Pamela Atwood, MA, CDP, CLL
Director of Dementia Care Services
Hebrew Health Care, Inc.
No matter your position on the subject of gun control, this may be the best time to discuss concerns about having guns in the home when someone has significant memory loss. I’d like to share two stories from clients I helped in the past.
One family had an uncle who lived alone, but needed more help and care. He was a disabled Veteran, proud of his service to our country. Unfortunately, as his dementia progressed, he became more paranoid and suffered flashbacks. He had a gun collection in his home and would frequently clean them, hold them, inspect them. More than once, when his nephew came to visit, the uncle held the gun up to protect himself. He lived in a well-populated area with many children nearby. The family was concerned that he would shoot at them, or if a child made a sudden loud noise, it would increase his paranoia and he could shoot someone else. The visiting nurse agency refused to deliver care as long as guns were in the home (which is standard practice in most areas).
Another situation occurred during the War with Iraq. A client with dementia was watching the news from his home in New England. At some point, he apparently became concerned about the reports of terrorists and acts of terror in the US. He went to his attic, found his bayonet and left his house. He was picked up by the local police; he stated he was there “to protect Main Street from the terrorists.”
Many citizens have a gun, multiple guns or in some cases gun collections. How prevalent is the issue? According to a recent report in the Washington Post (12/15/12) there are 270 million privately held guns in America – 9 guns for every 10 Americans. Over 5 million Americans have Alzheimer’s disease. A study conducted by the VA in 2004 found that 40% of Veterans with mild to moderate dementia had guns in the home.
When someone has significant memory problems, gun ownership poses a couple of special safety concerns. First, one thing we know for certain about dementia is that someone WILL lose his or her judgment and comprehension of the world at some point. This significantly increases the risk of disorientation to people, hallucinations, false beliefs/delusions and paranoia. Judgment and decision-making are guaranteed to become impaired. Second, the risk of depression is also high among people with dementia, as well as elders in general. In fact, older white men have the highest suicide rate, and a study by the American Journal of Geriatric Psychiatry (2003) indicated that 71% of the time, they used guns. The federal government and every state has laws which address the ability to sell guns to people “with mental defects” (see http://www.ncsl.org/issues-research/justice/possession-of-a-firearm-by-the-mentally-ill.aspx). But these special-risk dementia patients aren’t trying to buy guns; they already own them.
So what do we do? Gun ownership is obviously a huge issue in our country. And taking away Alzheimer’s patients drivers licenses is hard enough – guns don’t require “licenses” and there is no “right to drive” in the Constitution.
The first step is to admit there is a risk – face the fact that judgment will decline and the safety risks to the public, and the individual, are significant. If there is a gun collection, perhaps the person would like to donate it. Some families have had success removing guns slowly one at a time. A good idea is to remove ammunition and replace it with “blanks.” Having a gun professional disable firing pins may be an option. We discourage “hiding” the guns, because it doesn’t eliminate the risk, and may increase the chance that someone else, untrained, may find the gun. At the very least, you should ensure that the guns are locked and the ammunition stored in a separate, secured area. If removing guns would anger or agitate the person with dementia, speak with the physician – treatment of agitation could be part of the solution (and is really separate from gun ownership – agitation is not uncommon among people with dementia), or perhaps a pre-existing depression may be making the person more paranoid or concerned about keeping the guns.
For more information, you can read the VA Guidelines on Firearms & Dementia at http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2731 .