The Effect of the “Safety in Dementia” Online Tool to Assist Decision Making for Caregivers of Persons With Dementia and Access to Firearms

Abstract

Background: Caregivers face challenges (including competing desires to prevent injury, respect autonomy, and avoid conflict) when addressing firearm access by community-dwelling persons with Alzheimer disease and related dementias (ADRD). Objective: To test the effect of the online Safety in Dementia (SiD) decision aid on caregivers’ decision making about firearm access for people with ADRD. Design: Prospective 2-group randomized trial with longitudinal follow-up. (ClinicalTrials.gov: NCT05173922) Setting: United States. Participants: English- or Spanish-speaking caregivers (aged ≥18 years) of community-dwelling adults with ADRD and firearm access. Intervention: SiD versus a web-based information control. Measurements: The primary outcome was preparation for decision making about firearm access. The secondary outcome at follow-up was self-reported action to reduce access. Results: Among 500 participants enrolled between June 2022 and February 2024, the mean age was 47 years, 69% identified as female, half were the adult child or stepchild of the person with ADRD, and 99% chose study participation in English. Participant characteristics were similar by study group. For the primary outcome, SiD significantly increased preparation for decision making versus the control (69.8 vs. 64.8 out of 100; mean difference, 4.80 [95% CI, 0.53 to 9.07]; P ¼ 0.024). There was no significant effect on actions to reduce firearm access at 2 weeks or 2 months. Limitation: The results may not be generalizable to non–English-speaking populations. Conclusion: The online SiD decision aid increased preparation for decision making about firearm access in this sample of ADRD caregivers in the United States. Use of such resources in clinical or community settings may support caregivers and people with ADRD in avoiding firearm injury or death.