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Families confront guns and dementia



Kaiser Health News
Monday, July 23, 2018

With a bullet in her gut, her voice choked with pain, Dee Hill pleaded with the 911 dispatcher for help.

“My husband accidentally shot me,” Hill, 75, of The Dalles, Ore., groaned on the May 16, 2015, call. “In the stomach, and he can’t talk, please ...”

Less than four feet away, Hill’s husband, Darrell Hill, 76, a former local police chief and two-term county sheriff, sat in his wheelchair with a discharged Glock handgun on the table in front of him, unaware that he’d nearly killed his wife of almost 57 years.

He had been diagnosed two years earlier with a form of rapidly progressive dementia, a disease that quickly stripped him of reasoning and memory.

“He didn’t understand,” said Dee, who needed 30 pints of blood, three surgeries and seven weeks in the hospital to survive her injuries.

As America copes with an epidemic of gun violence that kills 96 people each day, there has been vigorous debate about how to prevent people with mental illness from acquiring weapons. But less on what to do about the vast cache of firearms in the homes of aging Americans with declining faculties.

Darrell Hill, who died in 2016, was among the estimated 9 percent of Americans 65 and older diagnosed with dementia, a group of terminal diseases marked by mental decline and personality changes. Many, like the Hills, are gun owners and supporters of Second Amendment rights. Forty-five percent of people 65 and older have guns in their household, according to a 2017 Pew Research Center survey.

But no one tracks the potentially deadly intersection of those groups.

A four-month Kaiser Health News investigation has uncovered over 100 cases across the U.S. in which people with dementia used guns to kill or injure themselves or others.

From news reports, court records, hospital data and public death records, KHN found 15 homicides and more than 60 suicides since 2012, although there are likely many more. At least four men with dementia who brandished guns were fatally shot by police. In cases where charges were brought, many assailants were deemed incompetent to stand trial.

Many killed themselves.

An analysis of government survey data in Washington state found that about 5 percent of respondents 65 and older reported both some cognitive decline and having firearms in their home. The assessment, conducted for KHN by a state epidemiologist, suggests that about 54,000 of the state’s more than 1 million residents 65 and older say they have worsening memory and confusion – and access to weapons.

In a politically polarized nation, where gun control is a divisive topic, even raising concerns about the safety of cognitively impaired gun owners and their families is controversial. Relatives can take away car keys far easier than removing a firearm, the latter protected by the Second Amendment. Only five states have laws allowing families to petition a court to temporarily seize weapons from people who exhibit dangerous behavior.

But in a country where 10,000 people a day turn 65, the potential for harm is growing, said Dr. Emmy Betz, associate research director at the University of Colorado School of Medicine, a leading researcher on gun access and violence. Even as rates of dementia fall, the sheer number of older people is soaring, and the number of dementia cases is expected to soar as well.

“You can’t just pretend it’s not going to come up,” Betz said. “It’s going to be an issue.”

Proponents of gun ownership say guns are not to blame.

Dr. Arthur Przebinda, who represents the group Doctors for Responsible Gun Ownership, said researchers raising the issue want to curtail gun rights guaranteed by the U.S. Constitution, and are “seeking ways to disarm as many people as possible.”

“I’m not disputing the case that it happens. I know it can happen,” Przebinda said. “My question is how prevalent it is, because the data is what should be driving our policy discussion, not fear or fear-mongering. It’s bad science.”

Two decades of political pressure that quashed public health research into the effects of gun violence partly explain the lack of data, experts said. But that doesn’t mean there’s no problem, said Dr. Garen Wintemute, director of the Violence Prevention Research Program at the University of California-Davis.

“(Critics) are arguing as if what we have is evidence of absence,” he said. “We have something quite different, which is absence of evidence.”

Even some families grappling with the problem are wary about calls to limit gun access.

Federal law prohibits people who are not mentally competent to make their own decisions, including those with advanced dementia, from buying or owning firearms. But a mere diagnosis of dementia does not disqualify someone from owning a gun, said Lindsay Nichols, federal policy director at the Giffords Law Center to Prevent Gun Violence. If a gun owner were reluctant to give up his arsenal, his family would typically have to take him to court to evaluate competency.

Belated diagnoses of dementia are too common, according to Dr. Melissa Henston, a geriatric psychologist in Denver who administers cognitive exams that can confirm impairment. She said many of the patients she sees have moderate or even severe dementia before being diagnosed.

“There’s denial and a false belief that a lot of cognitive problems are just normal for age,” she said.

Removing guns from the home is the best way to prevent violence, the Alzheimer’s Association and other experts advise. But Dr. Diana Kerwin, director of the Texas Alzheimer’s and Memory Disorders program at Texas Health, said that’s not the answer for all families.

“I don’t do a blanket ‘guns are bad, you can’t have guns in the home,’ ” she said.

Instead, she advocates storing guns safely – locked up, unloaded, with the ammunition kept separate from the guns. Firearms can also be disabled or, in some cases, replaced with a decoy, although that raises the risk of them being mistaken for a real weapon in an emergency.