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.

PROJECT NARRATIVE Deciding when and how to reduce firearm access for a person with Alzheimer's Disease and related dementias (ADRD) is one of the most emotional and difficult issues informal caregivers face – yet it is one that many caregivers must address, given the prevalence of firearms in the homes of community dwelling people with ADRD. The online “Safety in Dementia” decision aid provides caregivers with respectful, practical assistance in working through the decision, thereby helping them take action to reduce firearm access and prevent unintentional or intentional injuries. Through this multi-disciplinary proposal, we will test “Safety in Dementia” in an online, nationwide trial with a diverse sample of caregivers, thereby improving our understanding of both the decision aid's effects and how to use various methods to reach and engage caregivers.