Some patients refuse to answer. Many doctors don’t ask. Family members worry about offending a suffering loved one. As the number of Americans with dementia rises, health professionals are grappling with when and how to pose the question: “Do you have guns at home?”
While gun violence data is scarce, a Kaiser Health News investigation with PBS NewsHour published in June uncovered over 100 cases across the United States since 2012 in which people with dementia used guns to kill themselves or others. The shooters often acted during bouts of confusion, paranoia, delusion or aggression — common symptoms of dementia. Tragically they shot spouses, children and caregivers.
Yet health care providers across the country say they have not received enough guidance on whether, when and how to counsel families on gun safety.
Dr. Altaf Saadi, a neurologist at the University of California, Los Angeles, who has been practicing medicine for five years, said that she recently realized that talking to patients with cognitive decline about guns in the home was a “blind spot” in her clinical practice. She looked up the American Academy of Neurology’s advice on treating dementia patients. Its guidelines suggest doctors consider asking about “access to firearms or other weapons” during a safety screen — but they don’t say what to do if a patient does have guns.
With a dearth of national gun safety data, there are no scientific standards for when a health care provider should discuss gun access for people with cognitive impairment or at what point in dementia’s progression a person becomes unfit to handle a gun.
Most doctors don’t ask about firearms, research has found. In a 2014 study, 58 percent of internists surveyed reported never asking whether patients have guns at home.
“One of the biggest mistakes that doctors make is not thinking about gun access,” said Dr. Colleen Christmas, a geriatric primary care doctor at Johns Hopkins School of Medicine and member of the American Neurological Association. Firearms are the most common method of suicide among seniors, she noted. Dr. Christmas said she asks every incoming patient about access to firearms, in the same nonjudgmental tone that she asks about seatbelts, and “I find the conversation goes quite smoothly.”
Recently, momentum has been building among health professionals to take a greater role in preventing gun violence. In the wake of the Las Vegas shooting that left 58 concertgoers dead last October, over 1,300 health care providers publicly pledged to ask patients about gun ownership and gun safety when risk factors are present.
The pledges came in response to an article by Dr. Garen Wintemute, director of the Violence Prevention Research Program at the University of California, Davis. In response to feedback from that article, his center has now developed a tool kit called What You Can Do, offering health professionals guidance on how to reduce the risk of gun violence.
-By Melissa Bailey, Kaiser Health News