Dementia and Guns: A Dangerous Duo

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When an older relative’s failing cognitive or physical abilities begin to affect his or her driving skills, you know it’s time to have a heart-to-heart talk about giving up the car keys to protect your loved one—and others—from harm. But do you know to have a similar talk with a relative whose mental or physical state is declining about giving up his or her guns?

Individuals ages 65 and older have three significant risk factors that increase their chances of firearm injury, according to a study published in December 2018 in The Journal of the American Osteopathic Association:

  1. They have the highest rates of gun ownership.
  2. They have the highest rates of suicide.
  3. They have the highest prevalence of depression.

Some other factors that put people at increased risk for injury or death include cognitive impairment, recent or complicated bereavement, the presence of multiple other health conditions or a life-limiting condition, a serious and poorly controlled mental illness, post-traumatic stress disorder, male gender, a history of substance use disorder, and a history of violence or trouble with the law.

Fact: Almost 22 percent of American adults own at least one firearm. More than 40 percent live in a household where a firearm is kept (Gallup Poll, 8/14/19). Owners are predominately middle-aged or older white males who live in non-urban areas. The main reasons for ownership are self-protection and hunting and other sports.

Fact: Nearly 40 percent of older Americans have a gun in their home, according to a national survey conducted in 2015. Nearly one in five of them store their firearms loaded and not secured in a locked cabinet or with a locking device (Current Gerontology and Geriatrics Research, 2/2/16).

Proper storage of weapons is crucial in all households. Unloaded and locked with a locking device or secured in a locked container, and with ammunition locked in a separate location, is considered the safest method.

Fact: 91 percent of firearm deaths among older U.S. adults in 2017 resulted from self-inflicted injury (Annals of Internal Medicine, 6/4/19). Self-inflicted injury can be intentional or accidental, and dementia, cognitive impairment, and depression and other forms of poor mental function can all come into play here. Older adults are especially at risk for gunshot wounds to the head.

Fact: As many as 60 percent of Americans with dementia live in a home with a firearm—and in nearly half of those homes, the gun is stored loaded (Annals of Internal Medicine, 6/4/19).

Firearms access is a danger to patients with dementia or other mental states that cause confusion and poses a risk to their families, caretakers, and visitors like grandchildren. People with dementia may misperceive danger, break into locked gun cabinets, and find weapons and ammunition. They can become agitated and confused and mistake family members or caregivers for intruders.

Fact: Nearly 90 percent of firearm deaths among white men are suicides (Annals of Internal Medicine, 6/4/19). The use of guns is the most common method of suicide among older adults. And firearms are the most common method of suicide among people with dementia.

Broaching the subject
Just as you would monitor an aging relative’s ability to drive, you should monitor a relative’s ability to use a firearm. Dementia, depression, and suicidal thoughts aren’t the only signs to look for. Other conditions can interfere with safe handling of firearms, such as arthritis, impaired vision, impaired mobility, loss of balance, and substance use disorders. The risk of firearm injury also increases with unsafe storage and inadequate firearm safety training.

Deciding whether an older adult is no longer fit to own firearms is a challenging issue. Answering yes to either of the following questions indicates that it’s time to consider removing access to firearms:

  • Has the person’s judgment, insight, or personality changed?
  • Does the person have depressive symptoms?

Having mild cognitive impairment doesn’t necessarily mean someone needs to give up firearms unless the condition progresses to dementia. In a study published in 2015 in the American Journal of Alzheimer’s Disease & Other Dementias, researchers recommend that people with mild cognitive impairment consider an assessment or training by a firearms specialist or take a practical firearms update course

Some experts suggest developing a written agreement that includes a “firearm retirement date” with the person while he or she still understands the consequences of having dementia while owning a firearm. (See the “Sample Family Firearm Agreement” at the end of this article.)

Show compassion
Your relative may resist any suggestion to remove firearms from the home, including antiques, collector’s items, war souvenirs, hunting equipment, and decorative pieces. He or she may feel that the firearms represent his or her identity or independence.

When discussing your concerns, it’s usually best not to be confrontational and judgmental. Choose your words carefully. Avoid words like “restrict,” “surrender,” “seize,” “dispossess,” and “confiscate,” which he or she may perceive as threatening. Instead, use language that implies less permanence, such as “hold for safekeeping,” “let someone else keep,” “keep safe,” “transfer custody,” or even “babysit.”

The Alzheimer’s Association suggests certain tactics to take when persuading a loved one to give up his or her firearms because of safety concerns:

  • Bring up the topic by asking about the value of the firearms. A discussion might include asking who might inherit various pieces and suggesting giving them to the recipient sooner rather than later so the firearms can continue to be cared for properly.
  • Suggest donating antiques so others can learn about them.
  • Suggest selling firearms no longer used—along with other family heirlooms and valuable items, such as jewelry.
  • Consider asking an authority figure that your relative trusts and respects to participate in the conversation. You can also enlist other family members and friends, such as hunting buddies, to participate in an open discussion.
  • Acknowledge your relative’s emotions, including anger or sense of loss, which he or she may feel at the thought of relinquishing the firearms.

Seek outside help
Doctors can play a role in persuading patients to engage in safe storage of their firearms and create a safe environment in their home. However, the few studies done to address their role had conflicting results on their effectiveness. Still, your relative’s primary care doctor may be able to convince him or her to:

  • Rethink gun ownership if storing a gun in the home may be dangerous to your relative or other residents and visitors like young children or adolescents who may unintentionally find and fire the gun
  • Participate in firearm safety training
  • Store firearms outside of the home, such as at a gun range or a family member’s residence

If all else fails, you can offer to have the gun professionally cleaned but then also have the trigger mechanism disabled. You can also replace live ammunition with blanks. However, if someone is at risk of injuring themselves or others, disabling a firearm—and locking up or hiding an unloaded gun—may not be enough. If your relative finds the firearm, he or she can be seen as a threat by bystanders who don’t know the gun won’t fire or is loaded with blanks. The safest action is to remove all firearms from the home. In addition, you should advise visitors to never bring a firearm to the home of a person at risk for self-harm or injuring others.

If your relative won’t consent to removing the firearms, you may need to remove them against the person’s wishes, which is best done while he or she is out of the house. Be sure to remove reminders of the weapons, including cases, ammunition, racks, and holsters. If you need assistance removing the guns, local police may be able to help. If you feel that someone is at imminent risk or at risk for harming others, call local law enforcement or 9-1-1 immediately.

Sample Family Firearm Agreement
Following is a sample family firearm agreement, which was published in the July 3, 2018 issue of the Annals of Internal Medicine. Be sure that the agreement you use is signed and dated.

To my family: The time may come when I can no longer make the best decisions for the safety of myself and others. Therefore, in order to help my family make necessary decisions, this statement is an expression of my wishes and directions while I am still able to make these decisions. I have discussed with my family my desire to control possession of my firearm(s) as long as it is safe for me to do so.

When it is no longer safe for me to have access to my firearms, I desire (person’s name) to tell me. I trust my family will take the necessary steps to protect me and those around me while still protecting my dignity and rights.

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