Dementia and Firearms

Dementia elevates the risk for firearm-related harm

Cognitive, behavioral, and personality changes associated with dementia can increase the risk of firearm injury, and firearms are common in the homes of people with dementia.1,2

The incidence of dementia is increasing. Five million Americans, or 1.6% of the population, have Alzheimer’s dementia or related dementias (ADRD), and this proportion is expected to double by 2060.3 Though firearm suicide is a greater concern for patients with dementia, harm towards others—especially in times of confusion or paranoia—is also a risk. Clinicians should make it a priority to screen patients with cognitive decline for risk of firearm-related injury.4 If a clinician determines that a person with dementia (PWD) is at elevated risk for firearm-related injury, the severity of their cognitive deficits can help guide interventions.1

The primary risk of firearm-related harm for persons with dementia is suicide.5

The Numbers

An estimated five million Americans currently live with Alzheimer’s dementia or related dementias (ADRD).3 Up to 60% of PWD have firearms in their homes and half of these firearms are stored loaded.2

 

Who’s at Risk

The relationship between dementia and injury risk is complex. Dementia can impair thinking and memory, including the ability to recognize other people. It can also cause hallucinations, fluctuating levels of consciousness, and other behavioral disturbances that may impair judgment and increase suicidality or aggression towards others.1,5,6 After middle age, suicide risk progressively increases. Adults 85 years and older have the highest rate of dementia and the second highest rate of suicide across all age groups.7  

What You Can Do

At a minimum, for patients with cognitive impairment, clinicians should ask if there are firearms in the household, and if so, how they are stored.4 Clinicians should also engage the patient’s caregivers in the conversation about firearm access and safe storage. Other important considerations include whether the PWD has exhibited any depressive symptoms and/or changes in mood, judgement, or personality, as these conditions may signify increased risk.

As PWD are at risk for other forms of injury as well, clinicians may find it helpful to integrate screening for firearm injury risk into existing assessments of patient safety, such as driving or cooking. Online decision aids are available to assist clinicians, caregivers, and patients with risk assessment.8

Clinicians are critical to helping patients and families navigate the challenges associated with dementia and firearms.

Appropriate interventions will depend on the severity of the dementia.1 In cases of mild cognitive impairment, clinicians may focus on opening discussions with patients and family about the risk of firearm-related injury, establishing rapport, and preparing for follow up conversations.  

For more impaired patients, removing access to firearms is the most important goal.1 This can be accomplished by recommending safe storage in the home or removal of firearms from the home. Effective at-home storage requires that PWD are unable to access stored weapons; caregivers can lock up the weapons using locking devices, or they can disable the firearms.  

In emergent situations for which no voluntary solution is available, a civil protective order may be an effective way to reduce the risk of firearm injury.  

 

Ty Kelly, MD/MPH student at the University of Colorado School of Medicine, and Dr. Emmy Betz, Associate Professor in the Department of Emergency Medicine at the University of Colorado School of Medicine, contributed to this content.

Click to view references

  1. Betz, M. E., McCourt, A. D., Vernick, J. S., et al. (2018). Firearms and Dementia: Clinical Considerations. Annals of Internal Medicine.
  2. Spangenberg, K. B., Wagner, M. T., Hendrix, S., et al. (1999). Firearm presence in households of patients with Alzheimer's disease and related dementias. Journal of the American Geriatrics Society.
  3. Matthews, K. A., Xu, W., Gaglioti, A. H., et al. (2019). Racial and ethnic estimates of Alzheimer's disease and related dementias in the United States (2015-2060) in adults aged ≥65 years. Alzheimers and Dementia.
  4. Rosen, T., Makaroun, L. K., Conwell, Y., et al. (2019). Violence In Older Adults: Scope, Impact, Challenges, And Strategies For Prevention. Health Affairs.
  5. Serafini, G., Calcagno, P., Lester, D., et al. (2016). Suicide Risk in Alzheimer’s Disease: A Systematic Review. Current Alzheimer Research.
  6. Mertens, B., & Sorenson, S. B. (2012). Current considerations about the elderly and firearms. American Journal of Public Health.
  7. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online].
  8. Polzer, E. R., Nearing, K., Knoepke, C. E., et al. (2020). ''Safety in Dementia'': Development of an Online Caregiver Tool for Firearm, Driving, and Home Safety. Journal of the American Geriatric Society.

Learn more about potential interventions

If guns are kept in the home, storing them safely can prevent firearm injury.

Storing guns outside the home when someone is at risk can be lifesaving.

Protective orders can remove firearms from dangerous situations.

For more information, see these peer-reviewed articles.

Doucette, M. L., Dayton, H., Lapidus, G., et al. (2020). Firearms, Dementia, and the Clinician: Development of a Safety Counseling Protocol. Journal of the American Geriatrics Society.

Rosen, T., Makaroun, L. K., Conwell, Y., et al. (2019). Violence In Older Adults: Scope, Impact, Challenges, And Strategies For Prevention. Health Affairs.

Betz, M. E., McCourt, A. D., Vernick, J. S., et al. (2018). Firearms and Dementia: Clinical Considerations. Annals of Internal Medicine.  

Patel, D., Syed, Q., Messinger-Rapport, B. J., et al. (2015). Firearms in Frail Hands: An ADL or A Public Health Crisis! American Journal of Alzheimers Disease and Other Dementias.  

Mertens, B., & Sorenson, S. B. (2012). Current considerations about the elderly and firearms.  American Journal of Public Health.  

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