Many people with dementia may have access to a gun in their home, yet few families have gotten advice from a doctor on how to handle the situation, a small new study finds.
In the United States, somewhere between 39% and 49% of older adults live in a home with firearms, the researchers said. Meanwhile, more than 5 million Americans are living with Alzheimer's disease, the most common form of dementia, the U.S. Centers for Disease Control and Prevention says.
Exactly how often those two realities intersect is not clear. It's difficult to get good data on how many people with dementia have access to a firearm, said study author Dr. Emmy Betz.
Given that, it's also unclear how often that ends in harm to dementia patients or others, according to Betz, an associate professor of emergency medicine at the University of Colorado's School of Medicine.
While numbers are hard to come by, the Alzheimer's Association has long recognized that firearm safety is important, said Beth Kallmyer, vice president of care and support for the association.
"Families need to be aware of it as a safety issue, and it would be great if doctors were bringing it up as part of safety planning," Kallmyer said.
The Alzheimer's Association has created a safety checklist for doctors with questions to ask families, she noted. The topic of firearms is included.
In the latest study, however, few family caregivers said their doctor had broached the subject.
Betz said that for families and doctors, safety issues like driving are often top of mind.
"But firearm safety has flown a bit under the radar," she said.
The study, published July 16 in JAMA Network Open, included 124 people who were caregivers to someone with dementia. All were participants in a larger, national study of Americans living in homes with a firearm.
In cases where caregivers lived with a dementia patient, one-third said there was access to firearms in the home. Of all caregivers, most thought doctors should talk about firearm safety -- but only 5% said that had ever happened.
There are a number of reasons to be concerned about dementia patients having access to firearms, according to Betz and Kallmyer.
As the disease progresses, confusion, impaired judgment, agitation and even physical violence can all become issues, Betz said. So if, for example, a health care worker is coming to the home -- and could be seen as an intruder by the person with dementia -- gun access is worrying.
People with more advanced dementia can also fail to recognize a family member or friend, Kallmyer said. If they believe a stranger has entered their home, she noted, there's a chance they will go for the gun if it's around.
"We generally recommend firearms be removed from the home," Kallmyer said.
Locking the firearm and ammunition away in hidden locations, or having the gun disabled, are other options. But, Kallmyer noted, that does not guarantee the firearm won't be found. And even if the gun cannot be fired, she added, simply the appearance of the person with dementia holding a gun can be trouble -- especially if it's directed at someone from outside the household, or if law enforcement is involved, for example.
Ideally, Betz said, discussions about firearms should happen earlier in the course of dementia. If a family member with the disease is a gun owner, ask them what should be done with the firearms as the dementia progresses. They may, for instance, want a family member to inherit them.
Passing the firearm on can also be a strategy in cases where someone with more advanced dementia does not want to part with it, according to Kallmyer. "You might say, 'Hey, maybe you'd like to give that to your grandson to take care of?'" she said.
"This is not about confiscation or about gun control," Betz stressed. "And we're not trying to say older people with firearms are the coming menace."
Instead, she said, firearm issues should be seen as part of the overall safety plan for people with dementia.
If families need help with disabling a firearm, or want information on how to sell or give away a gun, local law enforcement or a gun retailer can be good resources, Betz said.
Advice is also available, Kallmyer said, at the Alzheimer's Association's 24-hour helpline: 800-272-3900.
The Alzheimer's Association has advice on firearm safety.