Shared Decision-Making for Firearm Safety among Older Adults with early changes associated with Alzheimer’s Disease/Alzheimer’s Disease-Related Dementias (AD/ADRD)

老年人中普遍存在的某些疾病，包括与阿尔茨海默病和阿尔茨海默病相关痴呆症（AD/ADRD）相关的早期认知变化，使他们处于枪支自杀的高风险之中。这些患者中枪支拥有率的增加通常在临床实践中没有得到解决，尽管相关医学协会建议这样做。如何储存枪支以及何时放弃枪支是一个最好在晚期损伤之前在初级保健中做出的决定，此时患者能够参与决策，陈述偏好并理解替代方案。老年人通常希望主要参与关于他们自己的治疗和护理的决策，以人为本的方法将需要它。共享决策（SDM）将患者的知情偏好集成到与首席临床医生的决策过程中。SDM特别适用于枪支决策，因为枪支和身份的交织，以及枪支作为老年人枪支拥有者的安全手段和独立标志。据估计，40%至60%的老年人，包括那些有记忆问题的人，要么拥有枪支，要么在家里生活。超过一半的自杀涉及使用枪支，这是一种高度致命的方法，死亡率高达90%。目前没有针对早期AD/ADRD和/或抑郁症患者的决策辅助工具，以帮助与主要提供者在初级保健环境中共同决策，以鼓励更安全的枪支储存。在这一分阶段创新提案中，我们将与华盛顿、怀俄明州、阿拉斯加、蒙大拿州和爱达荷州[WWAMI]实践与研究网络（WPRN）合作，完善和测试SDM视频决策辅助。在渥太华决策支持框架和模糊痕迹理论的指导下，在目标1中，我们将对患者和领先的临床提供者进行关键的线人访谈，以完善和完成基于ODSF的视频决策辅助，使用同伴叙述来帮助老年人做出更安全的枪支存储决策。在目标2中，我们将评估的可行性，可接受性，并产生一个效应量估计使用的视频决策辅助早期AD/ADRD和/或抑郁症的人在三个WPRN初级保健诊所。如果我们成功实现了我们的过渡里程碑，我们将在一项双臂全面随机对照试验中测试干预措施，以测试视频决策辅助对Aim 3（R33阶段）更安全的枪支储存的影响。我们假设，这种工具将提高早期AD/ADRD和/或抑郁症患者的枪支安全储存。通过跨学科的专家团队，我们的目标遵循行为改变干预发展的NIH阶段的第1阶段（R21）和第2阶段（R33）。

Certain conditions, prevalent among older adults, including early cognitive changes associated with Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias (AD/ADRD), place them at high-risk for firearm suicide. The increased rate of firearm ownership among these patients is typically not addressed in clinical practice despite recommendations to do so f from relevant medical societies. How to store firearms and when to relinquish them is a decision that is best made in primary care prior to advanced impairment, when patients are able to participate in decision- making, state preferences, and comprehend alternatives. Older adults often want to be primarily involved in decision-making about their own treatment and care and a person-centered approach would require it. Shared Decision Making (SDM) integrates the patient’s informed preferences into the decision-making process with the leading clinician. SDM is especially appropriate for firearm decisions due to the enmeshment of firearm and identity, and firearm as means for safety and sign of independence among older adult firearm owners. Estimates suggest that between 40-60% of older adults, including those with memory problems, either own a firearm or live with one in the home. Over half of all suicides involve the use of a firearm, a highly lethal method, with up to 90% mortality. There are currently no decision aids targeted to the person with early AD/ADRD and/or depression to assist in shared decision making in a primary care context with the leading provider, to encourage safer firearm storage. In this phased innovation proposal, we will partner with the Washington, Wyoming, Alaska, Montana, and Idaho [WWAMI] Practice and Research Network (WPRN) to refine and test an SDM video decision aid. Guided by the Ottawa Decision Support Framework and Fuzzy Trace Theory, in Aim 1 we will conduct key informant interviews of patients and leading clinical providers to refine and finalize an ODSF-based video decision aid using peer narratives to help older adults make decisions on safer firearm storage. In Aim 2 we will evaluate the feasibility, acceptability, and generate an effect size estimate for use of the video decision aid among persons with early AD/ADRD and/or depression in three WPRN primary care clinics. Provided we successfully achieve our transition milestones, we will test the intervention in a two-arm full-scale randomized controlled trial to test the impact of a video decision aid on safer firearm storage in Aim 3 (R33 phase). We hypothesize that this tool will improve firearm safe storage among persons with early AD/ADRD and/or depression. Engaging an interdisciplinary team of experts, our Aims follow Stage 1 (R21) and Stage 2 (R33) of the NIH stages of Behavioral Changes Intervention Development.