Pilot studies of complementary and integrative health approaches to support benzodiazepine deprescribing in older adults with the US Deprescribing Research Network

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Abstract This application is being submitted in response to the Notice of Special Interest identified as NOT-AT-22-012. Benzodiazepine receptor agonists (BZRAs), which include benzodiazepines as well as newer non- benzodiazepine, benzodiazepine receptor agonists such as zolpidem, are a major source of problematic prescribing for older adults. This is highly concerning, as both benzodiazepines and other benzodiazepine receptor agonists confer substantial harms including increased risk of falls, fractures, cognitive impairment, and motor vehicle accidents. Yet, the continued high rate of use of these medications is not surprising given the high prevalence of insomnia and anxiety among older adults and the physiological and psychological dependence which often makes stopping these medications difficult once they have been started. While a number of interventions have demonstrated promise to support deprescribing of BZRAs, the failure of these to gain traction in changing population-level use of BZRAs calls for new approaches to this vexing problem. A promising focus for such efforts is in complementary and integrative health (CIH). Engaging older adults to be active participants in changing their medications and to have self-efficacy in these efforts are vital components of strategies to reduce overuse of BZRAs. Many CIH modalities engage these psychological processes and/or are well-suited to complement them. Moreover, widespread interest in CIH among older adults creates fertile ground for widespread adoption of CIH modalities that are proven to be effective. The goal of this proposal is thus to select, fund, and support highly promising pilot studies that hold major potential to lead to large clinical trials investigating CIH interventions that promote deprescribing of BZRAs in older adults. To achieve this goal, we will adapt existing infrastructure of the US Deprescribing Research Network. This infrastructure and related processes involve not only selecting and funding awards, but providing ongoing support and guidance about research design, implementation, and engaging stakeholders to give pilot awardees the best chance of succeeding in their work and using it as a springboard for larger, definitive studies. We have 2 aims. Aim 1 is to identify and provide pilot funding for highly meritorious proposals that provide the groundwork for future clinical trials that use complementary and integrative health strategies to support deprescribing of benzodiazepine receptor agonists in older adults. Aim 2 is to provide skills and supports to pilot awardees that will enhance their ability to successfully apply for and conduct future large clinical trials in this area. These aims are highly complementary to the goals of the parent grant, which seeks to enhance the quality and quantity of research being conducted on deprescribing for older adults. This administrative supplement proposal offers an exciting opportunity to expand on the existing work of the US Deprescribing Research Network to promote the next generation of deprescribing research in this important area.