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Scott TL, Jaymes RWM, McCaul T, Wilton-Harding B, Cations M. Young onset dementia and driving cessation: a scoping review of lived experiences. BMC Geriatr 2024; 24:661. [PMID: 39112941 PMCID: PMC11305079 DOI: 10.1186/s12877-024-05265-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/30/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Driving cessation is one of the most challenging life transitions, associated with multiple negative consequences for individuals living with late-onset dementia. This paper extends the literature as to date there is no published review that details the experiences of people living with young onset dementia ("YOD"). METHODS A comprehensive search of the literature was conducted using the scoping review methodology. RESULTS Ten studies were included for full text review of 1634 initially identified through database searching. The results of the included articles indicated areas of concern for people living with YOD and their family members including, loss of independence; role change; threat to self-identify; feelings of isolation, grief; acceptance; predictors of driving cessation. CONCLUSION There is a lack of robust evidence related to driving cessation and the experiences of people living with YOD. No published paper reported psychosocial interventions specifically targeted at supporting persons with YOD through driving cessation.
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Affiliation(s)
- Theresa L Scott
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, 410 McElwain Building, St Lucia, Qld, 4072, Australia.
| | - R W M Jaymes
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, 410 McElwain Building, St Lucia, Qld, 4072, Australia
| | - Trudy McCaul
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, 410 McElwain Building, St Lucia, Qld, 4072, Australia
| | - Bethany Wilton-Harding
- College of Education, Social Work and Psychology, Flinders University, Bedford Park, SA, Australia
| | - Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Bedford Park, SA, Australia
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King S, Fernandes B, Jayme TS, Boryski G, Gaetano D, Premji Z, Venturato L, Santana MJ, Simon J, Holroyd-Leduc J. A scoping review of decision-making tools to support substitute decision-makers for adults with impaired capacity. J Am Geriatr Soc 2024; 72:2219-2231. [PMID: 38400764 DOI: 10.1111/jgs.18812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/22/2023] [Accepted: 01/21/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Substitute decision-makers (SDMs) make decisions that honor medical, personal, and end-of-life wishes for older adults who have lost capacity, including those with dementia. However, SDMs often lack support, information, and problem-solving tools required to make decisions and can suffer with negative emotional, relationship, and financial impacts. The need for adaptable supports has been identified in prior meta-analyses. This scoping review identifies evidence-based decision-making resources/tools for SDMs, outlines domains of support, and determines resource/tool effectiveness and/or efficacy. METHODS The scoping review used the search strategy: Population-SDMs for older adults who have lost decision-making capacity; Concept-supports, resources, tools, and interventions; Context-any context where a decision is made on behalf of an adult (>25 years). Databases included MEDLINE, Embase, CINAHL, PsycINFO, and Abstracts in Social Gerontology and SocIndex. Tools were scored by members on the research team, including patient partners, based on domains of need previously identified in prior meta-analyses. RESULTS Two reviewers independently screened 5279 citations. Articles included studies that evaluated a resource/tool that helped a family/friend/caregiver SDMs outside of an ICU setting. 828 articles proceeded onto full-text screening, and 25 articles were included for data extraction. The seventeen tools identified focused on different time points/decisions in the dementia trajectory, and no single tool encompassed all the domains of caregiver decision-making needs. CONCLUSION Existing tools may not comprehensively support caregiver needs. However, combining tools into a toolkit and considering their application relevant to the caregiver's journey may start to address the gap in current supports.
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Affiliation(s)
- Seema King
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Timothy S Jayme
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | - Maria J Santana
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- AbSPORU SUPPORT Unit, Calgary, Alberta, Canada
| | - Jessica Simon
- Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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3
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Ross R, Prater LC, Cole A, Mustafa A, Pham K, Gallagher A, Rowhani-Rahbar A, Phelan EA. Provider Perspectives on Addressing Firearm Safety with Older Adults in Primary Care. Clin Gerontol 2024; 47:555-570. [PMID: 37791738 PMCID: PMC10991080 DOI: 10.1080/07317115.2023.2264291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Chronic conditions, including mild cognitive impairment and depression, place older adults at high risk of firearm suicide. Approximately 40% of older adults have access to a firearm, and many do not store their firearms safely. However, firearm counseling occurs infrequently in clinical settings. Using by the Ottawa Decision Support Framework (ODSF) to conceptualize the decisional support needed by patients and their providers to facilitate firearm counseling, we explore provider perspectives on desired resources for addressing firearm safety with older adult patients. METHODS From March - August 2022, we conducted 21 semi-structured interviews with primary care providers caring for older adults. We report deductive concepts as well as emergent themes. RESULTS Major themes were identified from the three components of the ODSF; decisional needs, decision support and decisional outcomes. Themes included: provider self-efficacy to conduct firearm counseling, clinical workflow considerations, stories for change, patient diagnosis implications, and caregiver involvement. CONCLUSIONS There is a need for decision aids in the clinical setting that facilitate firearm counseling and promotes shared decision-making about firearm storage. CLINICAL IMPLICATIONS Implementing a decision aid in the clinical setting can improve provider self-efficacy to conduct firearm counseling and help reduce risk factors associated with firearm-related harm among older adults.
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Affiliation(s)
- Rachel Ross
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Laura C. Prater
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
- Department of Psychiatry & Behavorial Sciences, University of Washington, Seattle, WA, USA
| | - Allison Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Ayah Mustafa
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Kiet Pham
- School of Psychology, University of Washington, Seattle, WA, USA
| | - Amy Gallagher
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Elizabeth A. Phelan
- School of Medicine, Division of Gerontology and Geriatric Medicine, School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
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Betz M, Polzer E, Knoepke C, Prater L, Simonetti J, Lee T, Meador L, Nearing K. Cars, Guns, Aging, and "Giving Up the Keys". THE GERONTOLOGIST 2023; 63:717-730. [PMID: 36383376 PMCID: PMC10167763 DOI: 10.1093/geront/gnac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Age-associated changes can impair abilities for safe driving and the use of firearms. We sought to examine multiple perspectives on reducing access to firearms, including similarities and differences compared to reducing driving. RESEARCH DESIGN AND METHODS Online focus groups and 1-on-1 interviews were conducted (November 2020 to May 2021) in the United States with: older adults who drove and owned firearms; family members of older adult firearm owners/drivers; professionals in aging-related agencies; and firearm retailers/instructors. Recorded sessions were transcribed, coded, and analyzed following a mixed inductive-deductive thematic analysis process. RESULTS Among 104 participants (81 in focus groups, 23 in interviews), 50 (48%) were female, and 92 (88%) White. Key similarities: decisions are emotional and challenging; needs change over time; safety concerns are heightened by new impairments; prior experiences prompt future planning; tension between autonomy and reliance on trusted others; and strategies like reframing may ease transitions and avoid confrontations. Key differences: "retirement" was not an acceptable term for firearms; reducing driving may affect daily independence more, but there are few alternatives for the psychological safety conferred by firearms; and there are specific firearm-related legal concerns but more driving-related regulations, policies, and resources. DISCUSSION AND IMPLICATIONS The similarities and differences in the processes and preferences related to reducing driving or firearm access have implications for the development of resources to support planning and action. Such resources for the public and providers might empower older adults and their families to make voluntary, shared decisions, and reduce injuries and deaths.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Evan R Polzer
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, Colorado, USA
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Veterans Health Administration, Aurora, Colorado, USA
| | - Christopher E Knoepke
- Division of Cardiology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Laura C Prater
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington,USA
- Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington,USA
| | - Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Veterans Health Administration, Aurora, Colorado, USA
- Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Teresa M Lee
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Lauren E Meador
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, Colorado, USA
- Department of Pathology, Stanford Medicine, Palo Alto, California, USA
| | - Kathryn A Nearing
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- Division of Geriatrics and Multidisciplinary Center on Aging, School of Medicine, University of Colorado, Aurora, Colorado, USA
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5
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Leung T, Portz J, Fischer SM, Greenway E, Johnson RL, Knoepke CE, Matlock DD, Omeragic F, Peterson RA, Ranney ML, Betz ME. A Web-Based Decision Aid for Caregivers of Persons With Dementia With Firearm Access (Safe at Home Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e43702. [PMID: 36719721 PMCID: PMC9929727 DOI: 10.2196/43702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Firearm safety among individuals with Alzheimer disease and related dementias (ADRD) is an underdiscussed and underresearched concern in the United States, especially given the growing population of community-dwelling adults with ADRD. The "Safety in Dementia" (SiD) web-based decision aid was developed to support caregivers in addressing firearm access; the efficacy of SiD is unknown. OBJECTIVE Through the SiD decision aid, the Safe at Home (S@H) study aims to support caregivers in making decisions about home safety that align with their goals and values, and behaviors regarding firearm access for persons with ADRD and firearm access. METHODS The S@H study is a 2-armed randomized controlled trial to test the effect of the SiD decision aid on caregivers of community-dwelling adults with ADRD who have firearm access. S@H aims to recruit 500 ADRD caregivers (age ≥18 years, fluent in English or Spanish, and in the United States) through online or social media advertisements and through relevant organizations. Participants are randomized to view SiD or a control website at their own pace; all participants complete web-based questionnaires at baseline, 2 weeks, 2 months, and 6 months. The primary outcome is immediate preparation for decision-making; secondary outcomes include longitudinal decision outcomes and self-reported modifications to firearm access. The relative reach and effectiveness of each recruitment method (online/social media and through relevant organizations) will be assessed by examining differences in caregiver participation, retention rates, and relative cost. RESULTS The study enrollment began in May 2022. As of December 2022, a total of 117 participants had enrolled. CONCLUSIONS The S@H study is the first randomized trial of a firearm safety decision aid for ADRD caregivers. The results from this study will inform how best to support caregivers in decision-making regarding firearm safety. Further, results may guide approaches for recruiting caregivers and for dissemination of resources. TRIAL REGISTRATION ClinicalTrials.gov NCT05173922; https://clinicaltrials.gov/ct2/show/NCT05173922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43702.
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Affiliation(s)
| | - Jennifer Portz
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Stacy M Fischer
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emily Greenway
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christopher E Knoepke
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel D Matlock
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States.,Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Faris Omeragic
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ryan A Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Megan L Ranney
- Brown-Lifespan Center for Digital Health, Brown University, Providence, RI, United States.,School of Public Health, Brown University, Providence, RI, United States.,Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
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6
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Polzer ER, Nearing KA, Knoepke CE, Matlock DD, Betz ME. Firearm access and dementia: A qualitative study of reported behavioral disturbances and responses. J Am Geriatr Soc 2022; 70:439-448. [PMID: 34590304 PMCID: PMC8821127 DOI: 10.1111/jgs.17496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cognitive impairment and behavioral changes associated with Alzheimer's disease and related dementias (ADRDs) can impair safe firearm handling ability, an issue that can be challenging for ADRD caregivers to address. In this qualitative analysis, we sought to explore behavioral disruptions that raise concerns about firearm access in dementia and how caregivers react and respond. METHODS Secondary qualitative analysis using data from semi-structured, one-on-one interviews originally conducted as part of a study to develop firearm safety educational materials for ADRD caregivers. Interviewees were English-speaking adults (≥18 years) from three stakeholder groups: ADRD caregivers (professional or informal), medical professionals (geriatricians, neurologists), and firearm professionals (retailers, range employees, instructors). For secondary analysis, transcripts of interviews were recoded and analyzed after an inductive-deductive thematic analysis process. RESULTS Among 24 participants, 17 (70%) were female and 20 (83%) white; 13 (54%) had personal or professional experience with ADRD caregiving; and 5 (21%) had a firearm affiliation. Major themes were: (1) behavioral disturbances that make caregivers concerned about firearm access; (2) caregiver emotional responses to and difficulties associated with these disturbances; and (3) caregiver actions (planned or actual) to limit firearms access. CONCLUSION Various behavioral disturbances and emotional burdens can trigger ADRD caregiver concern about firearms access, but strategies exist for restricting or safeguarding firearms in the home. Study findings suggest a need for caregiver support on this topic, including counseling by healthcare providers, advance planning for older firearm owners, and development of community resources.
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Affiliation(s)
- Evan R. Polzer
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, 80045
| | - Kathryn A. Nearing
- Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado, School of Medicine, Aurora, CO, 80045,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, 80045
| | - Christopher E. Knoepke
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, CO, 80045, Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO, 80045
| | - Daniel D. Matlock
- Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado, School of Medicine, Aurora, CO, 80045, Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO, 80045,Division of Geriatric Medicine, University of Colorado, School of Medicine, Aurora, CO, 80045
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, 80045,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, 80045
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Polzer E, Nearing K, Knoepke CE, Matlock DD, McCourt A, Betz ME. "Firearm access in dementia: legal and logistic challenges for caregivers". Int Rev Psychiatry 2021; 33:653-661. [PMID: 33792478 PMCID: PMC8484338 DOI: 10.1080/09540261.2021.1887098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
The prevalence of Alzheimer's disease and related dementias (ADRD) is increasing. In the United States, older adults are among those most likely to have firearms in the home. Addressing firearm access among persons with ADRD can be confusing and stressful for family caregivers, healthcare providers, firearm industry representatives and law enforcement. This study sought to examine key stakeholder perspectives concerning legal and logistic considerations for temporary firearm transfers when a person with ADRD owned firearms. A secondary analysis of 24 qualitative interviews conducted to inform the development of a firearm safety tool for ADRD caregivers revealed four types of barriers. These barriers were each associated with logistical challenges and legal ambiguities that hampered ADRD-related firearm transfers: (1) legal questions on firearm ownership and permitted transferees; (2) transfer logistics and duration; (3) issues of engaging law enforcement or retailers for transfers; and, (4) lack of information resources and guidance. Siloes between stakeholder groups persist and limit information sharing. Broad initiatives engaging caregivers, older adults, clinicians, aging service providers, law enforcement, and firearm outlets could inform the development of policies, programs, and practices to enhance the safety and well-being of people with ADRD and their caregivers.
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Affiliation(s)
- Evan Polzer
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Kathryn Nearing
- Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado, School of Medicine, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Christopher E. Knoepke
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, CO
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Daniel D. Matlock
- Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado, School of Medicine, Aurora, CO, USA
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, CO
- Division of Geriatric Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Alexander McCourt
- Johns Hopkins Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
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Pallin R, Barnhorst A. Clinical strategies for reducing firearm suicide. Inj Epidemiol 2021; 8:57. [PMID: 34607607 PMCID: PMC8489372 DOI: 10.1186/s40621-021-00352-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
Suicide is complex, with psychiatric, cultural, and socioeconomic roots. Though mental illnesses like depression contribute to risk for suicide, access to lethal means such as firearms is considered a key risk factor for suicide, and half of suicides in the USA are by firearm. When a person at risk of suicide has access to firearms, clinicians have a range of options for intervention. Depending on the patient, the situation, and the access to firearms, counseling on storage practices, temporary transfer of firearms, or further intervention may be appropriate. In the USA, ownership of and access to firearms are common and discussing added risk of access to firearms for those at risk of suicide is not universally practiced. Given the burden of suicide (particularly by firearm) in the USA, the prevalence of firearm access, and the lethality of suicide attempts with firearms, we present the existing evidence on the burden of firearm suicide and what clinicians can do to reduce their patients' risk. Specifically, we review firearm ownership in the USA, firearm injury epidemiology, risk factors for firearm-related harm, and available interventions to reduce patients' risk of firearm injury and death.
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Affiliation(s)
- Rocco Pallin
- University of California Firearm Violence Research Center at UC Davis, 2315 Stockton Blvd, Sacramento, CA, USA.
- Department of Emergency Medicine, UC Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, USA.
| | - Amy Barnhorst
- University of California Firearm Violence Research Center at UC Davis, 2315 Stockton Blvd, Sacramento, CA, USA
- Department of Emergency Medicine, UC Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, USA
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9
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Betz ME, Polzer E, Nearing K, Knoepke CE, Johnson RL, Meador L, Matlock DD. Feasibility and Acceptability of a Web-Based Caregiver Decision Aid (Safety in Dementia) for Firearm Access: Pilot Randomized Controlled Trial. JMIR Form Res 2021; 5:e30990. [PMID: 34550082 PMCID: PMC8495566 DOI: 10.2196/30990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/26/2022] Open
Abstract
Background Firearms are common in the households of persons with Alzheimer disease and related dementias (ADRD). Safety in Dementia (SiD) is a free web-based decision aid that was developed to support ADRD caregivers in addressing firearm access. Objective We aimed to evaluate the feasibility and acceptability of SiD among a web-based sample of ADRD caregivers. Methods SiD was tested in 2 phases by using participants who were recruited from a web-based convenience sample (Amazon Mechanical Turk participants). In phase 1, caregivers were randomized to view either the intervention (SiD) or the control (Alzheimer’s Association materials), and the blinding of participants to the study arms was conducted. In phase 2, caregivers of individuals with ADRD and firearm access were recruited; all of these participants viewed the firearm section of SiD. In both phases, participants viewed SiD independently for as long as they wanted. Measures for evaluating decision-making and SiD acceptability were used, and these were assessed via a self-administered web-based questionnaire. Results Participants were recruited for phases 1 (n=203) and 2 (n=54). Although it was feasible to collect the study outcome data in a web-based format, in phase 1, there were no significant differences between SiD and the control in terms of decision-making and self-efficacy. The majority (137/203, 67.5%) of phase 1 participants spent between 5 and 10 minutes reviewing the resources. In phase 2, 61% (33/54) of participants spent 5 to 10 minutes viewing the firearm section, and 31% (17/54) spent 10 to 20 minutes viewing this section. Usability and acceptability were high across the phases. Conclusions SiD represents a new resource for promoting safety among people with dementia, and high acceptability was achieved in a pilot trial. In this sample, SiD performed similarly to Alzheimer’s Association materials in supporting decision-making and self-efficacy.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
| | - Evan Polzer
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kathryn Nearing
- Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States.,Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christopher E Knoepke
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Lauren Meador
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel D Matlock
- Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States.,Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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