Barriers to and Enablers of Supporting Deprescribing Benzodiazepines in Older Adults: A Survey of European Nonphysician Healthcare Professionals.

Although physicians are primarily responsible for Benzodiazepine Receptor Agonist (BZRA) deprescribing, nonphysician healthcare professionals (HCPs) can support deprescribing. This study explored barriers to and enablers of BZRA deprescribing among nonphysician HCPs. We surveyed 258 HCPs (63.

Association between hypoglycaemic drug de-intensification, mortality and hospital admission in older adults with type 2 diabetes: a cohort study emulating a target trial.

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.

Development and validation of the CARE-DM model to predict the cardiovascular risk in older persons with type 2 diabetes.

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: 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.

Measuring the Performance of Survival Models to Personalize Treatment Choices.

Various statistical and machine learning algorithms can be used to predict treatment effects at the patient level using data from randomized clinical trials (RCTs). Such predictions can facilitate individualized treatment decisions. Recently, a range of methods and metrics were developed for assessing the accuracy of such predictions.

Non-adherence and non-persistence of Direct Oral Anticoagulants among patients with non-valvular atrial fibrillation: a French retrospective cohort study.

Non-adherence and non-persistence of direct oral anticoagulants (DOAC) in patients with non-valvular atrial fibrillation remain major concerns. Most studies on non-persistence and non-adherence during the implementation phase (i.e.

Protocol to evaluate the feasibility of the D-PRESCRIBE intervention adapted to the Belgian community setting (END-IT CS study).

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.

Barriers to Deprescribing Benzodiazepines in Older Adults in a Survey of European Physicians.

Importance: The use of benzodiazepine receptor agonists (BZRA) poses serious health risks to older adults. Although several guidelines recommend deprescribing, implementation in clinical practice remains limited.

Objective: To identify physicians' barriers to and enablers of deprescribing BZRA in adults aged 65 years and older taking a BZRA for sleep problems; to determine factors associated with hospital physicians' intention to deprescribe BZRA and their self-reported routine BZRA deprescribing.

Early CRPS Is a Heterogeneous Condition: Results From a Latent Class Analysis.

Background: Complex regional pain syndrome (CRPS) is a debilitating condition characterised by significant heterogeneity. Early diagnosis is critical, but limited data exists on the condition's early stages. This study aimed to characterise (very) early CRPS patients and explore potential subgroups to enhance understanding of its mechanisms.

Diabetes and the risk of cardiovascular events and all-cause mortality among older adults: an individual participant data analysis of five prospective studies.

Background: Guidelines and studies provide conflicting information on whether type 2 diabetes (T2D) should be considered a coronary heart disease risk (CHD) equivalent in older adults.

Methods: We synthesized participant-level data on 82,723 individuals aged ≥65 years from five prospective studies in two-stage meta-analyses. We estimated multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of T2D (presence versus absence) on a primary composite outcome defined as cardiovascular events or all-cause mortality.

Antibiotic prophylaxis practice in gastrointestinal surgery in five hospitals in southern Benin.

Background: Benin's healthcare system is characterized by a lack of local guidelines for surgical antibiotic prophylaxis (SAP), which is essential to prevent surgical site infection.

Aim: To audit compliance for SAP practices in gastrointestinal surgery.

Methods: Data were prospectively collected from gastrointestinal surgery departments in five hospitals.

Deprescribing benzodiazepine receptor agonists in older adults: a mixed-methods study to adapt the Canadian D-PRESCRIBE intervention to the Belgian community setting.

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.

Development of a Behavior-Change Intervention toward Benzodiazepine Deprescribing in Older Adults Living in Nursing Homes.

Objective: We aimed to develop a context-specific intervention toward benzodiazepine deprescribing in nursing homes (NHs), with insights from behavior-change theories and involvement of stakeholders.

Design: Selection of behavior change techniques (BCTs), through online survey and group discussion, followed by operationalization of these BCTs into intervention components.

Setting And Participants: The intervention was developed for Belgian NHs, involving various stakeholders: health care professionals (HCPs), NH administrators, and policy makers.

Impact of deintensifying hypoglycaemic drugs in older adults with type 2 diabetes: protocol for an emulation of a target trial.

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.

Adaptation and validation of the revised Patients' Attitudes towards Deprescribing (rPATD) questionnaire for benzodiazepine receptor agonists.

Background: The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire explores older adults' views on deprescribing in general. Those views may differ, however, when the target is a specific drug such as benzodiazepine receptor agonists (BZRA).

Objective: This study aimed to adapt the 22-item French rPATD questionnaire to create a BZRA-specific instrument and to assess the psychometric properties of this new tool.

Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial.

Background: Benzodiazepine receptor agonists (BZRAs) are commonly prescribed in older adults despite an unfavorable risk-benefit ratio. Hospitalizations may provide a unique opportunity to initiate BZRA cessation, yet little is known about cessation during and after hospitalization. We aimed to measure the prevalence of BZRA use before hospitalization and the rate of cessation 6 months later, and to identify factors associated with these outcomes.

Cardiovascular disease and type 2 diabetes in older adults: a combined protocol for an individual participant data analysis for risk prediction and a network meta-analysis of novel anti-diabetic drugs.

Introduction: Older and multimorbid adults with type 2 diabetes (T2D) are at high risk of cardiovascular disease (CVD) and chronic kidney disease (CKD). Estimating risk and preventing CVD is a challenge in this population notably because it is underrepresented in clinical trials. Our study aims to (1) assess if T2D and haemoglobin A1c (HbA1c) are associated with the risk of CVD events and mortality in older adults, (2) develop a risk score for CVD events and mortality for older adults with T2D, (3) evaluate the comparative efficacy and safety of novel antidiabetics.

Inappropriate Combined Antiplatelet and Anticoagulant Therapy in Older Patients with Atrial Fibrillation: Trend over Time (2009-18).

Background And Objectives: Antiplatelet therapy, when prescribed in combination with anticoagulant therapy to older patients with atrial fibrillation and no recent cardiovascular event, is inappropriate and a reversible risk factor of major bleeding. We aimed to assess the trend over time of the prevalence of inappropriate combined antiplatelet and anticoagulant therapy and to determine its associated factors during the direct oral anticoagulant era.

Methods: This was a study of consecutive older patients (age ≥ 75 years) with atrial fibrillation, receiving anticoagulant therapy upon admission, and undergoing a comprehensive geriatric assessment during their first admission in a Belgian teaching hospital between 2009 and 2018.

Healthcare Costs and Health-Related Quality of Life in Older Multimorbid Patients After Hospitalization.

Objectives: We identified factors associated with healthcare costs and health-related quality of life (HRQoL) of multimorbid older adults with polypharmacy.

Methods: Using data from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid older people) trial, we described the magnitude and composition of healthcare costs, and time trends of HRQoL, during 1-year after an acute-care hospitalization. We performed a cluster analysis to identify groups with different cost and HRQoL trends.

Association between diabetes overtreatment in older multimorbid patients and clinical outcomes: an ancillary European multicentre study.

Background: Diabetes overtreatment is a frequent and severe issue in multimorbid older patients with type 2 diabetes (T2D).

Objective: This study aimed at assessing the association between diabetes overtreatment and 1-year functional decline, hospitalisation and mortality in older inpatients with multimorbidity and polypharmacy.

Methods: Ancillary study of the European multicentre OPERAM project on multimorbid patients aged ≥70 years with T2D and glucose-lowering treatment (GLT).

Overtreatment of older people with type 2 diabetes-a high impact frequent occurrence in need of a new definition.

Background: Diabetes overtreatment is a frequent and major issue in older people with type 2 diabetes but its definition is often inconsistent and may be misleading. This critical review has aimed at examining the definitions of diabetes overtreatment in older people used in research studies.

Methods: Studies addressing diabetes overtreatment in people aged 65 or older were identified by searching the PubMed database according to an extensive search equation.

Comparison of 6 Mortality Risk Scores for Prediction of 1-Year Mortality Risk in Older Adults With Multimorbidity.

Importance: The most appropriate therapy for older adults with multimorbidity may depend on life expectancy (ie, mortality risk), and several scores have been developed to predict 1-year mortality risk. However, often, these mortality risk scores have not been externally validated in large sample sizes, and a head-to-head comparison in a prospective contemporary cohort is lacking.

Objective: To prospectively compare the performance of 6 scores in predicting the 1-year mortality risk in hospitalized older adults with multimorbidity.

Cost-effectiveness of a structured medication review approach for multimorbid older adults: Within-trial analysis of the OPERAM study.

Background: Inappropriate polypharmacy has been linked with adverse outcomes in older, multimorbid adults. OPERAM is a European cluster-randomized trial aimed at testing the effect of a structured pharmacotherapy optimization intervention on preventable drug-related hospital admissions in multimorbid adults with polypharmacy aged 70 years or older. Clinical results of the trial showed a pattern of reduced drug-related hospital admissions, but without statistical significance.