The US Census Bureau estimates that older people will outnumber children for the first time in US history by 2035. So, it makes sense that we will see a corresponding increase in the more common “older people” conditions over the next several years. This includes Alzheimer’s and other dementias that impact cognitive functioning – including the reality they may no longer recognize close family and friends.
In prior blog posts I’ve addressed gun violence restraining orders, as well as, personal safety planning and want to bring these two together today. Why? Because I’ve been reading in social support groups about the struggles caregivers are facing as they remove guns, or attempt to remove them, from the homes of parents, grandparents, spouses, and others with dementia. It occurred to me that we are more focused on the safety of older loved who are still driving. But, what about those who own guns? Just as someone may no longer be considered a responsible/safe driver, they might also no longer be considered a responsible/safe gun owner.
The Alzheimer’s Association has produced a fact sheet that provides some tips to help caregivers with the conversation and process, but it isn’t always going to be easy. Family caregivers also need help from physicians and other professional caregivers; who should at least ask about the presence of guns in the home during the assessment process.
Friends and family members, as well as, healthcare providers need to assess risks and focus conversations on safety during care planning activities. For example, the Veterans Health Administrations recommends that clinicians and care teams ask about firearms during safety screenings of those with a suspected or definitive diagnosis of dementia.
The American College of Physicians has also established policy positions based on a public health approach to support caregivers. They recommend medical professionals speak out on prevention of firearm-related injuries and deaths, just as physicians have spoken out on other public health issues. They encourage physicians to counsel patients on the risk of having firearms in the home, especially when “children, adolescents, people with dementia, people with mental illnesses, people with substance use disorders or others who are at increased risk of harming themselves or others are present.”
In an NPR article, one psychologist who promotes the idea of talking to patients about the presence and location of guns, also addressed ways to guide the conversation to make it more acceptable. Dr. Joleen Susman suggests a more successful approach -- talking about “retiring” from driving and using firearms – instead of taking these privileges away.
Dr. Emmy Betz, an emergency room physician, also recommends having these conversations early in the disease and involving loved ones in the planning and decision process. She encourages use of written firearms agreements, such as the sample below.
Beyond being non-judgmental and simply asking patients if there are firearms in the home, UC Davis has created guidance for healthcare professionals who need and want to have a focused interventions with at risk patients. Resources available also include patient handouts.
In some cases, those with cognitive dysfunction can become angry, aggressive and refuse to voluntarily have guns removed from their possession and/or the home. In these cases, family member must keep safety – to self and others – at the forefront of conversations and reach out to local law enforcement for assistance.
Thirteen states have established “red flag” laws that allow law enforcement, and sometimes family members, to petition a judge for temporary seizure of firearms from those who exhibit dangerous behavior. The NRA Institute for Legislative Action, Giffords Law Center to Prevent Gun Violence and Project Gunner are all resources for the status in each state.
We do all have the right to keep and bear arms. But, we also have a responsibility to recognize when it is time to relinquish that privilege for the safety of others and ourselves.
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