When Should Older Americans with Alzheimer’s Lose Access to Guns?

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Individuals with dementia who possess or have access to firearms should receive special attention or screening from physicians, family members and authorities to gauge the risk of harm to themselves and others, according to a group of clinicians writing in the Annals of Internal Medicine.

“A diagnosis of cognitive impairment or dementia does not in itself mean that a person should not have access to firearms,” the clinicians cautioned in a paper released Monday.

“The level of cognitive impairment is probably most important.”

But, citing a 1999 estimate that 60 percent of persons with dementia (PWDs) live in a household with a firearm, the paper warned that, with the number of elderly Americans with Alzheimer’s Disease projected to grow to 13.8 million by 2050, such screenings should have the same priority as concerns about gun possession or access among individuals with mental illness.

“For PWDs (Persons With Dementia)—and their family members and health care providers—discussions about firearms access strongly parallel discussions about driving,” the paper said.

“When do PWDs need to ‘give up the keys’—whether they are to a gun safe or to a car, and how do they do so?”

Statistics show that 91 percent of all firearms deaths among older adults are suicides, and that firearms are the most comment method of suicide among persons with dementia, the paper said. noting the problem will increase as America’s population ages.

Some 33 percent of all adults aged 65 and older currently own a gun, and another 12 percent live in a household with someone who does, the paper said.

“Although family members may underestimate the ability of PWDs to access and use firearms stored in the home, no validated screening tool exists to assess firearm access among cognitively impaired persons,” the paper said.

The authors said no federal laws explicitly prohibit the purchase or possession of firearms by the cognitively impaired, and only two states—Hawaii and Texas—list dementia or similar conditions in their statutes related to gun possession, but they are limited in scope.

Texas, for example, bars anyone diagnosed with “chronic dementia” from obtaining a permit to carry a handgun in public but allows the purchase and possession of firearms.

They noted that the Veterans Health Administration currently lists firearms as among the safety assessments required when establishing a dementia diagnosis, in addition to power tools and driving status.

Physicians and caregivers should place the same focus on an elderly patients’ risk from having access to firearms as they do with driving ability, the paper said.

“Persons with dementia who have firearm access may also place families and caregivers at risk,” the authors said. “Delusions about home intruders or confusion about the identity of persons in their lives may lead PWDs to confront family members, health aides or other visitors (and) access to a firearm may increase the potential for injury or death in such a situation.”

Alzheimer‘s Disease, also known simply as Alzheimer’s, is considered the most common cause of dementia. A chronic neurodegenerative disease, whose causes are still not well understood, its most common early symptom is short-term memory loss.

In a statement accompanying the paper, Dr. Marian Betz of the University of Colorado School of Medicine and the lead author of the study, said she and her colleagues had developed a “sample family firearm document” which a person with dementia could sign before symptoms become too severe.

The document provides for an advance agreement signed by a person with dementia, agreeing that when he or she 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,” Dr. 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 other 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; and Garen J. Wintemute, MD, MPH, University of California, Davis School of Medicine.

The full study can be downloaded here.

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