Guns and the Elderly-A Growing Issue

Tips for Health Professionals

Gund and Elderly
Not a good combination!. Getty Images / TheBiggles

Lately it seems there are more cases of elder to elder violence, even homicides in nursing homes. Elderly Americans are the most likely to own a gun. Those aged 65 and older now have the highest rate of gun ownership in America and that presents both medical and legal problems for physicians and caregivers according to Dr. Ellen Pinholt writing in the Journal of the American Geriatrics Society. Here are some questions to ask, things to notice and actions to take to assure that everyone is safe when it comes to seniors possessing guns.

According to a national Firearms Survey, more than 25% of people ages 65 and older own guns. Some of these individuals live in retirement communities.

Geriatric managers in several Western gun-rights states said they regularly work with families struggling to persuade aging parents with dementia to give their children the firearms. For some individuals, guns like cars symbolize independence and individualism.

The Veterans Health Administration found that 40% of veterans with mild to moderate dementia had a gun in their home. After an 83-year old veteran shot a doctor in a VA emergency room in North Carolina, they issued guidelines for doctors to use to help family members with this complex problem.

Older white males have the highest suicide rate and 71% of the time they use a gun, according to a study in the American Journal of Geriatric Psychiatry.

As many of these folks bought their guns years ago they don’t show up in a data network.

Some care facilities are instituting rules—no firearms allowed.

Federal law prohibits mentally incompetent persons from possessing a gun; however, this only applies to a formal finding by a court and not necessarily to a physician’s diagnosis of dementia. Dr Pinholt suggests ‘5 L’s’, questions about gun ownership, which should be asked as routinely as questions about driving.

  1. If there is a gun present is it Locked?
  2. Is it Loaded?
  3. Are Little children present?
  4. Does the gun owner feel Low?
  5. Is the gun owner Learned?

Elderly people also have a high prevalence of depression and suicide. Dementia can add additional layers of risk. Geriatric professionals and home health providers have a unique and increasingly important role to play, but there are no national guidelines to aid providers in assessing gun safety.

To frame the discussion appropriately, a physician must first understand the laws pertaining to gun ownership according to Pinholt. Laws however fail to address the much more likely scenario of diminished capacity. Providers should be familiar with their state laws, which can be found online.

ASK: “IS THERE A FIREARM IN THE HOME?”
 

Geriatricians and PCPs who care for people in the outpatient setting may have this question already formatted in their electronic health record but it is uncertain how often it is actually asked of the patient or caregiver. The presence of a gun in the home becomes even more pertinent during a home healthcare visit.



“Is It “LOADED?”

Always assume that any gun is loaded. Gun safety training could make the professional in the home more at ease around a weapon.

“Is It “LOCKED?”

Is the firearm secured in a locked gun safe or is there a trigger lock or cable lock in place. Also ask, “Where is the ammunition stored?” Locking the ammunition separate from the firearm is the recommended.

“Are LITTLE Children Present?”

Nearly 6 million children, approximately one in 12, are living in households headed by grandparents. 2.8 million grandparents are living with and responsible for their grandchildren younger than 18. Grandparents could benefit from familiarization with childproofing and home safety concepts.

“Is the Operator Feeling “LOW?”

Elderly adults, especially those aged 80 and older, are at the highest risk of suicide, 80% of which are committed using a firearm. A classic study concluded that readily available guns increased the risk of suicide in the home. As a prevention strategy, the home health provider or PCP should address restricting access to a firearm and ammunition when an older adult is depressed.

“Is the Operator “LEARNED?”

Does the owner know how to use the weapon. Approximately one-fifth of guns in the home are given or inherited and not intentionally purchased. Firearm training may be in order. There is a high prevalence of firearms in the homes of individuals with dementia, and they are often kept loaded.

This issue also shows how increasingly healthcare providers have to move from treating episodic care to looking at and becoming involved with societal issues as a whole.

Source:

“Is There a Gun in the Home?” Assessing the Risks of Gun Ownership in Older Adults

Ellen M. Pinholt, MD, Joshua D. Mitchell, MD, Jane H. Butler, RN, and Harjinder Kumar, MD

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