Physicians call for policies to disarm older patients with dementia
The nation faces a possible epidemic of suicides and accidental shootings among older persons due to baby boomers’ high rates of gun ownership and increased risk of age-related dementia.
While a patient with dementia can be reported to the Department of Motor Vehicles and have their license revoked, there are currently no laws that give families or caregivers legal authority to confiscate firearms, according to an article in The Journal of the American Osteopathic Association. Authors say the lack of public policies has put physicians on the front lines to mitigate the damage.
“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 and as a society, 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 percent of people 65 and older owning one or more firearms, and 37 percent living in a home with a firearm present. One study of patients with dementia or related mental health issues revealed 18 percent lived in a home with one or more firearms. Of that group, 37 percent had delusions and 17 percent had documented hallucinations.
Another survey found 60 percent 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 demented patients as likely to have firearms in their homes as those with mild cognitive impairment. Of respondents who identified as having a firearm in the home, 45 percent reported that one or more of the guns was loaded; an additional 38 percent were unaware of whether the guns were loaded or unloaded. Fewer than 17 percent of family members reported that guns were maintained in an unloaded state.
A need for policy
Dr. Galluzzi sees promise in “red flag laws” that emerged in several states over the last year. Such laws allow families and law enforcement to petition a judge for the temporary removal of firearms from someone deemed to be a danger to themselves or others.
“I would like to see a similar policy enacted for families of people with dementia—but with a permanent confiscation of the weapon, because, unfortunately, their condition is only going to worsen,” she says.
The article shares two case scenarios to illustrate how such conditions can lead to tragedy. In one, an 80-year-old-man living alone with Alzheimer’s received regular care from a health aid. During a time when he had heightened confusion and did not recognize the aid, he retrieved a gun from his bedroom and fatally shot her.
In the other, a 72-year-old male patient who lived alone was diagnosed with cancer. After rejecting treatment options and saying he had “lived long enough”, he went home and killed himself with a gunshot to the head.
Older adults, especially older white men, are the most common group of individuals to complete suicide, according to research cited in the article. Unlike adolescents or younger adults, older adults are also more likely to verbalize suicide intent and to use violent means such as guns. According to research, between 50 and 66 percent of older adults who commit suicide have a diagnosis of major depressive disorder.
An opportunity to intervene
Research has shown patients planning to attempt suicide were twice as likely to see their physician as they were a mental health care provider, and nearly 50 percent visited their physician within 30 days of the attempt. Dr. Galluzzi sees this as evidence that physicians are the frontline to protect patients as well as their family members and caregivers.
“The first thing we all need to do is get comfortable talking about this. It is critical for physicians to ask whether the patient owns a gun or has access to a gun and whether it is loaded, where and how it’s stored and so on,” says Dr. Galluzzi.
The article cites a prior survey that comprised a similar set of questions called the “5 Ls”, which can help frame conversations with family members:
- Is there a Loaded gun in the home?
- Is there a Locked gun in the home?
- Are there Little children in the home?
- Has anyone been feeling Low in the home?
- Is there a Learned operator (someone with prior safety training) in the home?
If the patient is showing signs of dementia and unwilling to give up his or her guns, Dr. Galluzzi suggests family members take the weapon to be permanently disabled by a professional who can remove internal working parts. If that is not an option, she says the next course of action is to call local law enforcement, who may be able to intervene.
Before any of that occurs, Dr. Galluzzi encourages families to make a plan for transferring ownership of firearms before dementia sets in.
“Whether it’s a question of taking away a person’s car or gun, these are difficult discussions to have and they won’t get easier as the patient’s mental state deteriorates,” says Dr. Galluzzi. “Families need to talk about this early and decide on power of attorney so someone can act in the best interest of the patient before they are no longer able to do it for themselves.”