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Patients with Dementia and Firearms

Nurses Have a Role to Play

Kritz, Fran

AJN The American Journal of Nursing: November 2018 - Volume 118 - Issue 11 - p 14
doi: 10.1097/01.NAJ.0000547649.53897.bd
In the News

Asking about household guns is a place to start.

Fran Kritz

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Earlier this year, Kaiser Health News produced an investigative report on the intersection of dementia and guns in the home, identifying more than 100 cases in the United States in which people with dementia used guns on themselves or others (see https://khn.org/news/dementia-and-gun-safety-when-should-aging-americans-retire-their-weapons). According to the report, among Americans ages 65 and older, an estimated 9% (about 48 million people) have diagnosed dementia and about 45% have guns in the household. Yet there are no federal laws restricting gun ownership by people with dementia, and only Hawaii and Texas have laws that address the issue.

Nevertheless, firearms in the hands of people with dementia is an issue health care professionals must confront, according to Shirley Orr, executive director of the Association of Public Health Nurses. “A discussion of guns in the home of a person who is in the early stages of dementia is essential,” Orr told AJN. Even if patients or family members don't bring it up, nurses should routinely inquire about the presence of firearms and support efforts to remove guns from the home. “Hiding guns or keeping them in a locked area may not be enough,” Orr said. “The best way is to reach an agreement with the individual about when the guns will be ‘retired,’ whether sold, gifted, or otherwise removed.”

Hospital discharge nurses are frequently the health care professionals families of patients with dementia turn to for advice, according to Jennifer Mensik, division director of care management at Oregon Health and Science University Healthcare in Portland. “We advise our nurses to consult with the social work department, which has at times advised contacting the sheriff's office or police department” to intervene.

The presence of firearms in households of people with dementia isn't solely a family concern. For nurses who do home visits, it's an issue of personal safety. “Always ask about firearms before visiting a patient at home, especially in the case of dementia,” Mensik advised. “You are within your legal rights to say that when you visit, the guns must be locked up or put away.”

Some states have adopted or are considering laws to allow family members or others to petition for a court order to temporarily remove guns if they pose risk, according to Jon Vernick, associate director of the Johns Hopkins Center for Injury Research and Policy. “Nurses can inform family members about this option and can lend their voices to persuade more states that such laws are helpful and needed, Vernick told AJN.

For more information, see the Alzheimer's Association resource guide for speaking with patients with dementia about firearms at www.alz.org/national/documents/topicsheet_firearm_safety.pdf.—Fran Kritz

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