Dementia and Firearms

Cognitive, behavioral, and personality changes associated with dementia can increase the risk of firearm injury, and firearms are common in the homes of people with dementia.^1,2

The incidence of dementia is increasing. Five million Americans, or 1.6% of the population, have Alzheimer’s dementia or related dementias (ADRD), and this proportion is expected to double by 2060.³ Though firearm suicide is a greater concern for patients with dementia, harm towards others—especially in times of confusion or paranoia—is also a risk. Clinicians should make it a priority to screen patients with cognitive decline for risk of firearm-related injury.⁴ If a clinician determines that a person with dementia (PWD) is at elevated risk for firearm-related injury, the severity of their cognitive deficits can help guide interventions.¹

The Numbers

An estimated five million Americans currently live with Alzheimer’s dementia or related dementias (ADRD).³ Up to 60% of PWD have firearms in their homes and half of these firearms are stored loaded.²

Who’s at Risk

The relationship between dementia and injury risk is complex. Dementia can impair thinking and memory, including the ability to recognize other people. It can also cause hallucinations, fluctuating levels of consciousness, and other behavioral disturbances that may impair judgment and increase suicidality or aggression towards others.^1,5,6 After middle age, suicide risk progressively increases. Adults 85 years and older have the highest rate of dementia and the second highest rate of suicide across all age groups.⁷ Research suggests that older adults with recent diagnoses of dementia or mild cognitive impairment are at higher risk of suicide.⁸

What You Can Do

At a minimum, for patients with cognitive impairment, clinicians should ask if there are firearms in the household, and if so, how they are stored.⁴ Clinicians should also engage the patient’s caregivers in the conversation about firearm access and safe storage. Other important considerations include whether the PWD has exhibited any depressive symptoms and/or changes in mood, judgement, or personality, as these conditions may signify increased risk. Because older adults with recent diagnoses are especially at risk for suicide, providing support services at the time of or shortly following diagnosis may help decrease risk of suicide.⁸

Research indicates that a significant percentage of older firearm owners (78%) do not have a written or unwritten plan for future firearm safety. Such plans include securing, removing, or transferring firearms in case of future cognitive or physical impairment.⁹ Although dementia caregivers are open to clinician counseling on firearm safety for persons with ADRD, few have received such counseling¹⁰

As PWD are at risk for other forms of injury as well, clinicians may find it helpful to integrate screening for firearm injury risk into existing assessments of patient safety, such as driving or cooking. Online decision aids are available to assist clinicians, caregivers, and patients with risk assessment.¹¹

Clinicians are critical to helping patients and families navigate the challenges associated with dementia and firearms.

Appropriate interventions will depend on the severity of the dementia.¹ In cases of mild cognitive impairment, clinicians may focus on opening discussions with patients and family about the risk of firearm-related injury, establishing rapport, and preparing for follow up conversations.  

For more impaired patients, removing access to firearms is the most important goal.¹ This can be accomplished by recommending safe storage in the home or removal of firearms from the home. Effective at-home storage requires that PWD are unable to access stored weapons; caregivers can lock up the weapons using locking devices, or they can disable the firearms.  

In emergent situations for which no voluntary solution is available, a civil protective order may be an effective way to reduce the risk of firearm injury.  

Ty Kelly, MD/MPH student at the University of Colorado School of Medicine, and Dr. Emmy Betz, Associate Professor in the Department of Emergency Medicine at the University of Colorado School of Medicine, contributed to this content.

Page last updated May 2022.

For more information, see these peer-reviewed articles.

Doucette, M. L., Dayton, H., Lapidus, G., et al. (2020). Firearms, Dementia, and the Clinician: Development of a Safety Counseling Protocol. Journal of the American Geriatrics Society.

Rosen, T., Makaroun, L. K., Conwell, Y., et al. (2019). Violence In Older Adults: Scope, Impact, Challenges, And Strategies For Prevention. Health Affairs.

Betz, M. E., McCourt, A. D., Vernick, J. S., et al. (2018). Firearms and Dementia: Clinical Considerations. Annals of Internal Medicine.  

Patel, D., Syed, Q., Messinger-Rapport, B. J., et al. (2015). Firearms in Frail Hands: An ADL or A Public Health Crisis! American Journal of Alzheimers Disease and Other Dementias.  

Mertens, B., & Sorenson, S. B. (2012). Current considerations about the elderly and firearms.  American Journal of Public Health.