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Dementia and Weapons: When Should Physicians Address the Subject? | National



Some patients refuse to respond. Many doctors do not ask. As the number of people with dementia increases, health professionals struggle with when and how to ask the question, "Do you have weapons at home?"

While Gun Violence Data is Scarce, Kaiser Health News Investigates PBS NewsHour Since June 2012, the study has uncovered more than 100 cases in the United States of America where people with dementia use weapons to protect themselves or others kill. The shooters often acted during confusion, paranoia, delusions or aggression – common symptoms of dementia. Tragically, they shot spouses, children and carers.

But health care providers across the country say they have not received enough advice on whether, when, and how families should be counseled on weapon security.

Dr. Altaf Saadi, a neurologist at UCLA who has been practicing medicine for five years, said the KHN article revealed a "blind spot" in their clinical practice. After reading it, she sought the advice of the American Academy of Neurology to treat dementia patients. His guidelines suggest that doctors ask for "access to firearms or other weapons" during a security screen ̵

1; but they do not say what to do if a patient has weapons.

Lack of national weapons safety data leaves no scientific standards as to when a health care provider should discuss access to firearms for people with cognitive impairment, or at what point in the progression of dementia a person becomes unfit to handle a weapon [19659002] Most doctors do not ask about firearms, research has found. In a 2014 study, 58 percent of surveyed internists reported that they never asked if patients had weapons at home.

"One of the biggest mistakes doctors make is not access to weapons," Dr. Colleen Christmas, a geriatric primary care doctor at the Johns Hopkins School of Medicine and a member of the American Neurological Association. Firearms are the most common method of suicide among seniors, she noted. Christmas said she asks every incoming patient about access to firearms, in the same non-judgmental tone she asks for seatbelts, and "I find that the conversation goes quite smoothly."

Recently, health professionals have built a greater role in preventing gun violence. Following filming in Las Vegas, which killed 58 concertgoers last October, more than 1,300 healthcare providers have publicly committed to question patients about gun ownership and weapon safety when risk factors prevail

Dr. Garen Wintemute, director of the Violence Prevention Research Program at the University of California-Davis. In response to feedback from this article, its center has now developed a toolkit called What You Can Do that provides health professionals with pointers on how to reduce the risk of gun violence.

In a nation that is bitterly divided over weapons ownership issues Many are strongly defending the right to carry weapons under the second amendment, which has hit dissidents. Dr. Arthur Przebinda, Director of Doctors for Responsible Weapons Ownership, framed Wintemute's efforts as part of a broader anti-weapon bias on the part of institutional medicine. Przebinda said the doctors would sign such a pledge, encouraging them to "propagate Americans against their constitutionally protected rights to firearms and privacy."

Przebinda said he receives several requests daily from patients looking for weapons-friendly doctors. Some, he said, are tired of their doctors sending them anti-gun YouTube videos and other materials. His group, which has more than 1,400 members, has established a referral service that connects patients with gun-friendly doctors.

For doctors and other health professionals, navigating this politically sensitive issue can be difficult. Here are the main problems:

Q: Is it legal to talk to patients about weapons?

A: Yes. No state or federal law prohibits healthcare professionals from addressing the issue.

Q: Why do not doctors do that?

A: The three main reasons are lack of time, ambiguity about what to say to the patient (19659002) "There is no medical or medical school in the country that provides adequate training in firearms management," Wintemute argued. He said he is now working with the American Medical Association to design a continuing medical education course on the subject.

Other doctors do not think they should ask. Przebinda argues that doctors almost never ask their patients for weapons except in "very rare, very extraordinary circumstances" – for example, when a patient is discouraged or murderous. He said that taking possession of information about the weapon in an electronic medical record jeopardizes their privacy.

Q: When should you address the topic?

A: The Veterans Health Administration recommends asking for firearms as part of a safety screening when "the suspected diagnosis of dementia is being investigated or detected". The Alzheimer's Society also recommends asking in a security screening: "Are firearms present in the household?". This screening is part of a treatment plan that Medicare conducts annually after the diagnosis of dementia and the progression of the disease.

The American College of Physicians recommends physicians "to alert patients to the risk of firearms in the home, especially if children, adolescents, people with dementia, people with mental illness, people with substance abuse or others who are at increased risk, Witnessing himself or others is present. "

Wintemute said he does not suggest that all doctors routinely ask every patient about firearms. His group recommends doing so when risk factors exist, including the risk of violence against themselves or others, violent behavior or substance abuse in the past, "severe, poorly controlled mental illness," or part of a "demographic group at risk Firearms Injury "

Q: What should health care providers recommend to patients to use their weapons?

A: The National Rifle Association and What You Can Do Both offer tips on safe storage of weapons, including the use of trigger and weapon safes

The Alzheimer's Association advises that locking weapons is not enough could be because people with dementia could risk "misinterpreting danger" and breaking into a gun cabinet to protect themselves. To protect a family comprehensively, the organization recommends removing the weapons from the house.

But health professionals may be reluctant to recommend this because of legal concerns, said Jon Vernick, co-director of the Johns Hopkins Center for Gun Policy and Research. Most states allow the temporary transfer of firearms to a family member without a background check. But seven states fail: Connecticut, Hawaii (for handguns), Massachusetts, Michigan, New Jersey, North Carolina and Rhode Island, according to Vernick. He recommends that health professionals review their state weapons laws on sites such as the NRA Institute for Legislative Action or the Giffords Law Center to prevent gun violence. In addition, 13 states have passed "red flag" laws that allow prosecution, and sometimes family members, to ask a judge to temporarily take firearms from a gun owner who exhibits dangerous behavior.

Q: What happens when clinicians ask for weapons?

A: Natasha Bahr, a female instructor and social worker working with geriatric patients at a clinic focusing on memory impairment at the University of North Texas Health Science Center, said she in a standard study, she asks each patient, "Do you have firearms in the house? "

"I get so much pushback," she said. About 60 percent of their patients refuse to respond, she said.

Patients tell her, "It's none of your business," "I have the freedom not to answer that question," or "It's my second change right," she said. "You make it sound as if I'm judging, and I'm really not."

Dr. John Morris, director of Knight Alzheimer's Disease Research Center at Washington University in St. Louis, said he interviewed his patients about firearms related to other safety concerns. If security is at risk, he advises families to close firearms and store ammunition separately.

"People with dementia typically have no insight into their problems, so they're going to protest," he said. Dementia is characterized by "the gradual deterioration of not just memory, but judgment and problem-solving and good decision-making," Morris noted.

In one case, Morris said, he had to convince the daughter of a dementia patient to safely secure her father's hunting rifles. She was reluctant to change the role.

"It's very hard to tell your dad he can not have his guns anymore," Morris said. The father replied, "I never used my firearms … it will not be a problem," Morris recalls. "But he remembers his past – he can not predict the future."

Finally, the daughter decided to remove the rifles from the house. After a few weeks, her father forgot everything about her, Morris said.

Morris said history shows how difficult it is for families to treat people with dementia. "They are forced to make decisions, often against the will of the people," he said, "but they must do it for the safety and well-being of the person."

(Kaiser Health News (KHN) is a National Editor. This is an editorially independent program of the Henry J. Kaiser Family Foundation, supported by the Gordon and Betty Moore Foundation, the John A. Hartford Foundation, and the SCAN Foundation .)

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© 2018 Kaiser Health News

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