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 One in three people aged 65 and older in the U.S. owns a gun, and
another one in eight lives with someone who owns one. Up to 12
million Americans with dementia could be living in a household with
a gun by 2050, researchers estimate.
Even though suicide and accidental shootings are a big concern when
someone with dementia has a gun in the home, no valid screening
tools currently exist to help determine when it's time to take away
these firearms, the authors of an opinion piece published on Monday
in the Annals of Internal Medicine point out.
"Within the medical community, most of the focus has been on how to
work with youth or adults to prevent firearm injuries or deaths
including accidental shootings by young children, homicides among
teens and young adults, and suicide and domestic violence across the
lifespan," said lead author Dr. Marian Betz of the University of
Colorado School of Medicine in Aurora.
"There has been less attention towards how to help older adults and
family members make decisions about reducing firearm access," Betz
said in an email.
U.S. federal gun laws don't prohibit the purchase or possession of
guns by persons with dementia, the study team notes. Only Texas and
Hawaii mention dementia or similar conditions in their state
statutes.
A diagnosis of dementia or cognitive impairment does not necessarily
mean it's time to take away the keys to the car or the gun safe. But
it's not a bad time for doctors and families to discuss these safety
issues with patients if these conversations haven't already
occurred, Betz and colleagues write.
The best time would be before dementia advances, when older adults
can still make their own decisions about when and how they might be
willing to give up access to guns.
Families might consider a so-called "firearms retirement date," when
they will give up any guns in the home to avoid the potential for
these weapons to be in the house when they're no longer able to
store them or use them safely, the paper's authors suggest.
Or, in much the same way that people may set up an advance directive
giving a loved one the ability to make medical decisions on their
behalf, older adults might designate someone they trust to have the
authority to take away their guns when the time for this comes.
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That's because as dementia advances, families and caregivers might
be at risk if guns remain in the home. People with dementia might
have delusions about intruders, for example, and confront visitors
with a gun. Or, they might fail to store guns safely, making them
accessible to any young children in the home.
"In later stages of dementia, behavioral issues like paranoia or
aggression should raise concern, as should threats about suicide or
threats towards others," Betz said. "Families and friends can then
lock up or disable guns or move them out of the home, depending on
what works for the family and according to state firearm transfer
laws."
When guns do remain in the home, they should be locked so that the
person with dementia doesn't have unsupervised access to firearms,
and they should be stored unloaded and separate from ammunition, the
doctors also recommend.
Where guns and dementia are concerned, the conversation may need to
be ongoing as long as people with cognitive problems have any access
to firearms.
"As individuals age, it is important and healthy to stay active, and
that activity might involve hobbies such as hunting and shooting,"
said David Schwebel, a researcher at the University of Alabama at
Birmingham who wasn't involved in the study.
"However, if cognitive impairment or dementia creates risk, then use
and storage of firearms must be done with utmost care," Schwebel
said by email. "Forgetting to store a firearm safely could result in
tragedy."
SOURCE: https://bit.ly/2lUmw19 Annals of Internal Medicine, online
May 7, 2018.
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