Elderly Firearm Owners with Dementia Pose Shooting Risk

Red flag laws allowing for the removal of firearms from people with mental illness need to be widely extended to patients suffering from dementia, according to an article in The Journal of the American Osteopathic Association.

The authors noted that the current lack of public policy could lead to an increase in suicide and accidental shootings among baby boomers and older adults, who have high rates of gun ownership and increasing risk for age-related dementia. While physicians can alert local authorities if a patient should no longer drive a motor vehicle, no such process exists for firearm owners with cognitive impairment.

"Nothing about this is easy. People's identities are formed in large part by the ways and degree to which they can feel self-sufficient. That doesn't end with the onset of dementia," says author Katherine Galluzzi, DO, chair of the department of geriatrics at the Philadelphia College of Osteopathic Medicine. "However, as physicians and family members, we need to be able to do the hard thing in the interest of public safety."

A Widespread Problem

Researchers report that older adults have the highest rates of gun ownership, with 27% of people 65 and older owning one or more firearms, and 37% living in a home with a firearm present. One study of patients with dementia or related mental health issues revealed 18% lived in a home with one or more firearms. Of that group, 37% had delusions and 17% had documented hallucinations.

Another survey found 60% of households of individuals with a diagnosis of dementia had one or more firearms. According to the study, the presence of guns did not vary by the degree of dementia, with severely impaired patients as likely to have firearms in their homes as those with mild cognitive impairment.

Two cases illustrate the potential for tragedy. An 80-yearold- man living alone with Alzheimer's received regular care from a health aide, whom he shot and killed during a period of heightened confusion. In another case, a 72-year-old male patient with cancer rejected treatment options and ended his life with a gunshot to the head.

"Red flag laws" that emerged in several states over the last year offer a potential solution. Such laws allow families and law enforcement to petition a judge for temporary removal of firearms from someone deemed to be a danger to themselves or others. Similar policies could assist physicians and families of patients with dementia, Dr. Galluzzi noted.

An Opportunity to Intervene

Aside from public policy, the authors say physicians need to get comfortable talking with patients and their families about guns in the home.

The article cites a prior survey comprising a set of questions called the "5 Ls," which can help frame conversations with family members:

1. Is there a Loaded gun in the home?

2. Is there a Locked gun in the home?

3. Are there Little children in the home?

4. Has anyone been feeling Low in the home?

5. Is there a Learned operator (someone with prior safety training) in the home?

In addition, Dr. Galluzzi encourages patients and their families to make a plan for transferring ownership of the gun before dementia sets in.

"Whether it's a question of taking away a person's car or gun, these difficult discussions don't get easier as the patient's mental state deteriorates," says Dr. Galluzzi. "It's critical for families to talk about this early and decide on power of attorney so someone can act in the best interest of the patient when they are no longer able to do it for themselves."