# Addressing inappropriate benzodiazepine prescribing among older Veterans

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2022 · —

## Abstract

Background: Benzodiazepine (BZD) use is a significant and persistent concern among older Veterans given
the association of BZDs with adverse outcomes including falls, fractures, motor vehicle accidents, impaired
cognition, increased risk of dementia, and mortality. In FY2015, over 82,000 Veterans ≥75 years of age were
prescribed a BZD despite abundant evidence of harms from both acute and chronic use and recommendations
from professional organizations to limit use. Beginning in FY2013, the VA's Psychotropic Drug Safety Initiative
(PDSI) began monitoring a variety of psychotropic quality measures, including BZD use among Veterans ≥75
years of age (hereafter referred to as “BZD≥75”). Among the 52 facilities (out of 140) that selected BZD≥75 as
a priority, each developed its own local strategy to improve prescribing. In order for the VA to build upon
local successes at addressing the seemingly intractable problem of BZD prescribing, the aim of this
proposal is to understand the combinations of local facility strategies and context that generate these
outcomes. In addition, it is critical to understand the patient experience of these strategies, as
Veterans may experience some “successful” strategies as extremely distressful.
This work may directly influence the clinical care of Veterans and is of both great interest and immediate
relevance to our operational partners, including PDSI, Pharmacy Benefits Management, and the Academic
Detailing Service.
Objectives: Aim 1: Identify high- and low-performing facilities on acute and chronic BZD prescribing among
facilities that prioritized the BZD≥75 measure. Aim 2: Assess facility-level strategies and associated barriers
and facilitators to addressing the BZD≥75 goal along with the acceptability of those strategies to older
Veterans. Aim 3: Identify and pilot test context-sensitive strategies for facilities to successfully reduce both
acute and chronic BZD use among older Veterans.
Methods: We will use interrupted time-series analyses of national VA administrative data to examine BZD
prescribing across BZD≥75 priority facilities (n=52). We will specifically measure change in: (1) rate of acute
use (new BZD initiation) and (2) intensity of chronic use (average daily dose [mg/day]). As an exploratory sub-
aim, we will measure the rate of fall-related injury by facility to determine whether change in BZD prescribing is
associated with change in associated adverse outcomes. In Aim 2a we will conduct semi-structured telephone
interviews with up to 16 PDSI local facility champions and additional staff from top- and bottom-performing
facilities (identified in Aim 1), followed by on-site, semi-structured interviews with key stakeholders at up to 6
sites. We will gather information on facility-level strategies, barriers, and facilitators that may help or hinder
facility efforts. Finally, we will conduct telephone interviews with older Veterans prescribed chronic BZDs that
attempted a taper to learn whether patients ...

## Key facts

- **NIH application ID:** 10197990
- **Project number:** 5I01HX002340-04
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** DONOVAN T MAUST
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-02-01 → 2022-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10197990

## Citation

> US National Institutes of Health, RePORTER application 10197990, Addressing inappropriate benzodiazepine prescribing among older Veterans (5I01HX002340-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10197990. Licensed CC0.

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