A new program helps elders in cognitive decline and caregivers for people with Alzheimer’s disease and dementia to inventory guns and make decisions about safe handling and storage of firearms.

Dr. Emmy Betz is an emergency medicine doctor at UCHealth University of Colorado Hospital and a longtime advocate for finding practical ways to reduce the number of firearm injuries and deaths.

Betz recently received a $1.7 million grant from the National Institutes of Health to fund a “Safety in Dementia” initiative to help elders and their families make informed decisions about gun safety.

Betz cofounded the Colorado Firearms Safety Coalition, and directs the Firearm Injury Prevention Initiative at the Injury and Violence Prevention Center of the Colorado School of Public Health. The Firearm Injury Prevention Initiative in late February launched the Firearm Life Plan website to assist older gun owners and their families.

Innovative ways to reduce firearm injury risk

The Firearm Life Plan toolkit also includes a “Legacy Map” which owners can use to express the personal meaning and importance of their firearms – just as one would with any other valued possession.

The idea of the Firearm Life Plan, Betz explained, “is to lessen the burden of decision making for a family, especially with an object that carries an injury risk.”

Protecting the rising number of people with dementias and their caregivers from harm

The Safety in Dementia project began with a small pilot of a web-based decision-making tool that Betz and her colleagues developed to address an underrecognized public health issue: access to firearms among the growing number of people with Alzheimer’s disease and related dementias. In addition, research has shown that an estimated 40% to 60% of homes of people with Alzheimer’s and dementia have a firearm.

Yet “the practical tools for ADRD caregivers” to address the potential safety problems those plentiful firearms pose are lacking, Betz and her colleagues declared in a July 2020 article summarizing the pilot’s results.

“I think in the context of dementia, even though people probably agree, ‘Oh, yeah, that seems like a dangerous thing,’ it may be something caregivers haven’t thought about in the context of their own situation, or they haven’t thought about what their options might be,” said Betz, who is also a professor of Emergency Medicine at the University of Colorado School of Medicine on the Anschutz Medical Campus.

A new site aids decision making about firearm safety

The Safety in Dementia site, which was reviewed favorably by the two dozen pilot participants, features “decision aids” to assist caregivers of people with Alzheimer’s and dementia in making their homes safer in different ways. For those considering firearm safety, the tools include FAQs, help with decisions based on who owns the firearms, various storage solutions and personal stories describing conversations about and approaches to safely storing guns.

The three-year NIH trial of the Safety in Dementia site will recruit caregivers for individuals with Alzheimer’s and related dementia from across the country who have access to firearms. The goals are to improve firearm safety decision-making among caregivers and to compare the effectiveness of reaching them through social media and the Internet with outreach by “relevant organizations,” such as the American Alzheimer’s Association, Betz said.

Betz emphasized that it’s hard to estimate the extent of firearm injuries caused by people who are suffering from Alzheimer’s and dementia.

“Most firearm deaths in people with dementia are suicides,” she said – but the risk should not be downplayed.

“We are not trying to claim that this is some huge issue that is deserving of all attention being focused on it,” she said. “But for the families who are dealing with it, it is a major problem that is really difficult to solve. When you hear stories from families where there has been a near shooting or an actual shooting, it’s really devastating. It’s a big issue in a relatively small population.”

Focusing ‘legacy planning’ on firearms

Meanwhile, the Firearm Life Plan offers another way to start practical conversations about firearm safety. With this initiative, Betz and her colleagues focus on helping individuals and their caregivers consider how to pass on their firearms just as they do books, coins, crystals or other objects of personal and financial value.

The online site attempts to “demystify” the decision about what to do with guns after a person dies or reaches a point where it is no longer safe to handle them, Betz said. For example, a downloadable worksheet helps to inventory firearms, pinpoint where they are and decide who might receive them and when. Another suggests “Conversation Starters” to begin planning how to pass on firearms. A “Legacy Map” prods owners not only to think about the personal importance of their firearms but also to consider how they are trained to use them safely.

The process of transitioning firearms – as with any other possession – may be difficult, Betz acknowledged. “One way to help with that is to write down what these things mean to you,” she said.

Encouraging people to make practical decisions about firearm safety

There are many risk factors that increase the danger of firearm violence, Betz stressed. Dangerous situations might involve a person with dementia, a teenager riding “a rollercoaster of emotions and high impulsivity” who is at risk for suicide, an individual who is angry and sleep-deprived, or many other scenarios in which getting a gun easily could end in tragedy, she said. She is committed to identifying those situations and finding practical ways to minimize them.

“Underlying all of my work is the concept that there are times when individuals shouldn’t have access to firearms precisely because they are so lethal,” she said. “I’m very interested in how we help individuals and the people around them find ways to put [preventing] that into action,” she said. “It’s one thing to say it, but how do we then help them to actually do it?”

Both the Firearm Life Plan and Safety in Dementia site are “based on a desire to help people make their own decisions” in ways that encourage safety considerations, Betz said. The solutions ignore politics and polarizing viewpoints about guns in favor of assisting people in finding ways to reduce harm that makes sense in their own lives, she added.

“There are lots of firearms in this country, and they aren’t going anywhere,” Betz noted. “Our approach is based on listening to the ideas, opinions and experiences of diverse stakeholders – those who own guns, those who don’t, those who have been injured by them and many others. We try to understand all the viewpoints and find common ground. When we do work that is grounded in listening and respectful dialogue, it’s wonderful what can come out of it.”