1. In this randomized controlled trial involving caregivers for people with Alzheimer’s disease and related dementias, the use of the Safety in Dementia program increased preparation for decision-making about firearm access.

2. No effect was observed on caregivers’ self-reported action to reduce firearm access during study follow-up.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Alzheimer’s disease and related dementias (ADRD) affect more than one-tenth of the adult population aged 65 years or older. Most of these individuals have access to support from family members, but these informal caregivers often lack the resources to navigate complex circumstances surrounding issues such as safety and long-term medical planning. With the high prevalence of firearm ownership in the United States, firearm access is a common topic of concern, especially in the context of behavioral changes that can accompany dementia. This study was designed to assess the efficacy of the previously developed Safety in Dementia (SiD) online program, which provides information regarding firearm safety and general home hazards, on caregiver decision-making preparedness. The use of the SiD decision aid was found to help prepare the caregivers for making decisions, specifically related to the access and use of firearms. However, the aid did not significantly affect action taken by the caregivers to reduce firearm access in the short term. The study included Spanish and English speakers; however, few Spanish speakers participated, thus making it difficult to generalize the results to non-English speakers. Further, nearly half of participants had already taken action to reduce firearm access at the baseline visit, which may have reduced the apparent effect of the intervention. Regardless, this randomized controlled trial suggests that decision-making aids for caregivers of people with ADRD may increase confidence in making difficult decisions regarding firearms.

Click here to read the study in AIM

Relevant Reading: A web-based decision aid for caregivers of persons with dementia with firearm access (safe at home study): Protocol for a randomized controlled trial

In-Depth [randomized controlled trial]: This prospective randomized controlled trial involved adult individuals who were fluent in English or Spanish, lived in the United States, had internet access, and cared for an individual with ADRD with firearm access. Recruitment was accomplished through several methods including social media postings, paid influencer posts, and dementia-, firearm-, or aging-related organization postings. Participants were randomly assigned to either the SiD or control group in a 1:1 ratio. A total of 500 participants were enrolled (mean age, 47.0 years [SD, 15.0; range, 19-86 years]), with the majority being (68.7%) female and non-Hispanic (90.7%). At baseline, participants commonly reported behaviors concerning for suicide or violence risk including feelings of hopelessness (40.6%), feelings of worthlessness (39.1%), verbal aggression (41.5%), and threatening to hurt others (11.9%). Firearm ownership rates were high in both the caregivers (47.5%) and the persons with ADRD (67.7%). Participants in the SiD group scored higher on the Preparation for Decision Making scale (64.8 vs. 69.8 out of 100; mean difference, 4.80 [95% CI, 0.53 to 9.07]; P = 0.024) as compared to the control group. Regarding action, 46.5% of caregivers reported that they had previously taken steps to reduce the firearm access of the ADRD person in their care. This proportion increased at 2 weeks and 2 months follow-up; however, the between-group differences were not significant. These results demonstrated that decision aids may increase preparation for decision-making among caregivers of individuals with ADRD.

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