27 Sep ITHS WPRN Partners with UW Investigators on Firearm Injury Prevention Study
The ITHS Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI)Practice and Research Network (WPRN) is partnering with Dr. Laura Prater from the Harborview Injury Prevention and Research Center and the Department of Psychiatry & Behavioral Services and Dr. Elizabeth Phelan from the University of Washington’s (UW) Department of Medicine, Division of Gerontology and Geriatric Medicine and the Department of Health Systems and Population Health, UW School of Public Health on a new NIH-funded study titled “Shared Decision-Making for Firearm Safety among Older Adults with early changes associated with Alzheimer’s Disease/Alzheimer’s Disease-Related Dementias (AD/ADRD).”
This study aims to engage primary care providers and patients to develop and test a shared-decision making tool designed to help older adult patients with early signs of AD/ADRD and/or depression, care partners and primary care providers make decisions about firearm storage and access.
“Suicide is the tenth leading cause of death in the United States and over half of suicides involve the use of a firearm. The risk of firearm suicide is highest for people over the age of 55 and has increased by 23% since 2000,” shared Dr. Prater. Estimates suggest that 40-60% of older adults, including those with cognitive impairment and depression, either own a firearm or live with one in the home. “How to store firearms and when to relinquish them is a decision that may be best made in a primary care setting where major suicide risk factors may be detected like cognitive impairment, and depression,” Dr. Phelan added.
Suicide is the tenth leading cause of death in the United States and over half of suicides involve the use of a firearm
Studies show that older adults with dementia and/or depression want to be involved in making decisions about their lives and feel they should serve as primary decision-makers. Shared decision-making tools help people think about choices they face, and are especially appropriate for firearm decisions. There are currently no shared decision-making tools for safe firearm storage centered on the older adult with mild cognitive impairment/early dementia and/or depression for use with their primary care physician.
We asked Dr. Prater how this study came about. “I have a background in health services research and had done some work on advance care planning interventions for improved quality outcomes at the end of life. I was also nurturing an interest in firearm suicide. I started to feel like the two topics were related and, much like advance care planning, should happen early in primary care,” shared Dr. Prater.
Dr. Phelan is a board-certified physician specializing in geriatric medicine. With her expertise in injury prevention, geriatric syndromes, and pragmatic clinical trials testing health systems interventions designed to improve primary care of older adults, she and Dr. Prater were able to further develop the idea into a potentially impactful clinical trial to improve safe firearm storage. “With NIH’s new funding for firearm research, it became the perfect time to further develop this idea and partner with the WPRN to test and diffuse our innovation” Dr. Phelan said.
The study is partnering with WPRN for its geographically diverse network of primary care practices with clinics in regions where firearm ownership and suicide rates are both high, making it an ideal setting for this intervention
“The study is partnering with WPRN for its geographically diverse network of primary care practices with clinics in regions where firearm ownership and suicide rates are both high, making it an ideal setting for this intervention,” said Dr. Allison Cole, Director of WPRN.
The WPRN and ITHS Community Engagement program foster collaborative partnerships with primary care practices, ensuring that the intervention will incorporate the needs and preferences of diverse patients and clinicians and help support dissemination of an effective intervention in the future. “Getting to work with the WPRN leadership and staff as well as clinics that are highly motivated to participate in research made it even more appealing,” Dr. Prater told us.
“This study addresses a critical and understudied topic in primary care settings: how to have patient-centered discussions about safe storage and relinquishment of firearms with older adults at high risk for firearm suicide,” Dr. Cole explained.
This study addresses a critical and understudied topic in primary care settings: how to have patient-centered discussions about safe storage and relinquishment of firearms with older adults at high risk for firearm suicide
In this phased innovation proposal, Drs. Prater and Phelan will partner with the WPRN to refine and test a shared decision-making video aid. This project is a great example of ITHS collaboration that supports research with older adults (research across the lifespan) and collaboration with rural communities to address a critical public health priority.
“We hypothesize that this tool will improve firearm safe storage among persons with mild cognitive impairment/early dementia and/or depression,” shared Dr. Phelan. “I believe this intervention, as planned, is very promising and has the potential to address a critical public health problem,” shared Dr. Prater.