“痴呆症安全”在线工具对痴呆症患者照料者决策及获取枪支的影响：一项随机试验

The Effect of the "Safety in Dementia" Online Tool to Assist Decision Making for Caregivers of Persons With Dementia and Access to Firearms : A Randomized Trial.

作者信息

Betz Marian E, Portz Jennifer, Knoepke Christopher, Ranney Megan L, Fischer Stacy M, Peterson Ryan A, Johnson Rachel L, Omeragic Faris, Castaneda Mirella, Greenway Emily, Matlock Daniel

机构信息

Department of Emergency Medicine and Firearm Injury Prevention Initiative, University of Colorado School of Medicine, and VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (M.E.B.).

Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado (J.P.).

出版信息

Ann Intern Med. 2024 Dec;177(12):1630-1640. doi: 10.7326/ANNALS-24-00763. Epub 2024 Oct 22.

DOI:10.7326/ANNALS-24-00763

PMID:39531391

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]; = 0.024). There was no significant effect on actions to reduce firearm access at 2 weeks or 2 months.

LIMITATION

The results may not be generalizable to non-English-speaking populations.

CONCLUSION

The online SiD decision aid increased preparation for decision making about firearm access in this sample of ADRD caregivers in the United States. Use of such resources in clinical or community settings may support caregivers and people with ADRD in avoiding firearm injury or death.

PRIMARY FUNDING SOURCE

National Institute on Aging, National Institutes of Health.

摘要

背景

在处理社区居住的阿尔茨海默病及相关痴呆症（ADRD）患者的枪支获取问题时，护理人员面临诸多挑战（包括防止受伤、尊重自主权和避免冲突等相互矛盾的愿望）。

目的

测试在线痴呆症安全（SiD）决策辅助工具对护理人员关于ADRD患者枪支获取决策的影响。

设计

前瞻性两组随机试验，并进行纵向随访。（ClinicalTrials.gov：NCT05173922）。

地点

美国。

参与者

有ADRD且能接触到枪支的社区居住成年人的英语或西班牙语护理人员（年龄≥18岁）。

干预措施

SiD与基于网络的信息对照。

测量指标

主要结局是对枪支获取决策的准备情况。随访时的次要结局是自我报告的减少获取的行动。

结果

在2022年6月至2024年2月招募的500名参与者中，平均年龄为47岁，69%为女性，一半是ADRD患者的成年子女或继子女，99%选择用英语参与研究。各研究组的参与者特征相似。对于主要结局，与对照组相比，SiD显著提高了决策准备（100分制中分别为69.8分和64.8分；平均差值，4.80[95%CI，0.53至9.07]；P = 0.024）。在2周或2个月时，对减少枪支获取的行动没有显著影响。