Provider Perspectives on Addressing Firearm Safety with Older Adults in Primary Care

ABSTRACT

Objectives

Chronic conditions, including mild cognitive impairment and depression, place older adults at high risk of firearm suicide. Approximately 40% of older adults have access to a firearm, and many do not store their firearms safely. However, firearm counseling occurs infrequently in clinical settings. Using by the Ottawa Decision Support Framework (ODSF) to conceptualize the decisional support needed by patients and their providers to facilitate firearm counseling, we explore provider perspectives on desired resources for addressing firearm safety with older adult patients.

Methods

From March – August 2022, we conducted 21 semi-structured interviews with primary care providers caring for older adults. We report deductive concepts as well as emergent themes.

Results

Major themes were identified from the three components of the ODSF; decisional needs, decision support and decisional outcomes. Themes included: provider self-efficacy to conduct firearm counseling, clinical workflow considerations, stories for change, patient diagnosis implications, and caregiver involvement.

Conclusions

There is a need for decision aids in the clinical setting that facilitate firearm counseling and promotes shared decision-making about firearm storage.

Clinical Implications

Implementing a decision aid in the clinical setting can improve provider self-efficacy to conduct firearm counseling and help reduce risk factors associated with firearm-related harm among older adults.

KEYWORDS:

• Firearm safety
• older adults
• primary care

Acknowledgments

The authors would like to thank Lauren Rooney for assisting with the project management.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials.

Clinical Implications

• A decision aid should be developed and implemented within the primary care setting to assist providers in facilitating firearm counseling with older adult patients.

• The decision aid should include information and resources that increase provider knowledge of firearm storage devices and firearm types, while also providing additional guidance on how best to facilitate firearm counseling through conversation starters or discussion prompts.

• Older adults with MCI and/or depression are at greater risk for firearm-related harm and should be a priority focus of firearm counseling when utilizing the decision aids in the primary care setting.

Additional information

Funding

This work is ongoing and is supported by the National Institute on Aging (1R21AG076362-01) and the American Foundation for Suicide Prevention (YIG-0-151-20). This project was supported in part by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1 TR002319.