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Background: Benzodiazepines and Z-drugs (e.g., zopiclone, zolpidem) (benzodiazepine receptor agonists or BZRAs), are prescribed for anxiety and insomnia disorders. However, they are not indicated as first line therapies for long-term management due to harms and efficacy limitations. BZRAs have also been associated with traffic accident risks. Patients taking BZRAs are told to consult with health care providers regarding motor vehicle operation safety. However, advice on driving is variable. The objective of this scoping review is to identify, map, and characterize the evidence for assessments that measure driving performance in people taking BZRAs. Methods: Embase (Elsevier), MEDLINE (Ovid), and PsycINFO (EBSCO) were searched. Covidence was used for screening. Each stage of screening included two independent reviewers. A REDCap database was used for data extraction by two independent reviewers. Results were tabulated and summarised as a narrative. Results: Driving performance was assessed with 20 unique BZRAs across 183 studies (n = 92 experimental; n = 91 observational) in 178 publications. Zopiclone was the most studied. In experimental studies, the Standard Deviation of Lateral Position (SDLP) was used most often (n = 54, 62 %) and many studies (n = 35, 38 %) were conducted in the Netherlands. For observational studies, biological detection (e.g., urine, blood) (n = 73, 80 %) followed by prescription drug/dispensing records (n = 17, 19 %) were the most common impairment measures and Norway (n = 20) is where most studies took place. In experimental studies, most (n = 89, 97 %) were conducted using only one driving setting. Simulated driving in a car (n = 36) and road driving in traffic (n = 36) were common as compared to nontraffic driving course (n = 8) and simulated driving (n = 9). In experimental studies, seventy-eight of the 92 studies (85 %) had at least one measure that identified impairment. Conclusions: BZRA effects on motor vehicle driving performance have been studied using heterogenous protocols with multiple measures and settings, ranging from simulation to authentic traffic situations in experimental studies to biological detection and dispensing records in observational studies. Many BZRAs have been studied but study representation does not match prescribing pattern prevalence. The interpretation and contextualization of results for clinical practice is challenging due to the complexity (i.e., protocols, measures, settings). Future work in this area should work to improve knowledge translation of results so information is more readily accessible and applicable to health care providers and patients.

Background: Recruitment to clinical trials is a challenge for researchers that became more pronounced because of COVID-19 public health protective measures, especially with respect to studies enrolling older adults. We completed an effectiveness and cost analysis of the recruitment methods used in The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study, a randomized controlled trial of a deprescribing intervention that recruited older adults with chronic use of sedatives during the pandemic. Methods: Study recruitment began during the COVID-19 pandemic. Strategies included random digit dialing (RDD), a targeted mail campaign and advertising through newspapers, online platforms (Google and Facebook), and television. Other awareness raising and recruitment strategies involved seniors' organizations, pharmacies, television news stories, and referrals. Recruitment effectiveness and cost analysis involved enrollment rate (ER), cost per randomized participant (CPRP), fractional cost (FC), fractional enrollment (FE), fractional enrollment-cost ratio (FEC), and efficacy index (EI) calculations. Results: There were 1295 interested older adults with 594 randomized into the study for an enrollment rate of 46%. The efficacy index (EI) was highest for Facebook ads (EI = 0.683) followed by television (EI = 0.426), and newsprint ads (EI = 0.298). The cost of RDD was highest per randomized participant at $1117.90 and produced the lowest EI (0.013). Conclusion: Facebook ads had the best efficacy index for recruiting older adults to the YAWNS NB study during the COVID-19 pandemic and television ads produced the most enrollments. RDD was expensive and yielded few recruits. Recruitment costs can be significant for recruiting community-dwelling older adults. This experience can inform recruitment strategy and budget development for future community studies enrolling older adults, especially in the context of the COVID-19 pandemic.

Background: Chronic benzodiazepine receptor agonist (BZRA) use among older adults is a public health concern given cognitive and physical risks. One in four older adults in New Brunswick, Canada, is a long-term user of BZRAs. Previous studies using a direct-to-patient approach as the primary intervention target have shown promise in reducing BZRA use. The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study aims to reduce the long-term use of BZRAs in older adults and increase the use of cognitive behavioural therapy for insomnia (CBTi), which is the recommended first line treatment. Methods: The trial (ClinicalTrials.gov registration NCT04406103) is a three arm, open-label, parallel randomized controlled trial in NB, Canada. Eligible participants 65 years and older using BZRAs long-term will be randomly allocated to: the Eliminating Medications through Patient Ownership of End Results (EMPOWER) information package group; the Sleepwell information package group; or treatment-as-usual (TAU). Information packages will be mailed via Canada Post. The primary outcome of BZRA discontinuation at 6 months will be compared across groups. Secondary outcomes include participants with ≥25% BZRA dose reduction, and switching to newly prescribed alternate sedative-hypnotics. Several exploratory outcomes will also be examined. Discussion: Targeting participants with information packages informing them of appropriate use, dangers, and approaches to reducing BZRA use and increasing CBTi use may be beneficial in a region of Canada with the highest rate of chronic BZRA use in older adults. Comparing information packages and TAU will provide insights into the effectiveness of direct-to-patient interventions for BZRA reduction.