"Safety in Dementia": An Online Caregiver Intervention.

项目总结 阿尔茨海默病和相关痴呆(ADRD)带来的认知和行为变化可能 增加受伤或死亡的风险，包括枪支造成的伤害或死亡。自杀是枪支造成的主要伤害风险 患有ADRD的人，但与ADRD相关的困惑或偏执可能会将其他人置于危险之中。在美国，一个 据估计，33%-60%的ADRD患者在家中有枪支，38%的ADRD照顾者认为 将枪支作为一个需要解决的问题。然而，人们很少与ADRD患者或护理人员讨论枪支安全问题， 让一些ADRD的照顾者没有关于何时以及如何解决这个敏感话题的指导。至 为了解决这个问题，我们为非正式照顾者开发了《痴呆症中的安全》(SID)，以解决枪支安全问题 (R34MH113539-NIA Suppl)基于理论和开发的国际标准，SID是一个在线 帮助照顾者澄清价值观和偏好，然后致力于实施他们的 首选选项。SID在小型试点试验中具有很高的可接受性，我们假设SID将增加非正式 护理者的准备和自我效能，以制定和实施有效解决枪支问题的决定 进入，从而降低受伤风险。在三年的时间里，我们的多学科、成熟的研究团队 将进行全国招募和纵向跟踪的SID在线随机试验， 招募非正式照顾者，照顾有枪支通道的社区成年人。穿过 本次试验和与利益相关者的定性访谈，我们的目的是：(1)测试SID在枪支安全方面的有效性 全国非正式照顾者样本的决策质量和行为；(2)比较不同的方法 (社交媒体/互联网与相关组织)接触非正式照顾者；以及(3)探索 利益相关者在SID和枪支相关决策方面的纵向经验，包括以下建议 最佳SID使用。我们的基本假设是，SID将与更高的即期显著相关 决策质量和减少获得枪支的后续行动，照顾者人数将因情况而异 联系方式(社交媒体/互联网与相关组织)。拟议的研究将满足 迫切需要有效、可接受的工具，以帮助照顾者在ADRD的背景下解决枪支获取问题， 从而有助于减少枪伤和死亡，同时尊重和促进老年人的独立， 自主性和权利。美国人口老龄化突显了这些问题的紧迫性，我们的 拟议的工作将为未来实施和评估人- 以现实世界环境中的工具为中心，包括通过增强对达到和 引人入胜的照顾者。

PROJECT SUMMARY Cognitive and behavioral changes that come with Alzheimer's Disease and related dementias (ADRD) can increase the risk of injury or death, including from firearms. Suicide is the primary injury risk from firearms for people with ADRD, but ADRD-related confusion or paranoia can put others at risk. In the United States, an estimated 33-60% of people with ADRD have a firearm in the home, and 38% of ADRD caregivers identify firearms as an issue to address. Yet firearm safety is rarely discussed with ADRD patients or caregivers, leaving some ADRD caregivers without guidance about when and how to address the sensitive topic. To address this gap, we developed “Safety in Dementia” (SiD) for informal caregivers to address firearm safety (R34MH113539-NIA suppl). Based on theory and international standards for development, SiD is an online decision aid that helps caregivers clarify values and preferences and then commit to implementing their preferred options. SiD had high acceptability in a small pilot trial, and we hypothesize SiD will increase informal caregivers' preparation and self-efficacy to make and implement decisions that effectively address firearm access, thereby reducing injury risk. Overa three-year period,our multi-disciplinary, established study team will conduct an online randomized trial of SiD with national recruitment and longitudinal follow-up, with recruitment of informal caregivers of community-dwelling adults with ADRD who have firearm access. Through this trial and qualitative interviews with stakeholders, we aim to: (1) test the efficacy of SiD on firearm safety decision quality and behaviors among a national sample of informal caregivers; (2) compare varied methods (social media/internet versus via relevant organizations) in reaching informal caregivers; and (3) explore stakeholder longitudinal experiences with SiD and firearm-related decisions, including recommendations for optimal SiD use. Our underlying hypotheses are that SiD will be significantly associated with higher immediate decision quality and subsequent action to reduce firearm access, and that caregiver populations will vary by method of contact (social media/internet versus relevant organizations). The proposed research will meet a critical need for effective, acceptable tools to help caregivers address firearm access in the context of ADRD, thereby helping reduce firearm injuries and deaths while respecting and promoting older adult independence, autonomy, and rights. The aging of the U.S. population underscores the urgency of these issues, and our proposed work will provide the scientific foundation for future implementation and evaluation of person- centered tools in real-world settings, including through enhanced understanding of methods for reaching and engaging caregivers.