Issues of dementia and gun ownership need more discussion, researchers say

"Firearm access, like driving, can pose a risk of injury or death to both cognitively- impaired individuals and those with whom they interact," said the study's lead author Marian (Emmy) Betz, MD, MPH, of the University of Colorado School of Medicine. "How can health care providers, family members and friends balance firearm-related safety concerns with the rights and wishes of the individual?"

The study was published today in the Annals of Internal Medicine.

Betz and her colleagues from institutions including Johns Hopkins University, the University of Michigan and the University of California Davis, examined clinical perspectives relating to assessment and counseling about firearm access for those with dementia or other cognitive impairment.

They found that nearly 4.7 million adults had Alzheimer's in 2010 and that number was expected to grow to 13.8 million by 2050. The disease accounts for about 70 percent of all dementia cases. That means the total number of people with cognitive impairment and a firearm at home will also grow.

The study noted that even in the highly politicized atmosphere surrounding gun ownership, about 89 percent of Americans support limiting firearm purchases and access to those with a mental illness. Americans also support temporarily reducing gun access in times of elevated suicide risks.

"The primary firearm injury risk for individuals with dementia is likely to be death by suicide," said Betz, an associate professor of emergency medicine at the CU School of Medicine. "Some 91 percent of older adults' firearm deaths are due to suicide, and firearms are the most common method of suicide among people with dementia."

People with dementia can experience hallucinations, delusions, agitation or aggression. If a person is delusional and believes people are breaking into their home, they may feel caregivers and family members are intruders and confront them with a gun.

Betz said conversations about guns in these situations are similar to talks with older drivers.

"When is it time to give up the keys, be they to a gun safe or a car?" she asked. "What are the relevant state and national laws? When and how should conversations occur?"

Right now there are no validated screening tools for assessing firearm access among cognitively-impaired people. For those with milder forms of dementia, some experts recommend discussions with the patient and family about setting a `firearm retirement date.'

Caregivers can also ensure that guns are securely locked so the patient can't have access without supervision. They can reduce risks of gun injury by making firearms less lethal -- removing ammunition from the home, storing firearms unloaded or having trigger mechanisms removed.

Betz said physicians have a right and a duty to ask and counsel patients about potential health risks so long as they balance the welfare of the person with the health and safety of the public.

Federal law forbids the sale of a gun to someone judged `mentally defective' or who has been committed to a mental institution. Still, federal and state laws don't explicitly prohibit those with dementia from buying guns.

Betz said working with stakeholders in the dementia and firearms community would go a long way toward creating effective materials and programs to address this problem.

She and her colleagues have developed a sample family firearm document. The person with dementia would be able to sign the agreement before symptoms become too severe. The agreement says that when the person with dementia can no longer make the best safety decisions, the family can control the possession of his or her firearm.

"It's best to have these conversations early and be aware that you have to take action at some point," Betz said. "This is not about the government or anyone else seizing guns, but about a family making the best decision for everyone involved."

The co-authors of the study include Alexander McCourt, JD, MPH, Johns Hopkins Bloomberg School of Public Health; Jon S. Vernick, JD, MPH, Johns Hopkins Bloomberg School of Public Health; Megan L. Ranney, MD, MPH, Rhode Island Hospital/Alpert Medical School; Donovan T. Maust, MD, MS, Department of Psychiatry, University of Michigan Center for Clinical Management Research, VA Ann Arbor Healthcare System; Garen J. Wintemute, MD, MPH, University of California, Davis School of Medicine.