Conference Coverage
COPENHAGEN – More than 1 in 10 community-dwelling dementia patients had firearms in their homes, and many of those patients suffered from delusions, hallucinations, or depression, a study of nearly 500 Midwestern patients revealed.
"This combination of a growing elderly population and guns presents some very concerning public health issues," said study investigator Jason Hsieh, a fourth-year medical student at Cleveland Clinic Lerner College of Medicine. "First and foremost, they have the highest suicide rate of any population segment, and a firearm in the home is the most common method of carrying out that act. Dementia patients are also victims of a high rate of homicide, most committed by family members or caregivers."
The inexorable personality changes that develop as disease progresses – aggression, hallucinations, and paranoid delusions – also make the combination of dementia and a loaded weapon an extraordinarily bad one, Mr. Hsieh said.
National statistics already identify gun ownership as fairly high among U.S. elders: As many as 27% own at least one. And those who do have a firearm at home are likely to have more than one – up to six, in fact, according to the National Rifle Association. But a not-insignificant proportion of those senior citizens also have diagnosed dementia disorders, and this combination should be ringing a very loud alarm bell for doctors, families, and communities, Mr. Hsieh said at the Alzheimer’s Association International Conference 2014.
Mr. Hsieh and his colleagues conducted a chart review of 495 patients who underwent initial evaluation for cognitive impairment at an outpatient memory clinic at the Cleveland Clinic. Of these, 89 (18%) lived in a home with a gun; 70% of that group (62) had a formal diagnosis of Alzheimer’s or another dementia disorder.
Associated mental disorders were common in the group with dementia. More than half (33) had delusions, 15 had hallucinations, and nearly all (57) had a diagnosed depression or endorsed depressive symptoms during their evaluation.
The delusions and hallucinations were likely to be paranoid (73% and 47%, respectively). Charts also included descriptions of aggressive behavior – some of which included firing weapons in the house and through open windows. Family members also reported some patients who repeatedly asked for their gun in order to commit suicide.
The unsettling combination is a difficult knot for U.S. doctors, Mr. Hsieh said.
"Doctors have no legal right here to remove weapons from the home," he said. "The only thing we can do is try to identify if one exists and encourage family members and carers to consider removing it or at least store it locked and unloaded in an inaccessible location."
Mr. Hsieh had no financial disclosures.
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