Betz ME, Portz J, Knoepke C, Ranney ML, Fischer SM, Peterson RA, Johnson RL, Omeragic F, Castaneda M, Greenway E, Matlock D. The Effect of the "Safety in Dementia" Online Tool to Assist Decision Making for Caregivers of Persons With Dementia and Access to Firearms : A Randomized Trial.
Ann Intern Med 2024;
177:1630-1640. [PMID:
39531391 DOI:
10.7326/annals-24-00763]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND
Caregivers face challenges (including competing desires to prevent injury, respect autonomy, and avoid conflict) when addressing firearm access by community-dwelling persons with Alzheimer disease and related dementias (ADRD).
OBJECTIVE
To test the effect of the online Safety in Dementia (SiD) decision aid on caregivers' decision making about firearm access for people with ADRD.
DESIGN
Prospective 2-group randomized trial with longitudinal follow-up. (ClinicalTrials.gov: NCT05173922).
SETTING
United States.
PARTICIPANTS
English- or Spanish-speaking caregivers (aged ≥18 years) of community-dwelling adults with ADRD and firearm access.
INTERVENTION
SiD versus a web-based information control.
MEASUREMENTS
The primary outcome was preparation for decision making about firearm access. The secondary outcome at follow-up was self-reported action to reduce access.
RESULTS
Among 500 participants enrolled between June 2022 and February 2024, the mean age was 47 years, 69% identified as female, half were the adult child or stepchild of the person with ADRD, and 99% chose study participation in English. Participant characteristics were similar by study group. For the primary outcome, SiD significantly increased preparation for decision making versus the control (69.8 vs. 64.8 out of 100; mean difference, 4.80 [95% CI, 0.53 to 9.07]; P = 0.024). There was no significant effect on actions to reduce firearm access at 2 weeks or 2 months.
LIMITATION
The results may not be generalizable to non-English-speaking populations.
CONCLUSION
The online SiD decision aid increased preparation for decision making about firearm access in this sample of ADRD caregivers in the United States. Use of such resources in clinical or community settings may support caregivers and people with ADRD in avoiding firearm injury or death.
PRIMARY FUNDING SOURCE
National Institute on Aging, National Institutes of Health.
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