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How to have 'the talk' with aging parents about their guns

By Lisa Rapaport

(Reuters Health) - When a loved one starts suffering from dementia, taking away the car keys isn't the only tough conversation many families need to face - they also need to talk about removing any guns from the home, some doctors argue.

One in three people aged 65 and older in the U.S. owns a gun, and another one in eight lives with someone who owns one. Up to 12 million Americans with dementia could be living in a household with a gun by 2050, researchers estimate.

Even though suicide and accidental shootings are a big concern when someone with dementia has a gun in the home, no valid screening tools currently exist to help determine when it's time to take away these firearms, the authors of an opinion piece published on Monday in the Annals of Internal Medicine point out.

"Within the medical community, most of the focus has been on how to work with youth or adults to prevent firearm injuries or deaths including accidental shootings by young children, homicides among teens and young adults, and suicide and domestic violence across the lifespan," said lead author Dr. Marian Betz of the University of Colorado School of Medicine in Aurora.

"There has been less attention towards how to help older adults and family members make decisions about reducing firearm access," Betz said in an email.

U.S. federal gun laws don't prohibit the purchase or possession of guns by persons with dementia, the study team notes. Only Texas and Hawaii mention dementia or similar conditions in their state statutes.

A diagnosis of dementia or cognitive impairment does not necessarily mean it's time to take away the keys to the car or the gun safe. But it's not a bad time for doctors and families to discuss these safety issues with patients if these conversations haven't already occurred, Betz and colleagues write.

The best time would be before dementia advances, when older adults can still make their own decisions about when and how they might be willing to give up access to guns.

Families might consider a so-called "firearms retirement date," when they will give up any guns in the home to avoid the potential for these weapons to be in the house when they're no longer able to store them or use them safely, the paper's authors suggest.

Or, in much the same way that people may set up an advance directive giving a loved one the ability to make medical decisions on their behalf, older adults might designate someone they trust to have the authority to take away their guns when the time for this comes.

That's because as dementia advances, families and caregivers might be at risk if guns remain in the home. People with dementia might have delusions about intruders, for example, and confront visitors with a gun. Or, they might fail to store guns safely, making them accessible to any young children in the home.

"In later stages of dementia, behavioral issues like paranoia or aggression should raise concern, as should threats about suicide or threats towards others," Betz said. "Families and friends can then lock up or disable guns or move them out of the home, depending on what works for the family and according to state firearm transfer laws."

When guns do remain in the home, they should be locked so that the person with dementia doesn't have unsupervised access to firearms, and they should be stored unloaded and separate from ammunition, the doctors also recommend.

Where guns and dementia are concerned, the conversation may need to be ongoing as long as people with cognitive problems have any access to firearms.

"As individuals age, it is important and healthy to stay active, and that activity might involve hobbies such as hunting and shooting," said David Schwebel, a researcher at the University of Alabama at Birmingham who wasn't involved in the study.

"However, if cognitive impairment or dementia creates risk, then use and storage of firearms must be done with utmost care," Schwebel said by email. "Forgetting to store a firearm safely could result in tragedy."

SOURCE: Annals of Internal Medicine, online May 7, 2018.

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