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Chennapragada L, Osterberg T, Strouse M, Sullivan SR, Silver C, LaMarca M, Boucher C, Fonseca E, Goodman M. A PRISMA Scoping Review to Explore Interventions to Prevent Firearm-Related Injury and Suicide in Older Adults. Clin Gerontol 2024; 47:519-535. [PMID: 38626064 DOI: 10.1080/07317115.2024.2339366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
OBJECTIVES This scoping review aims to examine existing research into firearm safety interventions designed to prevent firearm injury and suicide in older adults. METHODS Select databases were searched in 5/2023. Included articles involved an/a 1. aim to develop or investigate firearm safety interventions, 2. focus on adults 50 years and older, and 3. primary analysis. RESULTS The search yielded 10 articles which primarily focused on firearm safety counseling with older adults with suicide risk or emerging impairment. The review found that older adults may be open to receiving firearm safety counseling but that providers feel ill-equipped to have these conversations and to reliably identify suicide risk. Two studies presented promising data on the impact and acceptability of training providers in a firearm safety intervention. The review also identified the importance of building trust between older patients and providers to have helpful discussions regarding firearms, and highlighted specific approaches that facilitate openness to participate in these exchanges. CONCLUSIONS Further research into adapting interventions to meet the clinical needs of older adults and treatment efficacy trials is necessary. CLINICAL IMPLICATIONS Training healthcare providers to conduct firearm safety interventions with older adults may be an acceptable and impactful avenue to prevent suicide.
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Affiliation(s)
- Lakshmi Chennapragada
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Terra Osterberg
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Madison Strouse
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Sarah R Sullivan
- Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA
- Department of Psychology, Hunter College, City University of New York, New York, NY, USA
| | - Chana Silver
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Mary LaMarca
- Executive Division, National Center for PTSD Department of Veterans Affairs, White River Junction, Vermont, USA
| | - Caroline Boucher
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Emilia Fonseca
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Betz ME, Frattaroli S, Knoepke CE, Johnson R, Christy A, Schleimer JP, Pear VA, McCarthy M, Kapoor R, Norko MA, Rowhani-Rahbar A, Ma W, Wintemute GJ, Swanson JW, Zeoli AM. Extreme Risk Protection Orders in Older Adults in Six U.S. States: A Descriptive Study. Clin Gerontol 2024; 47:536-543. [PMID: 37688772 PMCID: PMC11229607 DOI: 10.1080/07317115.2023.2254279] [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: 09/11/2023]
Abstract
OBJECTIVES Extreme Risk Protection Orders (ERPOs) allow a court to restrict firearm access for individuals ("respondents") at imminent risk of harm to self/others. Little is known about ERPOs use for older adults, a population with higher rates of suicide and dementia. METHODS We abstracted ERPO cases through June 30, 2020, from California, Colorado, Connecticut, Florida, Maryland, and Washington. We restricted our analysis to petitions for older (≥65 years) respondents, stratified by documented cognitive impairment. RESULTS Among 6,699 ERPO petitions, 672 (10.0%) were for older adults; 13.7% (n = 92) of these noted cognitive impairment. Most were white (75.7%) men (90.2%). Cognitively impaired (vs. non-impaired) respondents were older (mean age 78.2 vs 72.7 years) and more likely to have documented irrational/erratic behavior (30.4% vs 15.7%), but less likely to have documented suicidality (33.7% vs 55.0%). At the time of the petition, 56.2% of older adult respondents had documented firearm access (median accessible firearms = 3, range 1-160). CONCLUSIONS Approximately 14% of ERPO petitions for older adults involved cognitive impairment; one-third of these noted suicide risk. Studies examining ERPO implementation across states may inform usage and awareness. CLINICAL IMPLICATIONS ERPOs may reduce firearm access among older adults with cognitive impairment, suicidality, or risk of violence.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Shannon Frattaroli
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher E Knoepke
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel Johnson
- Center for Innovative Design & Analysis, Department of Biostatistics & Informatics, Colorado School of Public health, Aurora, Colorado, USA
| | - Annette Christy
- Department of Mental Health Law and Policy at the de la Parte Florida Mental Health Institute, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Julia P Schleimer
- Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Veronica A Pear
- Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA
| | - Megan McCarthy
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Reena Kapoor
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael A Norko
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Wenjuan Ma
- Center for Statistical Training and Consulting, Michigan State University, Lansing, Michigan, USA
| | - Garen J Wintemute
- Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA
| | - Jeffrey W Swanson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - April M Zeoli
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
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Dineen JN, Doucette M, Carey M, Raissian KM. Conversation starters: Understanding the facilitators and barriers to physician-initiated secure firearm storage conversations. PATIENT EDUCATION AND COUNSELING 2024; 119:108062. [PMID: 37992529 DOI: 10.1016/j.pec.2023.108062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE This paper aims to understand what general practice physicians (GPs) perceive as facilitators and barriers to initiating anticipatory guidance around firearm safety. METHODS We employ qualitative interviewing to have in-depth conversations with 18 GPs. Participants were randomly selected from a national panel of physicians and screened for specialty (general practice or internist), practice setting (not hospital-based), and time spent on direct patient care (80% +). The sample was stratified at the state level by the presence of safe storage or child access protection laws, with half of the participants selected from each stratum. RESULTS We identify five physician-perceived barriers to providing secure firearm storage counseling, including inadequate screening mechanisms to trigger conversations, physician perceptions of who is at risk for firearm injury, time pressures, concerns about patient receptivity, and a need for training. CONCLUSION Prior to focusing on how to have conversations about firearm safety, interventions designed to increase the incidence of physician-initiated guidance need to address the structural issues of why those conversations typically do not occur. PRACTICE IMPLICATIONS Findings indicate the need for revised screening tools and improved physician education as to who is at risk for gun injury and how to best approach firearm safety conversations.
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Affiliation(s)
- Jennifer Necci Dineen
- University of Connecticut School of Public Policy, School of Public Policy, University of Connecticut, Hartford Times Building, Fourth Floor, 10 Prospect Street, Hartford, CT, USA; ARMS Center for Gun Injury Prevention, University of Connecticut, School of Public Policy, University of Connecticut, Hartford Times Building, Fourth Floor, 10 Prospect Street, Hartford, CT, USA.
| | - Mitchell Doucette
- Johns Hopkins Center for Gun Violence Solutions, Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Mekaila Carey
- University of Connecticut School of Public Policy, School of Public Policy, University of Connecticut, Hartford Times Building, Fourth Floor, 10 Prospect Street, Hartford, CT, USA
| | - Kerri M Raissian
- University of Connecticut School of Public Policy, School of Public Policy, University of Connecticut, Hartford Times Building, Fourth Floor, 10 Prospect Street, Hartford, CT, USA; ARMS Center for Gun Injury Prevention, University of Connecticut, School of Public Policy, University of Connecticut, Hartford Times Building, Fourth Floor, 10 Prospect Street, Hartford, CT, USA
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Villarreal RI, Stanley IH, Anestis MD, Buck-Atkinson J, Betz ME. Older Adults' Preferences Regarding Firearm Locking Device Use: Results of a National Survey. Clin Gerontol 2023:1-11. [PMID: 37994864 DOI: 10.1080/07317115.2023.2285994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVES Use of firearm locking devices may reduce the risk of suicide and injury among older adults. This study describes older adults' preferences when choosing a firearm locking device. METHODS We conducted a secondary analysis of a nationally representative survey of US adult firearm owners (N = 2,152). We compared older adults (≥65y) with relatively younger adults (<65y), stratified by self-reported gender. RESULTS The top three factors cited as impacting firearm locking device selection included speed (53.6%) and ease of firearm access from device (52.4%), and cost of the device (28.7%). These top factors were comparable for all adults across genders. A larger proportion of older vs younger males reported that a primary preference was whether the device allows the firearm to remain loaded with ammunition; smaller proportions of older vs younger males reported strength of device (device durability) and costs. CONCLUSIONS Preference among older adults, particularly older males, for locking devices that maintain the firearms easy to access - especially, loaded with ammunition - might impact firearm injury prevention efforts for this high-risk group. CLINICAL IMPLICATIONS For harm reduction, use of any firearm locking device may reduce the risk of firearm injury or death. Clinicians are encouraged to explore reasons for locking device selection within motivational interviewing frameworks.
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Affiliation(s)
- Ricardo I Villarreal
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Center for COMBAT Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ian H Stanley
- Center for COMBAT Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- School of Public Health, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
| | - Jessica Buck-Atkinson
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
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Betz ME, Bowen DM, Rowhani-Rahbar A, McCourt AD, Rivara FP. State Reporting Requirements for Involuntary Holds, Court-Ordered Guardianship, and the US National Firearm Background Check System. JAMA HEALTH FORUM 2023; 4:e233945. [PMID: 37976049 PMCID: PMC10656649 DOI: 10.1001/jamahealthforum.2023.3945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/19/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Firearm violence is a leading cause of death in the US. There is broad public agreement that individuals at high risk of perpetrating violence should not be allowed to purchase or possess firearms. The National Instant Criminal Background Check System (NICS) is a national system intended to stop firearm purchases or possession by prohibited persons, but there is heterogeneity in how states interact with and report data to NICS. Objective To examine variability in state requirements for NICS reporting for mental health prohibitions. Design and Setting This cross-sectional study in the US reviewed current statutes for all 50 states and the District of Columbia (enacted through the 2021 legislative session) regarding reporting mental health prohibitions to NICS or state systems. Data were analyzed from October 2022 to April 2023. Main Outcomes and Measures For each state, the following were recorded: reliance on Federal Bureau of Investigation vs state point of contact for NICS checks; regulation requiring or allowing reporting to NICS for 3 hypothetical cases; and details on reporting responsibility and time frame. The number of NICS listings for adjudicated mental health reasons was obtained, and state rates per 1000 population were calculated. To compare states, we developed 3 hypothetical cases of individuals with risk of firearm violence, whether possibly temporary (involuntary commitment for decompensated psychosis, or involuntary short-term psychiatric hold for suicidal ideation) or chronic and progressive (court-appointed guardianship for dementia). Results A total of 39 states required and 5 allowed reporting to NICS for court-ordered, involuntary psychiatric hospitalization. Thirteen states required and 5 allowed reporting to NICS when a court determines an individual is mentally incompetent to manage their affairs (with or without guardianship). Two states required NICS reporting for short-term emergency psychiatric holds. Five states and the District of Columbia had no legislation explicitly requiring or allowing NICS reporting in the 3 scenarios. Conclusions and Relevance In this cross-sectional study of state laws, there was substantial heterogeneity in NICS reporting requirements and lack of clarity around processes. This raises questions about the ability of NICS to be used to block firearm purchases or possession by individuals with court-identified high risk of perpetrating violence toward themselves or others.
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Affiliation(s)
- Marian E. Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver
| | - Deirdre M. Bowen
- Seattle University School of Law, Seattle, Washington
- Firearm Injury and Policy Research Program, University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Firearm Injury and Policy Research Program, University of Washington, Seattle
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
| | - Alexander D. McCourt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Frederick P. Rivara
- Firearm Injury and Policy Research Program, University of Washington, Seattle
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
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Lafferty M, O'Neill A, Cerra N, Maxim L, Mulcahy A, Wyse JJ, Carlson KF. Let's Talk About Firearms: Perspectives of Older Veterans and VA Clinicians on Universal and Dementia-Specific Firearm Safety Discussions. Clin Gerontol 2023:1-11. [PMID: 37665611 DOI: 10.1080/07317115.2023.2254292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Veterans experience high rates of fatal and non-fatal firearm injuries. This risk may be compounded among Veterans who are rural-residing, aging, and/or experiencing cognitive decline or dementia. Firearm safety discussions are not broadly implemented across Department of Veterans Affairs (VA) healthcare settings due, in part, to concerns of causing Veterans to disengage from care. This study examines perceptions about firearm safety discussions to inform healthcare-based harm-reduction efforts. METHODS We conducted interviews with 34 Veterans (median age 70) and 22 clinicians from four VA facilities that treat high rates of rural patients with firearm-related injuries. RESULTS Most Veterans accepted the idea of universal firearm safety discussions at the VA. Some reported they might not be forthright in such discussions, but raising the topic would not stop them from engaging with VA care. Veterans and clinicians unanimously endorsed firearm safety discussions for older patients experiencing cognitive decline or dementia. CONCLUSIONS VA patients and clinicians are amenable to firearm safety discussions during healthcare visits and especially endorse the need for such discussions among high-risk populations. CLINICAL IMPLICATIONS Universal firearm safety discussions could be incorporated into standard VA practice, particularly for Veterans experiencing cognitive decline or dementia, without risking Veteran disengagement from care.
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Affiliation(s)
- Megan Lafferty
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
| | - AnnaMarie O'Neill
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
| | - Nicole Cerra
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, USA
| | - Lauren Maxim
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
| | - Abigail Mulcahy
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, USA
| | - Jessica J Wyse
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, USA
| | - Kathleen F Carlson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, 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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Toigo S, Pollock NJ, Liu L, Contreras G, McFaull SR, Thompson W. Fatal and non-fatal firearm-related injuries in Canada, 2016-2020: a population-based study using three administrative databases. Inj Epidemiol 2023; 10:10. [PMID: 36788597 PMCID: PMC9930327 DOI: 10.1186/s40621-023-00422-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/05/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Firearms are a substantial cause of injury-related morbidity and mortality in Canada and globally, though evidence from contexts other than the USA is relatively limited. We examined deaths, hospitalizations and emergency department (ED) visits due to firearm-related injuries in Canada to identify population groups at increased risk of fatal and non-fatal outcomes. METHODS We conducted a population-based study using three national administrative databases on deaths, hospitalizations, and ED visits. ICD-10 codes were used to identify firearm-related injuries from January 1, 2016, through December 31, 2020. Fatal and non-fatal firearm injuries were classified as suicide/self-harm, homicide/assault, unintentional, undetermined or legal intervention injuries. We analyzed the data with counts, rates and proportions, stratified by sex, age group, province/territory, and year. RESULTS Over the 5-year period, we identified 4005 deaths, 3169 hospitalizations, and 2847 ED visits related to firearm injuries in various jurisdictions in Canada. Males comprised the majority of fatal and non-fatal injury cases. The highest rates of fatal and non-fatal firearm injuries were among 20- to 34-year-olds. The leading cause of fatal firearm injuries was self-harm (72.3%). For non-fatal firearm hospitalizations and ED visits, assault (48.8%) and unintentional injuries (62.8%) were the leading causes of injury. Rates varied by province and territory. CONCLUSIONS Our results showed that males comprised the majority of fatal and non-fatal firearm injuries in Canada. The rates of both fatal and non-fatal firearm injuries were highest among the 20- to 34-year-old age group. This comprehensive overview of the epidemiology of firearm injuries in Canada provides baseline data for ongoing surveillance and policy evaluation related to public health interventions.
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Affiliation(s)
- Stephanie Toigo
- Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada.
| | - Nathaniel J. Pollock
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Li Liu
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Gisèle Contreras
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Steven R. McFaull
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Wendy Thompson
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
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Coley RY, Smith JJ, Karliner L, Idu AE, Lee SJ, Fuller S, Lam R, Barnes DE, Dublin S. External Validation of the eRADAR Risk Score for Detecting Undiagnosed Dementia in Two Real-World Healthcare Systems. J Gen Intern Med 2023; 38:351-360. [PMID: 35906516 PMCID: PMC9904522 DOI: 10.1007/s11606-022-07736-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fifty percent of people living with dementia are undiagnosed. The electronic health record (EHR) Risk of Alzheimer's and Dementia Assessment Rule (eRADAR) was developed to identify older adults at risk of having undiagnosed dementia using routinely collected clinical data. OBJECTIVE To externally validate eRADAR in two real-world healthcare systems, including examining performance over time and by race/ethnicity. DESIGN Retrospective cohort study PARTICIPANTS: 129,315 members of Kaiser Permanente Washington (KPWA), an integrated health system providing insurance coverage and medical care, and 13,444 primary care patients at University of California San Francisco Health (UCSF), an academic medical system, aged 65 years or older without prior EHR documentation of dementia diagnosis or medication. MAIN MEASURES Performance of eRADAR scores, calculated annually from EHR data (including vital signs, diagnoses, medications, and utilization in the prior 2 years), for predicting EHR documentation of incident dementia diagnosis within 12 months. KEY RESULTS A total of 7631 dementia diagnoses were observed at KPWA (11.1 per 1000 person-years) and 216 at UCSF (4.6 per 1000 person-years). The area under the curve was 0.84 (95% confidence interval: 0.84-0.85) at KPWA and 0.79 (0.76-0.82) at UCSF. Using the 90th percentile as the cut point for identifying high-risk patients, sensitivity was 54% (53-56%) at KPWA and 44% (38-51%) at UCSF. Performance was similar over time, including across the transition from International Classification of Diseases, version 9 (ICD-9) to ICD-10 codes, and across racial/ethnic groups (though small samples limited precision in some groups). CONCLUSIONS eRADAR showed strong external validity for detecting undiagnosed dementia in two health systems with different patient populations and differential availability of external healthcare data for risk calculations. In this study, eRADAR demonstrated generalizability from a research sample to real-world clinical populations, transportability across health systems, robustness to temporal changes in healthcare, and similar performance across larger racial/ethnic groups.
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Affiliation(s)
- R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Julia J Smith
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Leah Karliner
- Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, USA
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Abisola E Idu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Sei J Lee
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sharon Fuller
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Rosemary Lam
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Deborah E Barnes
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Weill Institute for Neurosciences, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA, USA
| | - Sascha Dublin
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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10
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Seewald LA, Myers M, Zimmerman MA, Walton MA, Cunningham RM, Rupp LA, Haasz M, Carter PM. Firearm safety counseling among caregivers of high-school age teens: Results from a National Survey. Prev Med 2022; 165:107285. [PMID: 36183798 PMCID: PMC9900740 DOI: 10.1016/j.ypmed.2022.107285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 02/08/2023]
Abstract
Firearms are the leading cause of death for high-school age teens. To inform prevention efforts, we characterize the prevalence of healthcare provider (HCP) counseling of caregivers of teens around firearm safety, safety conversation elements, and caregiver receptivity towards counseling. A cross-sectional web survey (6/24/2020-7/22/2020) was conducted among caregivers (n = 2924) of teens (age:14-18). Weights were applied to generate nationally representative estimates. Bivariate analyses and multivariate regressions were examined. Among respondents, 56.0% were women, 75.1% were non-Hispanic White, and mean (SD) age was 47.4. Firearm safety was the least discussed topic among caregivers reporting their teen received HCP preventative counseling (14.9%). For caregivers receiving counseling, the most common issues discussed were household firearms screening (75.7%); storing firearms locked (66.8%); and storing firearms unloaded (53.0%). Only 24.6% of caregivers indicated firearm safety was an important issue for teen HCPs to discuss and only 21.9% trusted teen HCPs to counsel about firearm safety. Female caregivers (aOR = 1.86;95%CI = 1.25-2.78), those trusting their teen's HCP to counsel on firearm safety (aOR = 9.63;95%CI = 6.37-14.56), and those who received teen HCP firearm safety counseling (aOR = 5.14;95%CI = 3.02-8.72) were more likely to favor firearm safety counseling. Caregivers of teens with prior firearm safety training (aOR = 0.50;95%CI = 0.31-0.80) were less likely to agree that firearm safety was an important preventative health topic. In conclusion, few caregivers receive preventive counseling on firearm safety from their teen's HCP, with trust a key barrier to effective intervention delivery. Future research, in addition to understanding barriers and establishing effective strategies to increase safety practices, should focus on increasing provider counseling competency.
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Affiliation(s)
- Laura A Seewald
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, United States of America.
| | - Matthew Myers
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Marc A Zimmerman
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ of Michigan School of Public Health, 1415 Washington Heights 3790A, SPH I, Ann Arbor, MI 48109, United States of America
| | - Maureen A Walton
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Addiction Center, Dept of Psychiatry, Univ of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI 48109, United States of America
| | - Rebecca M Cunningham
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Laney A Rupp
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ of Michigan School of Public Health, 1415 Washington Heights 3790A, SPH I, Ann Arbor, MI 48109, United States of America
| | - Maya Haasz
- Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, 13123 East 16th Ave B251, Aurora, CO 80045, United States of America
| | - Patrick M Carter
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
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11
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Carter PM, Losman E, Roche JS, Malani PN, Kullgren JT, Solway E, Kirch M, Singer D, Walton MA, Zeoli AM, Cunningham RM. Firearm ownership, attitudes, and safe storage practices among a nationally representative sample of older U.S. adults age 50 to 80. Prev Med 2022; 156:106955. [PMID: 35065980 DOI: 10.1016/j.ypmed.2022.106955] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/07/2022] [Accepted: 01/15/2022] [Indexed: 11/19/2022]
Abstract
Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for older adult populations. To inform prevention efforts, we conducted a probability-based web survey (12/1/2019-12/23/2019) of 2048 older adults (age 50-80) to characterize national estimates of firearm ownership, safety practices, and attitudes about health screening, counseling, and policy initiatives. Among older U.S. adults, 26.7% [95%CI = 24.8%-28.8%] report owning one or more firearms. The primary motivation for ownership was protection (69.5%), with 90.4% highlighting a fear of criminal assault. 39.4% of firearm owners reported regularly storing firearm(s) unloaded and locked, with 24.2% regularly storing at least one loaded and unlocked. While most firearm owners found healthcare screening (69.2% [95%CI: 64.9-73.1]) and safety counseling (63.2% [95%CI = 58.8-67.3]) acceptable, only 3.7% of older adults reported being asked about firearm safety by a healthcare provider in the past year. Among firearm owners, there was support for state-level policy interventions, including allowing family/police to petition courts to restrict access when someone is a danger to self/others (78.9% [95%CI = 75.1-82.3]), comprehensive background checks (85.0% [95%CI = 81.5-87.9]), restricting access/ownership under domestic violence restraining orders (88.1%; 95%CI = 84.9-90.7], and removing firearms from older adults with dementia/confusion (80.6%; 95%CI = 76.8-84.0]. Healthcare and policy-level interventions maintained higher support among non-owners than owners (p's < 0.001). Overall, data highlights opportunities exist for more robust firearm safety prevention efforts among older adults, particularly healthcare-based counseling and state/federal policies that focus on addressing lethal means access among at-risk individuals.
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Affiliation(s)
- Patrick M Carter
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ. of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America.
| | - Eve Losman
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America.
| | - Jessica S Roche
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America.
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States of America.
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America; Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd., NCRC 16-330W, Ann Arbor, MI 48019, United States of America; Dept of Health Management/Policy, Univ. of Michigan School of Public Health, 1415 Washington Heights 3790A, SPH I, Ann Arbor, MI 48109, United States of America; Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd., Ann Arbor, MI 48105, United States of America.
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America.
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America.
| | - Dianne Singer
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America; Child Health Evaluation and Research Center, University of Michigan, North Ingalls Building, 300N. Ingalls St., 6th Floor, Ann Arbor, MI 48109, United States of America.
| | - Maureen A Walton
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Addiction Center, Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI 48109, United States of America.
| | - April M Zeoli
- School of Criminal Justice, Michigan State University, 655 Auditorium Rd., East Lansing, MI 48824, United States of America.
| | - Rebecca M Cunningham
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ. of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America.
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12
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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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13
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Schmutte T, Olfson M, Maust DT, Xie M, Marcus SC. Suicide risk in first year after dementia diagnosis in older adults. Alzheimers Dement 2022; 18:262-271. [PMID: 34036738 PMCID: PMC8613307 DOI: 10.1002/alz.12390] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/30/2021] [Accepted: 04/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Receiving a diagnosis of Alzheimer's disease or related dementias (ADRD) can be a pivotal and stressful period. We examined the risk of suicide in the first year after ADRD diagnosis relative to the general geriatric population. METHODS We identified a national cohort of Medicare fee-for-service beneficiaries aged ≥ 65 years with newly diagnosed ADRD (n = 2,667,987) linked to the National Death Index. RESULTS The suicide rate for the ADRD cohort was 26.42 per 100,000 person-years. The overall standardized mortality ratio (SMR) for suicide was 1.53 (95% confidence interval [CI] = 1.42, 1.65) with the highest risk among adults aged 65 to 74 years (SMR = 3.40, 95% CI = 2.94, 3.86) and the first 90 days after ADRD diagnosis. Rural residence and recent mental health, substance use, or chronic pain conditions were associated with increased suicide risk. DISCUSSION Results highlight the importance of suicide risk screening and support at the time of newly diagnosed dementia, particularly for patients aged < 75 years.
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Affiliation(s)
| | - Mark Olfson
- Columbia University, Department of Psychiatry and the New York State Psychiatric Institute
| | - Donovan T. Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Ming Xie
- University of Pennsylvania, Department of Psychiatry
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14
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Prater LC, Haviland MJ, Rivara FP, Bellenger MA, Gibb L, Rowhani-Rahbar A. Extreme Risk Protection Orders and Persons with Dementia in the State of Washington. J Gen Intern Med 2021; 36:3885-3887. [PMID: 33067710 PMCID: PMC8642559 DOI: 10.1007/s11606-020-06273-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Laura C Prater
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Miriam J Haviland
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Departments of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - M Alex Bellenger
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
| | - Lauren Gibb
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Departments of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
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15
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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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16
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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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17
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Schwertner E, Zelic R, Secnik J, Johansson B, Winblad B, Eriksdotter M, Religa D. Biting the Bullet: Firearm Ownership in Persons with Dementia. A Registry-Based Observational Study. J Alzheimers Dis 2021; 81:179-188. [PMID: 33720891 PMCID: PMC8203223 DOI: 10.3233/jad-201365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: In Sweden, 2,296,000 firearms were legally owned by private persons in 2017 and there were 150,000 persons living with a dementia diagnosis. A proportion of these persons owning a firearm may pose safety concerns. Objective: The aim was to describe firearm ownership in persons with dementia in Sweden and examine which characteristics are explaining physicians’ decision to report a person to the police as unsuitable to possess a firearm. Methods: This was a registry-based observational study. 65,717 persons with dementia registered in the Swedish Dementia Registry were included in the study. Logistic regression was used to evaluate which of the persons’ characteristics were most important in predicting the likelihood of being reported as unsuitable to possess a firearm. Relative importance of predictors was quantified using standardized coefficients (SC) and dominance analysis (DA). Results: Out of 53,384 persons with dementia, 1,823 owned a firearm and 419 were reported to the police as unsuitable owners. Firearm owners were predominantly younger, males, living alone, and without assistance of homecare. The most important predictors of being reported to the police were: living with another person (SC = 0.23), frontotemporal dementia (SC = 0.18), antipsychotics prescription (SC = 0.18), being diagnosed in a memory/cognitive clinic (SC = –0.27), female gender (SC = 0.18), mild (SC = –0.25) and moderate (SC = –0.21) dementia, and hypnotics prescription (SC = 0.17). Conclusion: Firearm owners with dementia were mostly younger males who were still living more independent lives. The decision to remove a weapon was not solely based on a diagnosis of dementia but a combination of factors was considered.
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Affiliation(s)
- Emilia Schwertner
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Renata Zelic
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Stockholm, Sweden
| | - Juraj Secnik
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Björn Johansson
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Winblad
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden.,Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Dorota Religa
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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18
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Vars FE. Older Firearm Owners and Advance Planning. Ann Intern Med 2021; 174:1038-1039. [PMID: 34280342 DOI: 10.7326/l21-0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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19
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Armstrong MJ, Sullivan JL, Amodeo K, Lunde A, Tsuang DW, Reger MA, Conwell Y, Ritter A, Bang J, Onyike CU, Mari Z, Corsentino P, Taylor A. Suicide and Lewy body dementia: Report of a Lewy body dementia association working group. Int J Geriatr Psychiatry 2021; 36:373-382. [PMID: 33169435 DOI: 10.1002/gps.5462] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/16/2020] [Accepted: 11/01/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Boston University School of Public Health, Boston, Massachusetts, USA
| | - Katherine Amodeo
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Angela Lunde
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Debby W Tsuang
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.,VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Mark A Reger
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.,VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Jee Bang
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA.,Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Angela Taylor
- Lewy Body Dementia Association, Lilburn, Georgia, USA
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Betz ME, Miller M, Matlock DD, Wintemute GJ, Johnson RL, Grogan C, Lum HD, Knoepke CE, Ranney ML, Suresh K, Azrael D. Older Firearm Owners and Advance Planning: Results of a National Survey. Ann Intern Med 2021; 174:279-282. [PMID: 33017563 PMCID: PMC8422861 DOI: 10.7326/m20-2280] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marian E Betz
- University of Colorado Anschutz Medical Campus and VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado (M.E.B.)
| | - Matthew Miller
- Harvard School of Public Health and Northeastern University, Boston, Massachusetts (M.M.)
| | - Daniel D Matlock
- VA Eastern Colorado Geriatric Research Education and Clinical Center, University of Colorado Anschutz Medical Campus, and University of Colorado School of Medicine, Aurora, Colorado (D.D.M.)
| | | | - Rachel L Johnson
- University of Colorado Anschutz Medical Campus, Aurora, Colorado (R.L.J., C.G., C.E.K., K.S.)
| | - Conor Grogan
- University of Colorado Anschutz Medical Campus, Aurora, Colorado (R.L.J., C.G., C.E.K., K.S.)
| | - Hillary D Lum
- VA Eastern Colorado Geriatric Research Education and Clinical Center and University of Colorado School of Medicine, Aurora, Colorado (H.D.L.)
| | - Christopher E Knoepke
- University of Colorado Anschutz Medical Campus, Aurora, Colorado (R.L.J., C.G., C.E.K., K.S.)
| | | | - Krithika Suresh
- University of Colorado Anschutz Medical Campus, Aurora, Colorado (R.L.J., C.G., C.E.K., K.S.)
| | - Deborah Azrael
- Harvard School of Public Health, Boston, Massachusetts (D.A.)
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21
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Pallin R, Charbonneau A, Wintemute GJ, Kravitz-Wirtz N. California Public Opinion On Health Professionals Talking With Patients About Firearms. Health Aff (Millwood) 2020; 38:1744-1751. [PMID: 31589535 DOI: 10.1377/hlthaff.2019.00602] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medical and public health organizations have recommended that health professionals discuss firearm safety with patients at risk for gun-related injury, yet few health professionals do so. Concerns that patients may view conversations about firearms as inappropriate have been reported in prior studies. Using state-representative data from the 2018 California Safety and Wellbeing Survey, this study found that most Californians report gun safety conversations with health professionals to be at least sometimes appropriate when these conversations involved a patient who had a known risk factor for firearm-related harm (depending on the risk factor, 83.7-90.2 percent among all respondents and 70.0-91.2 percent among firearm owners). Majorities of respondents also found intervention by health professionals for those at imminent risk to be at least sometimes appropriate (depending on the intervention, 84.0-89.9 percent among all respondents and 82.6-91.0 percent among firearm owners). These findings can inform health policy and education on clinical strategies for preventing firearm-related harm.
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Affiliation(s)
- Rocco Pallin
- Rocco Pallin ( rspallin@ucdavis. edu ) is a research data analyst in the Violence Prevention Research Program, Department of Emergency Medicine, University of California (UC) Davis School of Medicine, in Sacramento
| | - Amanda Charbonneau
- Amanda Charbonneau is a postdoctoral fellow in the Violence Prevention Research Program
| | - Garen J Wintemute
- Garen J. Wintemute is the Baker-Teret Chair in Violence Prevention and a professor of emergency medicine at UC Davis. He directs the Violence Prevention Research Program and the University of California Firearm Violence Research Center
| | - Nicole Kravitz-Wirtz
- Nicole Kravitz-Wirtz is a professional researcher in the Violence Prevention Research Program
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22
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23
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Affiliation(s)
- Erin R Morgan
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
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24
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Betz ME, Azrael D, Johnson RL, Knoepke CE, Ranney ML, Wintemute GJ, Matlock D, Suresh K, Miller M. Views on Firearm Safety Among Caregivers of People With Alzheimer Disease and Related Dementias. JAMA Netw Open 2020; 3:e207756. [PMID: 32667652 PMCID: PMC7364369 DOI: 10.1001/jamanetworkopen.2020.7756] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE The population of adults with Alzheimer disease and related dementias (ADRD) is increasing, and many people with ADRD have access to firearms. Little is known, however, about how caregivers of people with ADRD think about or address firearm safety. OBJECTIVE To assess views on firearm safety risks among caregivers of persons with ADRD, experiences of caregivers with health care professional-delivered counseling, and their preferred sources of information about firearm safety. DESIGN, SETTING, AND PARTICIPANTS This survey study used a probability-based online survey (National Firearms Survey, July 30 to August 11, 2019) with weights used to generate nationally representative estimates of adults living in households with firearms to assess firearm safety views of English-speaking adults 35 years or older. Respondents for the National Firearm Survery were drawn from I KnowledgePanel, a frame with approximately 55 000 US adults selected on an ongoing basis using address-based sampling methods. MAIN OUTCOMES AND MEASURES Caregivers were asked whether the person with ADRD owned or had access to firearms. Additional ADRD-related measures assessed perceptions about the likelihood of types of firearm injuries involving people with ADRD, support for firearm safety counseling by health care professionals with regard to dementia, and history of ever having received such counseling. RESULTS Of 6712 invited panel members, 4030 completed the survey (completion rate, 65%). For this analysis, we excluded the youngest participants (aged 18-34 years; n = 498); among the remaining 3532 participants, 124 reported being caregivers for persons with ADRD. Of the 124 caregivers, 51% were female and the mean (SD) age was 60 (12.5) years. Most participants (71%; 95% CI, 69%-72%) thought that a person with ADRD was more likely to hurt someone else unintentionally than intentionally hurt themselves or someone else. Many participants thought health care professionals should always (45%; 95% CI, 43%-47%) or sometimes (34%; 95% CI, 32%-37%) talk about firearm safety with caregivers or patients with dementia, but only 5% of caregivers (95% CI, 2%-12%) reported that a health care professional had ever spoken to them about firearm safety. Among the 41% (95% CI, 31%-51%) of caregivers who lived with a person with dementia, 31% (95% CI, 18%-49%) said the person with dementia could access firearms in the home. CONCLUSIONS AND RELEVANCE In this study, few caregivers of adults with ADRD reported having received health care professional counseling about firearm safety, although most thought health care professionals should provide such counseling. These findings raise concerns about home firearm access among adults with ADRD and indicate potential opportunities for enhanced education by health care professionals and community organizations.
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Affiliation(s)
- Marian E. Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts
| | - Rachel L. Johnson
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Christopher E. Knoepke
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus
| | - Megan L. Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Garen J Wintemute
- Department of Emergency Medicine, University of California, Davis, Sacramento
| | - Daniel Matlock
- Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Krithika Suresh
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
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25
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Doucette ML, Dayton H, Lapidus G, Borrup KT, Campbell BT. Firearms, Dementia, and the Clinician: Development of a Safety Counseling Protocol. J Am Geriatr Soc 2020; 68:2128-2133. [PMID: 32356587 DOI: 10.1111/jgs.16450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Using available literature, our aim was to design a firearm safety counseling protocol tool for dementia patients. DESIGN We conducted a literature review on firearm safety counseling by healthcare providers using several databases to inform the creation of our evidence-based protocol. SETTING Roughly 5.7 million Americans currently live with some form of dementia with approximately 60% of persons with dementia (PWD) owning a firearm. The mental deterioration associated with dementia creates an opportunity for firearm abuse, misuse, and injury. Patient and family safety counseling from a healthcare provider is one potential opportunity for reducing the level of danger. This literature review identifies the available clinical guidelines for firearm safety for PWD and creates a firearm safety counseling protocol based on existing literature. PARTICIPANTS Persons with dementia and their families or care takers. MEASUREMENTS Databases were searched using variations of the terms "Firearms," "Dementia," and "Alzheimer's disease." Studies were included for review if they provided either recommendations or guidelines for healthcare provider's counseling around firearm safety for PWD or their families. RESULTS Search terms yielded 456 articles, of which 12 met inclusion criteria. Using the available literature, we developed a firearm safety counseling protocol that provides measurable means to assess risk and offer harm mitigation strategies for patients and their families. Mitigation strategies are based on Clinical Dementia Rating scale assessment at time of patient interaction and results of risk assessment. CONCLUSION Providing standardized and effective clinical guidelines to healthcare providers who interact with firearm-owning PWD can act as a means to reduce firearm injury and violence. The protocol proposed in this article needs further testing and validation to determine if it will help reduce firearm-related events in PWD.
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Affiliation(s)
- Mitchell L Doucette
- Department of Health Sciences, Eastern Connecticut State University, Willimantic, Connecticut, USA.,Injury Prevention Center, Connecticut Children's & Hartford Hospital, Hartford, Connecticut, USA
| | - Harrison Dayton
- Department of Health Sciences, Eastern Connecticut State University, Willimantic, Connecticut, USA
| | - Garry Lapidus
- Injury Prevention Center, Connecticut Children's & Hartford Hospital, Hartford, Connecticut, USA.,School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Kevin T Borrup
- Injury Prevention Center, Connecticut Children's & Hartford Hospital, Hartford, Connecticut, USA.,School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Brendan T Campbell
- Injury Prevention Center, Connecticut Children's & Hartford Hospital, Hartford, Connecticut, USA.,School of Medicine, University of Connecticut, Farmington, Connecticut, USA.,Pediatric Surgery, Connecticut Children's Medical Center, Hartford, Connecticut, USA
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26
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Saadi A, Choi KR, Takada S, Zimmerman FJ. The impact of gun violence restraining order laws in the U.S. and firearm suicide among older adults: a longitudinal state-level analysis, 2012-2016. BMC Public Health 2020; 20:334. [PMID: 32252702 PMCID: PMC7137454 DOI: 10.1186/s12889-020-08462-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults complete suicide at a disproportionately higher rate compared to the general population, with firearms the most common means of suicide. State gun laws may be a policy remedy. Less is known about Gun Violence Restricting Order (GVRO) laws, which allow for removal of firearms from people deemed to be a danger to themselves or others, and their effects on suicide rates among older adults. The purpose of this study was to examine the association of state firearm laws with the incidence of firearm, non-firearm-related, and total suicide among older adults, with a focus on GVRO laws. METHODS This is a longitudinal study of US states using data from 2012 to 2016. The outcome variables were firearm, non-firearm and total suicide rates among older adults. Predictor variables were [1] total number of gun laws to assess for impact of overall firearm legislation at the state level, and [2] GVRO laws. RESULTS The total number of firearm laws, as well as GVRO laws, were negatively associated with firearm-related suicide rate among older adults ages 55-64 and > 65 years-old (p < 0.001). There was a small but significant positive association of total number of firearm laws to non-firearm-related suicide rates and a negative association with total suicide rate. GVRO laws were not significantly associated with non-firearm-related suicide and were negatively associated with total suicide rate. CONCLUSION Stricter firearm legislation, as well as GVRO laws, are protective against firearm-relate suicides among older adults.
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Affiliation(s)
- Altaf Saadi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
| | - Kristen R Choi
- University of California Los Angeles School of Nursing, Los Angeles, CA, 90024, USA
| | - Sae Takada
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90024, USA
| | - Fred J Zimmerman
- Department of Health Policy and Management, Fielding School of Public Health University of California, Los Angeles, 90024, USA
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27
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Gondi S, Pomerantz AG, Sacks CA. Extreme Risk Protection Orders: An Opportunity to Improve Gun Violence Prevention Training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1649-1653. [PMID: 31397705 DOI: 10.1097/acm.0000000000002935] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
States are increasingly enacting extreme risk protection order (ERPO) laws, also known as "red flag" or gun violence restraining order laws, as one part of a multidisciplinary approach to address the national gun violence epidemic. Passed into law in more than 10 states and under consideration by legislatures in approximately 30 others, ERPO laws create a legal process to temporarily remove firearms from people who may pose a risk to themselves or others. By enabling family or household members, law enforcement, and, in some cases, health care professionals to petition courts when they are concerned about a potential crisis, these laws can potentially prevent firearm-related violence and save lives. Most states with ERPO laws do not give health care professionals a direct role in filing petitions; still, physicians may serve as a resource for patients or their families by counseling on firearm safety and raising awareness of this legal pathway. In this way, the success of ERPO laws depends, in part, on the ability of physicians to accurately assess risk. However, physicians are often not proficient in making these types of risk assessments, largely because of insufficient training, particularly in the context of firearm-related violence. The authors review the literature on physician skill in violence-related risk assessment, medical education in gun violence prevention, and the capacity for training to improve such risk assessments. The authors then make recommendations for integrating focused gun violence prevention training into undergraduate, graduate, and continuing medical education, reviewing notable examples.
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Affiliation(s)
- Suhas Gondi
- S. Gondi is a third-year medical student, Harvard Medical School, Boston, Massachusetts. A.G. Pomerantz is a third-year medical student, Harvard Medical School, Boston, Massachusetts. C.A. Sacks is physician, Division of General Internal Medicine, Massachusetts General Hospital, and instructor in medicine, Harvard Medical School, Boston, Massachusetts
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28
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Rosen T, Makaroun LK, Conwell Y, Betz M. Violence In Older Adults: Scope, Impact, Challenges, And Strategies For Prevention. Health Aff (Millwood) 2019; 38:1630-1637. [PMID: 31589527 PMCID: PMC7327526 DOI: 10.1377/hlthaff.2019.00577] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although often perceived to be a problem of the young, violence commonly affects older adults, a rapidly growing segment of the population. Violence can be directed toward older adults (elder abuse and intimate partner violence), self-directed (suicide), or perpetrated by older adults against others (intimate partner violence and violence in dementia). Across forms of violence, firearm access increases lethality, and veterans may be a particularly high-risk population. The forms of violence in older adults have some common risk factors (such as medical or psychiatric illness) and common challenges for prevention (such as balancing autonomy and well-being in vulnerable adults). The integration of prevention strategies across the life span, disciplines, and forms of violence offers promise for promoting older adult health and well-being. Looking forward, key areas for attention will include raising awareness about these topics and prioritizing funding for the implementation and evaluation of violence prevention interventions in health care settings and the community.
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Affiliation(s)
- Tony Rosen
- Tony Rosen is an assistant professor of emergency medicine at Weill Cornell Medical College, in New York City
| | - Lena K Makaroun
- Lena K. Makaroun is a research fellow in the Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, in Pennsylvania
| | - Yeates Conwell
- Yeates Conwell is a professor in the Department of Psychiatry, University of Rochester Medical Center, in New York
| | - Marian Betz
- Marian Betz ( Marian. Betz@ucdenver. edu ) is an associate professor of emergency medicine at the University of Colorado School of Medicine and a research physician at the Eastern Colorado VA Geriatric Research Education and Clinical Center, both in Aurora
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29
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Betz ME, Ranney ML, Knoepke CE, Johnson RL, Pallin R, Miller M, Wintemute GJ. Dementia and Firearms: an Exploratory Survey of Caregiver Needs. J Gen Intern Med 2019; 34:1984-1986. [PMID: 31197733 PMCID: PMC6816792 DOI: 10.1007/s11606-019-05089-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E 17th Ave B215, Aurora, CO, 80045, USA.
| | - Megan L Ranney
- Department of Emergency Medicine, Rhode Island Hospital/Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Rachel L Johnson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Rocco Pallin
- Violence Prevention Research Program, Department of Emergency Medicine, Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Matthew Miller
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, 02115, USA
| | - Garen J Wintemute
- Violence Prevention Research Program, Department of Emergency Medicine, Davis School of Medicine, University of California, Sacramento, CA, USA
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30
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Morgan ER, Gomez A, Rivara FP, Rowhani-Rahbar A. Household Firearm Ownership and Storage, Suicide Risk Factors, and Memory Loss Among Older Adults: Results From a Statewide Survey. Ann Intern Med 2019; 171:220-222. [PMID: 30986820 DOI: 10.7326/m18-3698] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Erin R Morgan
- University of Washington, Seattle, Washington (E.R.M., F.P.R., A.R.)
| | - Anthony Gomez
- Public Health-Seattle & King County and University of Washington, Seattle, Washington (A.G.)
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31
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Holt SR, Rosenbaum J, Ellman M, Doolittle B, Tobin DG. Physicians Should Play a Role in Ensuring Safe Firearm Ownership. J Gen Intern Med 2019; 34:1637-1640. [PMID: 31062224 PMCID: PMC6667526 DOI: 10.1007/s11606-019-05034-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 02/05/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
The USA is unique among industrialized nations in its dramatic rate of firearm violence. Unfortunately, firearm-related issues in America are politically divisive and fraught with controversy, thus impeding the study and implementation of safety strategies. Despite the lack of consensus, there is agreement that firearms should be kept away from individuals with criminal intent and those who are dangerous due to medical impairment. While predicting criminal intent remains challenging, assessment of medical impairment remains a viable target. One approach in which physicians could contribute their expertise includes training a subset of doctors to perform specialized medical evaluations as a prerequisite for gun ownership. Such a process is not unprecedented, as physicians currently have a role in protecting the public's safety through assessments for commercial drivers, pilots, and train operators. Certified physician examiners could conduct these evaluations with a focus on evaluating objective, skill-based metrics to limit potential evaluator bias. The results of the medical evaluation would then be considered by an existing regulatory body to determine if disqualifying criteria are present. This proposal provides a mechanism for trained physicians to meaningfully participate in addressing an alarming public health issue, while still working within existing legal frameworks.
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Affiliation(s)
- Stephen R Holt
- Yale University School of Medicine, 1450 Chapel Street, Rm P-312, New Haven, CT, USA.
| | - Julie Rosenbaum
- Yale University School of Medicine, 1450 Chapel Street, Rm P-312, New Haven, CT, USA
| | - Matthew Ellman
- Yale University School of Medicine, 1450 Chapel Street, Rm P-312, New Haven, CT, USA
| | - Benjamin Doolittle
- Yale University School of Medicine, 1450 Chapel Street, Rm P-312, New Haven, CT, USA
| | - Daniel G Tobin
- Yale University School of Medicine, 1450 Chapel Street, Rm P-312, New Haven, CT, USA
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32
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Shepard MD, Perepezko K, Broen MPG, Hinkle JT, Butala A, Mills KA, Nanavati J, Fischer NM, Nestadt P, Pontone G. Suicide in Parkinson's disease. J Neurol Neurosurg Psychiatry 2019; 90:822-829. [PMID: 30661029 PMCID: PMC7187903 DOI: 10.1136/jnnp-2018-319815] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/24/2018] [Accepted: 12/27/2018] [Indexed: 01/22/2023]
Abstract
Persons with Parkinson's disease (PwP) have many known risk factors for suicide and suicidal ideation (SI). Despite this, there is limited understanding of suicidality in this population. We conducted a systematic review to synthesise the available literature on suicidality in PwP and highlight areas for potential intervention and further research. We identified 116 articles discussing SI, suicidal behaviours, suicide attempts and/or fatal suicide in PwP. These articles describe prevalence, suicide methods, risk factors for suicide and SI and treatment of suicidality. In this review, we summarise the current literature and provide suggestions for how clinicians can identify and treat PwP who are at risk for suicide, for example, through aggressive treatment of depression and improved screening for access to lethal means.
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Affiliation(s)
- Melissa Deanna Shepard
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kate Perepezko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Martijn P G Broen
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jared Thomas Hinkle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ankur Butala
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly A Mills
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Morris K. Udall Parkinson's Disease Research Center of Excellence, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie Nanavati
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole Mercado Fischer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gregory Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Morris K. Udall Parkinson's Disease Research Center of Excellence, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Pallin R, Spitzer SA, Ranney ML, Betz ME, Wintemute GJ. Preventing Firearm-Related Death and Injury. Ann Intern Med 2019; 170:ITC81-ITC96. [PMID: 31158880 DOI: 10.7326/aitc201906040] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deaths and injuries from firearms are significant public health problems, and clinicians are in a unique position to identify risk among their patients and discuss the importance of safe firearm practices. Although clinicians may be ill-prepared to engage in such discussions, an adequate body of evidence is available for support, and patients are generally receptive to this type of discussion with their physician. Here, we provide an overview of existing research and recommended strategies for counseling and intervention to reduce firearm-related death and injury.
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Affiliation(s)
- Rocco Pallin
- University of California Davis School of Medicine, Sacramento, California (R.P., G.J.W.)
| | | | - Megan L Ranney
- Alpert Medical School, Brown University, Providence, Rhode Island (M.L.R.)
| | - Marian E Betz
- University of Colorado School of Medicine, Aurora, Colorado (M.E.B.)
| | - Garen J Wintemute
- University of California Davis School of Medicine, Sacramento, California (R.P., G.J.W.)
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34
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Taichman D, Bornstein SS, Laine C. Firearm Injury Prevention: AFFIRMing That Doctors Are in Our Lane. Ann Intern Med 2018; 169:885-886. [PMID: 30458522 DOI: 10.7326/m18-3207] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Sue S Bornstein
- Chair, Health and Public Policy Committee, American College of Physicians (S.S.B.)
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35
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Ertle AR. Firearms and Dementia. Ann Intern Med 2018; 169:739-740. [PMID: 30452571 DOI: 10.7326/l18-0522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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