Assessing the Risks of Gun Ownership in Older Adults
Healthcare professionals should respectfully review the possible risks of gun ownership with their patients. Guns are often not secured, grandchildren may have access to the guns, and the prevalence of dementia and depression in older adults increase the risk of accidents and suicide. When the home health checklist or outpatient interview confirms that a firearm is present in the home, the health worker should gather more information using the 5 L's. The 5 L's assess the older gun owner by addressing the most important "red flags."
Always assume that any gun is loaded. Even in the homes of individuals with dementia, where one could reasonably assume that a weapon would not be loaded, 44.6% of weapons were kept loaded. Another 38% of respondents in that study did not know whether the weapon was loaded. Asking whether the weapon is loaded may therefore yield uncertainty. Assume it is loaded. Gun safety training could make the professional in the home more at ease around a weapon.
Is the firearm secured in a locked gun safe or is there a trigger lock or cable lock in place (Figures 1 and 2)? If not, would the owner consider any of these safety options? Also ask, "Where is the ammunition stored?" Locking the ammunition separate from the firearm is the recommended safe option. If the firearm is used for sport shooting and hunting, then the client may be persuaded to follow these recommendations, but in rural areas, an empty, locked gun may not be considered an option because the purpose may be for home defense or for protection from predator animals. In urban areas, gun owners tend to keep them loaded and unlocked for protection against violent crimes. If the owner presents these rationales, the next three "L's" assume much greater importance.
(Enlarge Image)
Figure 1.
Trigger lock.
(Enlarge Image)
Figure 2.
Cable locks.
This question's importance was unfortunately highlighted with the recent death of a 4-year-old boy whose 4-year-old cousin shot him after they found a loaded shotgun under their grandfather's bed. Nearly 6 million children, approximately one in 12, are living in households headed by grandparents. This large number includes children who also have their parents present in the home, but some of these grandparents have assumed responsibility for these children without the parent of the child being in the home. This is a growing trend, with numbers increasing from 2.4 million grandparents in 2000 to 2.8 million in 2010 who are living with and responsible for their grandchildren younger than 18. When one considers that the concept of home safety and childproofing has occurred after the children of today's grandparents left home, it is likely that most grandparents will benefit from familiarization with childproofing and home safety concepts, especially as they apply to firearm safety.
The culture of childproofing and home safety for children is new. National efforts to prevent childhood unintentional injuries did not begin until 1986 and became a robust coalition called Safe Kids USA in 1995. Laws regarding firearms and child protection have been enacted over time but are still not enacted in all states. The Child Access Prevention (CAP) laws or "safe storage" laws were passed between 1989 and 2000. CAP laws were passed in an attempt to reduce gun-related accidents and suicides in children. These laws, depending on the state, may hold the adult criminally liable for unsafe firearm storage when children are in the environment. State laws vary and can be accessed through each state's Department of Justice website. Despite these laws, more than 40% of homes with children and firearms report the presence of at least one unlocked firearm. Some of these households are most certainly grandparent-headed households, and some are homes that grandchildren visit. This is a relevant question and represents an opportunity to educate these grandparents on gun safety. Knowledge of the CAP laws should be a competency for home health providers that will guide counseling on removing or properly storing the weapon and ammunition.
As previously stated, elderly adults, especially those aged 80 and older, are at the highest risk of suicide, 80% of which are committed using a firearm. The question of a relationship between ready availability of a firearm and risk of suicide in the home was answered in 1992. That classic study concluded that readily available guns increased the risk of suicide in the home. The majority of suicides occurred in the home, and a firearm was the means of death most commonly used. As a prevention strategy, the home health provider or PCP should address restricting access to a firearm and ammunition when an older adult is depressed. The practices of keeping a gun locked and unloaded and storing ammunition in a separate, locked location is associated with significantly fewer unintentional and self-inflicted firearms injuries and deaths in youth that may be in the home.
This question should prompt the PCP or home health professional to ask whether this owner knows how to use the weapon. Approximately one-fifth of guns in the home are given or inherited and not intentionally purchased. The majority of gun owners, 56% in one survey of 800 gun owners, have received firearm training, but 21% of those owners stored their guns improperly. The 97-year-old that the home healthcare team encountered relinquished the gun when it was pointed out that she neither knew how to use it nor how to store it properly. The weapon may have also been used against her.
"LEARNED" also refers to the possibility of dementia in the client. The Aging, Demographics, and Memory Study in 2007 reported prevalence rates according to age group for dementia. The rates increased with age, with 24% of individuals aged 80 to 89 and 37% of those aged 90 and older having dementia. In addition, cognitive impairment often goes unrecognized unless older clients are specifically screened.
If the owner has dementia, he or she would generally not be considered safe to operate a gun. The great majority of individuals with Alzheimer's disease are cared for in the home, not in institutions. Guns are not typically removed from these homes. There is a high prevalence of firearms in the homes of individuals with dementia, and they are often kept loaded. Case 1 nearly had a disastrous outcome when the nephew did not follow through on removing the loaded guns. The PCP or the home health professional should recommend that a family member remove the firearm from the home. If the family is uncooperative, the local Adult Protective Services agency should be notified for investigation. When no family member is present, the police should be notified of the concern.
When a Firearm is Present
Healthcare professionals should respectfully review the possible risks of gun ownership with their patients. Guns are often not secured, grandchildren may have access to the guns, and the prevalence of dementia and depression in older adults increase the risk of accidents and suicide. When the home health checklist or outpatient interview confirms that a firearm is present in the home, the health worker should gather more information using the 5 L's. The 5 L's assess the older gun owner by addressing the most important "red flags."
Is it "LOADED?"
Always assume that any gun is loaded. Even in the homes of individuals with dementia, where one could reasonably assume that a weapon would not be loaded, 44.6% of weapons were kept loaded. Another 38% of respondents in that study did not know whether the weapon was loaded. Asking whether the weapon is loaded may therefore yield uncertainty. Assume it is loaded. Gun safety training could make the professional in the home more at ease around a weapon.
Is it "LOCKED?"
Is the firearm secured in a locked gun safe or is there a trigger lock or cable lock in place (Figures 1 and 2)? If not, would the owner consider any of these safety options? Also ask, "Where is the ammunition stored?" Locking the ammunition separate from the firearm is the recommended safe option. If the firearm is used for sport shooting and hunting, then the client may be persuaded to follow these recommendations, but in rural areas, an empty, locked gun may not be considered an option because the purpose may be for home defense or for protection from predator animals. In urban areas, gun owners tend to keep them loaded and unlocked for protection against violent crimes. If the owner presents these rationales, the next three "L's" assume much greater importance.
(Enlarge Image)
Figure 1.
Trigger lock.
(Enlarge Image)
Figure 2.
Cable locks.
Are LITTLE Children Present?
This question's importance was unfortunately highlighted with the recent death of a 4-year-old boy whose 4-year-old cousin shot him after they found a loaded shotgun under their grandfather's bed. Nearly 6 million children, approximately one in 12, are living in households headed by grandparents. This large number includes children who also have their parents present in the home, but some of these grandparents have assumed responsibility for these children without the parent of the child being in the home. This is a growing trend, with numbers increasing from 2.4 million grandparents in 2000 to 2.8 million in 2010 who are living with and responsible for their grandchildren younger than 18. When one considers that the concept of home safety and childproofing has occurred after the children of today's grandparents left home, it is likely that most grandparents will benefit from familiarization with childproofing and home safety concepts, especially as they apply to firearm safety.
The culture of childproofing and home safety for children is new. National efforts to prevent childhood unintentional injuries did not begin until 1986 and became a robust coalition called Safe Kids USA in 1995. Laws regarding firearms and child protection have been enacted over time but are still not enacted in all states. The Child Access Prevention (CAP) laws or "safe storage" laws were passed between 1989 and 2000. CAP laws were passed in an attempt to reduce gun-related accidents and suicides in children. These laws, depending on the state, may hold the adult criminally liable for unsafe firearm storage when children are in the environment. State laws vary and can be accessed through each state's Department of Justice website. Despite these laws, more than 40% of homes with children and firearms report the presence of at least one unlocked firearm. Some of these households are most certainly grandparent-headed households, and some are homes that grandchildren visit. This is a relevant question and represents an opportunity to educate these grandparents on gun safety. Knowledge of the CAP laws should be a competency for home health providers that will guide counseling on removing or properly storing the weapon and ammunition.
Is the Operator Feeling "LOW?"
As previously stated, elderly adults, especially those aged 80 and older, are at the highest risk of suicide, 80% of which are committed using a firearm. The question of a relationship between ready availability of a firearm and risk of suicide in the home was answered in 1992. That classic study concluded that readily available guns increased the risk of suicide in the home. The majority of suicides occurred in the home, and a firearm was the means of death most commonly used. As a prevention strategy, the home health provider or PCP should address restricting access to a firearm and ammunition when an older adult is depressed. The practices of keeping a gun locked and unloaded and storing ammunition in a separate, locked location is associated with significantly fewer unintentional and self-inflicted firearms injuries and deaths in youth that may be in the home.
Is the Operator "LEARNED?"
This question should prompt the PCP or home health professional to ask whether this owner knows how to use the weapon. Approximately one-fifth of guns in the home are given or inherited and not intentionally purchased. The majority of gun owners, 56% in one survey of 800 gun owners, have received firearm training, but 21% of those owners stored their guns improperly. The 97-year-old that the home healthcare team encountered relinquished the gun when it was pointed out that she neither knew how to use it nor how to store it properly. The weapon may have also been used against her.
"LEARNED" also refers to the possibility of dementia in the client. The Aging, Demographics, and Memory Study in 2007 reported prevalence rates according to age group for dementia. The rates increased with age, with 24% of individuals aged 80 to 89 and 37% of those aged 90 and older having dementia. In addition, cognitive impairment often goes unrecognized unless older clients are specifically screened.
If the owner has dementia, he or she would generally not be considered safe to operate a gun. The great majority of individuals with Alzheimer's disease are cared for in the home, not in institutions. Guns are not typically removed from these homes. There is a high prevalence of firearms in the homes of individuals with dementia, and they are often kept loaded. Case 1 nearly had a disastrous outcome when the nephew did not follow through on removing the loaded guns. The PCP or the home health professional should recommend that a family member remove the firearm from the home. If the family is uncooperative, the local Adult Protective Services agency should be notified for investigation. When no family member is present, the police should be notified of the concern.
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