Citation

Betz ME, Miller M, Matlock DD, Wintemute GJ, Johnson RL, Grogan C, Lum H, Knoepke CE, Ranney ML, Suresh K, Azrael D. Ann. Intern Med. 2021; 174(2): 279-282.

Copyright

(Copyright © 2021, American College of Physicians)

DOI

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PMID

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Abstract

We agree with Dr. Ertle that older adults and their family members face myriad health issues. We suggest that information about firearm safety could be easily integrated into other resources or counseling, and our group has developed "Safety in Dementia" (1) to support these considerations. As outlined in prior work, considerations about how and when to reduce firearm access for an older adult are critical in certain contexts - such as worsening dementia or suicide risk (2). Counseling by healthcare providers about these topics, when relevant, is supported by the public (3) and by dementia caregivers (4), although they also identify community organizations as a source for information. Suicide rates rise among older age groups, especially men, with firearms used in a majority of suicide deaths. Particularly in the context of dementia or suicide risk, reduced firearm access could prevent the likelihood of a serious injury or death. But the rationale for engaging older firearm owners in advance planning about firearm access is not solely for prevention of injury - rather, it is to respect autonomy and independence and hopefully minimize the emotional impact for adults and their families of non-voluntary transfers. Dr. Ertle mentions driving among older adults, which we think may be a model for conversations about firearm access. Prior work has shown that older drivers want time to prepare for future changes and want to maintain control of decisions, when they are able (5); facilitating a smoother transition (for example by engaging the "trusted messenger" the older adult has identified) may minimize the negative psychosocial impacts of driving cessation. Similarly, if an older adult already has a plan for when they would transfer firearms or otherwise reduce their access (e.g., development of specific impairments), it may facilitate that family conversation, should the situation arise.

Polzer ER et al. "Safety in Dementia": Development of an Online Caregiver Tool for Firearm, Driving, and Home Safety. J Am Geriatr Soc. 2020;Jul 6.
Betz ME et al. Firearms and Dementia: Clinical Considerations. Ann Intern Med. 2018;169(1):47-49.
Pallin R et al. California Public Opinion on Health Professionals Talking With Patients About Firearms. Health Aff. 2019;38(10):1744-1751.
Betz ME et al. Views on Firearm Safety Among Caregivers of People with Alzheimer Disease and Related Dementias. JAMA Netw Open. 2020;3(7):e207756. 
Betz ME et al. "Are you still driving?" Metasynthesis of Patient Preferences for Communication with Health Care Providers. Traffic Inj Prev. 2016;17(4):367-73.