not change during the follow-up period. Psychosocial factors, such as baseline disability, psychosocial severity, and social support, as well as body mass index and allodynia, were predictors of long-term outcomes. Biopsychosocial Early CRPS profiles defined through a latent class analysis carried out on the basis of data measured at inclusion revealed distinct clinical trajectories and showed stronger prognostic value than previously suggested CRPS classifications (eg, based on skin temperature). These findings highlight the importance of an early assessment incorporating biopsychosocial elements to stratify risk and tailor interventions. Our study paves the way for the development of a clinical tool to predict CRPS evolution, potentially enabling tailored treatments. Future research should validate these predictive models and explore their integration into routine practice, potentially improving the management of early CRPS.

Background: Hypoglycaemic drugs (sulfonylureas, glinides or insulins) are commonly prescribed for older adults with type 2 diabetes (T2D) but may carry risks of adverse events. Whether de-intensifying hypoglycaemic drugs is associated with clinical benefit in older adults remains unknown. Objective: To evaluate the association between de-intensification of hypoglycaemic drugs and clinical outcomes in older adults with T2D. Methods: Cohort study conducted with the target trial emulation approach, using data collected from 2000 French general practises between January 2010 and February 2019 (The Health Improvement Network—THIN database). Eligible participants were ≥75 years old, on stable hypoglycaemic drugs (no change in drug or dose) for at least 6 months, and had an HbA1c value <9%. Hypoglycaemic drug de-intensification (exposure) was defined as cessation or reduction of ≥50% of total dose. The primary outcome was a composite measure of all-cause death or hospital admissions within 3 months, and its association with exposure was assessed using multivariable logistic regression adjusted for potential baseline confounders. Results: The study included 14 383 unique individuals corresponding to 177 314 trial emulation participants (mean age 80 years; 44.7% female). Of these, 6480 participants were allocated to de-intensification group, and 170 834 to the control group. At 3 months, the primary outcome occurred in 3.96% of the de-intensification group and 2.99% of controls [adjusted relative risk, 1.33 (95% CI, 1.22–1.43)]. Subgroup analyses showed consistent associations across most participants’ profiles. Conclusions: In older adults with T2D, de-intensification of hypoglycaemic drugs was associated with a higher short-term risk of all-cause death or hospitalisation.

Aims: No cardiovascular risk prediction model dedicated to individuals aged ≥70 years with diabetes is currently recommended by the European Society of Cardiology. We aimed to develop a new model, CArdiovascular Risk Estimation—Diabetes Mellitus (CARE-DM), to predict the risk of cardiovascular disease (CVD) in older adults with type 2 diabetes. Methods and results: We developed a model to predict the risk of incident CVD in participants aged ≥65 years with diabetes using data from four population-based prospective cohorts, accounting for the competing risk of non-cardiovascular death. Pre-specified predictors were age, gender, smoking status, alcohol consumption, body mass index, total and HDL cholesterol, use of antihypertensive, cholesterol-lowering and glucose-lowering medication, diabetes duration, and glycated haemoglobin. We assessed model performance using measures of calibration and discrimination. We used a 10-fold cross-validation and a bootstrapping approach to correct estimates for optimism and conducted an internal–external cross-validation. A total of 6943 participants (median age 72 years, 56% women) with diabetes were included in the model development. Over a median follow-up of 6.3 (interquartile range 3.7, 7.2) years, 1204 (17.3%) participants experienced a CVD event. Internal validation with optimism correction showed adequate model performance with a C-index of 0.65 (95% confidence interval 0.63–0.67), an observed-to-expected ratio of 1.01 (0.95–1.08), and a calibration slope of 1.13 (0.95–1.31) at 5 years. Conclusion: The new CARE-DM model allows prediction of the incident CVD risk in older adults with type 2 diabetes. Independent external validation should be conducted to confirm the model’s performance before implementation in clinical practice.

Introduction: Benzodiazepine receptor agonists (BZRA) deprescribing interventions are needed to tackle high BZRA use in the older population. This study aims to assess the feasibility of the D-PRESCRIBE intervention, adapted from Canada to the Belgian community setting. This pharmacist-led intervention comprises a patient educational brochure and a pharmacist-to-prescriber communication tool. Methods and analysis: We will conduct a feasibility study of a cluster randomised controlled trial involving 8–10 community pharmacies (clusters) and aiming to recruit 56–80 patients (≥65 years). Intervention pharmacies will deliver the adapted D-PRESCRIBE intervention and control pharmacies, usual care. Patients will be blinded to group allocation. Quantitative data will be collected at baseline, 3 months and 6 months through patients’ and pharmacists’ questionnaires, aiming: (1) to test the feasibility of the intervention, (2) to test the feasibility of the study design needed for its evaluation and (3) to perform an exploratory cost-effectiveness analysis. Hence, data about implementation outcomes, mechanisms of impact (ie, mechanisms through which the intervention is supposed to be effective) and contextual factors will be gathered. Patient-centred outcomes will also be collected as they would be in a full cost-effectiveness trial. The feasibility of the study design will be assessed through participation rate, completeness of the data and a satisfaction survey, sent to participants after the 6-month data collection. Data will be analysed using descriptive statistics. To gain a deeper understanding of pharmacists and patients’ experience with the intervention, interviews will be conducted after the 6-month data collection and the Theoretical Domains Framework will be used as a deductive framework for analysis. Ethics and dissemination: This study was approved by the Ethics Committee of CHU UCL Namur (NUB: B0392023000036). Participants will receive a summary of the results. Results will also be disseminated through the organisation of a local symposium and a peer-reviewed publication. Trial registration number: NCT05929417 .

Introduction Despite several calls to deprescribe benzodiazepine receptor agonists (BZRA) in older adults, their use among nursing home residents (NHRs) remains high. Therefore, we developed an intervention targeting general practitioners’ and healthcare professionals’ behaviours regarding BZRA deprescribing in nursing homes (NHs): The END-IT NH (bENzodiazepines Deprescribing InTerventions Nursing homes) 6-component intervention. Before moving on to a large-scale effectiveness and cost-effectiveness evaluation, this feasibility study aims at: (1) assessing the feasibility of the intervention implementation in NHs, (2) assessing the feasibility of conducting a larger-scale evaluation, in terms of recruitment and data collection and (3) conducting an exploratory cost-effectiveness evaluation. Methods and analysis We will conduct a cluster-randomised controlled trial in a sample of 6 NHs, with 10–15 NHRs included per NHs. Four NHs will be randomised into the intervention group, and two NHs will deliver usual care (control group). Data collection will occur at baseline, 3, and 6 months (study end). We will collect information to explore implementation fidelity, mechanisms of impact and contextual factors at patient-level, NH-level and healthcare professional-level, using both quantitative and qualitative measures. The feasibility of the study conduction will be assessed by measuring recruitment and attrition rates and completeness of data collection. An exploratory cost-effectiveness evaluation will be conducted based on quality of life and healthcare use and cost data. Ethics and dissemination This study protocol received approval from the ethical committee of CHU UCL Namur on the 20 June 2023. All data are confidential and will be anonymised prior to analysis. De-identified data will be shared on a data depository with a 2-year embargo. The results of the study will be disseminated through a scientific paper and will be communicated to local stakeholders and policymakers through a local symposium. Trial registration number NCT05929443.

Objective Guidelines recommend deprescribing benzodiazepine receptor agonists (BZRA) in older adults, yet implementation in clinical practice remains limited. Adapting effective, evidence-based interventions to a new context is a resource-saving strategy. In Canada, the D-PRESCRIBE intervention comprised a patient educational brochure and a pharmaceutical opinion inviting physicians to revise BZRA prescribing and consider safer alternatives. Due to its effectiveness on BZRA deprescribing among Canadian older adults, we aimed to adapt the D-PRESCRIBE intervention to the Belgian community setting. Design Recommendations from the ADAPT guidance, that provides a systematic approach for adapting interventions to new contexts, were followed. We conducted a mixed-methods study that comprised (1) group discussions and cognitive interviews to assess the acceptability and need for adaptation of the intervention’s components and (2) a survey on the adapted pharmaceutical opinion. A research committee involving stakeholders’ representatives decided on the adaptations, respecting the core functions of both tools. Changes in intervention components were reported following the Model for Adaptation Design and Impact framework. Setting Belgian French-speaking community setting. Participants Six older adults (≥65 years), six general practitioners (GPs) and seven pharmacists participated in the group discussions or interviews. 46 GPs and 91 pharmacists responded to the survey. Results Participants welcomed the brochure positively. Still, some changes in the vocabulary, wording, photos and icons were made for several purposes including making the patient feel concerned about the brochure and softening the use of fear. The pharmaceutical opinion aroused mixed perceptions. Its name, layout and content were adapted to enhance its acceptability and fit with our healthcare system, practices and national guidelines. The survey highlighted several enablers and barriers to its use from the perspectives of GP and pharmacist. Conclusions The Canadian D-PRESCRIBE intervention was adapted to the Belgian setting following a thorough and transparent process. Its feasibility will be tested in a future pilot study (NCT:05929417).

Introduction In older adults with type 2 diabetes (T2D), overtreatment with hypoglycaemic drugs (HDs: sulfonylureas, glinides and/or insulins) is frequent and associated with increased 1-year mortality. Deintensification of HD is thus a key issue, for which evidence is though limited. The primary objective of this study will be to estimate the effect of deintensifying HD on clinical outcomes (hospital admission or death) within 3 months in older adults (≥75 years) with T2D. Methods We will emulate with real-world data a target trial, within The Health Improvement Network cohort, a large-scale database of data collected from electronic medical records of 2000 general practitioners in France. From 1 January 2010 to 28 February 2019, we will include eligible patients ≥75 years who will have T2D, a stable dose of HDs, glycated haemoglobin A1c (HbA1c) value 75 mmol/mol within 1 year. Participants will be followed from baseline to 12 months after randomisation, administrative censoring, or death, whichever occurs first. A pooled logistic regression will be used to estimate the treatment effect on the incidence of the outcomes. Dissemination and ethics No ethical approval is needed for using retrospectively this fully anonymised database. The results will be disseminated during conferences and through publications in scientific journals.