New tool assists caregiver decision making about firearms for dementia patients
Caregivers who used the Safety in Dementia decision aid felt more prepared to make decisions about firearms access for patients with Alzheimer's disease than those given a control resource, although there was no significant change in patients' access to firearms, a trial found.
An online tool increased caregivers' preparation for decision making about firearms access for community-dwelling persons with Alzheimer's disease and related dementias (ADRD), a randomized trial found.
The prospective randomized trial included 500 caregivers between June 2022 and February 2024 and compared the Safety in Dementia (SiD) decision aid with the National Institute on Aging Home Safety Checklist for Alzheimer's Disease Website, which served as a control. The SiD was developed with partners in the firearms community and includes sections on firearms safety, driving safety, and general home hazards, the researchers explained. The primary outcome was caregivers' reported preparation for decision making about firearms access, and the secondary outcome was self-reported action to reduce access after two weeks and two months of follow-up.
The mean participant age was 47 years, 69% were female, and half were the adult child or stepchild of the person with ADRD. English- and Spanish-speaking caregivers were eligible for inclusion; 99% chose study participation in English. All ADRD patients lived in a private home, and caregivers did not need to live in the same home or geographic location as the patient to participant. Findings were published by Annals of Internal Medicine on Oct. 22.
After receiving the intervention (n=251) or control checklist (n=249), participants filled out the Preparation for Decision Making scale. Scores range from 0 to 100 with higher scores conferring a higher level of perceived preparation for decision making. Use of the SiD significantly increased preparation for decision making versus the control (score, 69.8 vs. 64.8; mean difference, 4.80 [95% CI, 0.53 to 9.07]; P=0.024). Researchers found no significant effect on actions to reduce firearms access at either follow-up timepoint.
When caregivers were asked about dementia severity and behaviors in patients with ADRD, 40.6% reported that patients expressed hopelessness, 39.1% that they felt a sense of being worthless or a burden, and 11.6% that they threatened self-harm. Of the patients who owned a firearm, caregivers reported that 50.2% owned between two and five firearms. Twenty percent of caregivers reported that at least one of the firearms was stored unlocked and loaded.
“The SiD decision aid improved caregiver preparation for decision making, especially in caregivers with lower levels of preparedness, but had no significant effect on caregivers' self-reported action to reduce access at short-term follow-up,” the authors wrote. The tool is available online for free public use in English and Spanish and “may support caregivers in difficult decisions and thereby help prevent firearm injury and death,” they concluded.