John Phillips is the owner of one of California's largest shooting ranges and a full-throated advocate of gun rights. But he joined his family in persuading his grandmother to relinquish her guns when she was in her 80s. She had been a strong, independent woman and had single-handedly raised her family in the rugged Pacific Northwest, where guns were part of community life. As she began to experience dementia, though, Phillips believed her guns had to go.
"I know what it does, how brutal it is," he says of the disease.
Some 45 percent of Americans over the age of 65 live in a home with a gun, according to the Pew Research Center. That statistic is scary, given an aging population: By 2040, the number of people in the United States living with dementia is expected to double to 14 million, the Alzheimer's Association says.
Older Americans might sometimes forget a treasured recipe, or the rules of a card game, but loading and firing a gun is an act of muscle memory, Phillips says. And that muscle memory has led to accidents, self-harm, and even murder among people with dementia. A 2018 study by Kaiser Health News found 100 cases in just a four-month period across the U.S. in which people with dementia used guns to kill or injure a loved one, a caregiver, or themselves. There were also several incidences over that period of police shooting a gun-wielding dementia patient who seemed to pose a public threat.
The stories are heartbreaking. One West Virginia man killed his wife after he failed to recognize her and thought she was an intruder. He spent the rest of his days asking why she didn't visit him. A 72-year-old widower with metastatic prostate cancer and dementia declined hospital treatment because he wanted to go home to care for his cat; two days later, he arrived in the emergency room, where he died from a self-inflicted gunshot wound, the American Osteopathic Association reported in a 2018 study.
The widower's story is sadly common. Some 91 percent of all firearm deaths over the age of 65 are suicides, says Dr. Emmy Betz, associate professor of emergency medicine at the University of Colorado School of Medicine and the author of a research study on guns and dementia. That's compared with 60 percent of firearm deaths among all age groups, according to the Centers for Disease Control and Prevention.
"Dementia itself may be a risk factor for suicide," Betz says. She has recommended that families consider drawing up firearms agreements similar to advanced medical directives before dementia begins to take a toll. She also recommends the development of screening protocols to help physicians and professional caregivers assess the level of risk for gun access.
Philips and his family were able to address the issue before his grandmother's dementia had gripped her completely, persuading her to pass on her guns to family members. That process might sound easier than it is, though, thanks to complex state and federal gun ownership laws, Phillips says. California, for instance, requires most transfers be overseen by a federally licensed gun dealer. A father can give a gun to a son without dealer involvement, but not to a brother or a son-in-law.
Plus, the strong attachment many gun owners have to their firearms can complicate family efforts. "You are taking away a fundamental right," Phillips says.
Phillips himself is now focusing on a practical solution for gun-owning dementia patients after being approached last summer by the non-profit Alzheimer's San Diego. As the owner of the largest indoor shooting range in Southern California, and as a retired federal law enforcement officer, Phillips was well known to many local gun owners and the local public-safety community, among them several officers who worked with Alzheimer's San Diego on safety issues. In memory of his grandmother, who died years before his Poway Weapons and Gear Range opened in 2014, he has donated 500 gun locks to families dealing with the challenges of dementia. He unveiled the program to an audience of 2,500 gun-range members gathered at his facility in July of 2018.
The Gun Safety Program grew out of growing concerns among San Diego social workers who, like their counterparts across the country, are sometimes met at the door by a client brandishing a gun, says Jessica Empeño, vice president of Alzheimer's San Diego. Dementia symptoms such as confusion and disorientation can present as paranoia, she says. Plus, people with dementia also sometimes have difficulty recognizing faces, so a friend or family member can quickly become a stranger or intruder in their view.
The idea of gun locks came from a deputy sheriff serving on a safety working group that includes local law enforcement, behavioral health specialists, and caregivers, Empeño says. This was a way for family caregivers, so busy dealing with everything else, to be proactive without depriving patients of guns that might be a comfort to them. The brightly colored locks are secured with a key that a caregiver can keep off-site.
Often, "it's not realistic to walk in there and take the guns," Empeño says. "Their guns are an extension of who they are." The gun lock allows the owner to keep the weapon, handle it, and treasure it, while rendering it unusable. It becomes essentially "a big fancy paperweight," Empeño says. The vivid color of the lock also allows law enforcement to immediately recognize that the weapon is not deadly, Phillips says.
But sometimes it is necessary to walk in and take the guns when they become a source of obsessive behavior that provokes family and caregivers, so Alzheimer's San Diego has also been working with the local city attorney to enable families to get restraining orders under so-called "red flag" laws, sometimes called "extreme risk laws." Some 14 states now have these laws, which allow law enforcement to seek a court order removing guns temporarily from a person's possession if that person is exhibiting threatening behavior to themselves or others. Seven of those 14 states allow family members to initiate the process.
There are few voices right now calling for an outright ban on weapons ownership by people living with dementia—a likely result of polarized Second Amendment politics in America. Still, advocacy for more extreme risk laws continues to grow, with support from groups like the Brady Campaign to Prevent Gun Violence. Physicians, also, are increasingly speaking publicly about the need to engage with elderly patients on the issue, including a high-profile call to action campaign by Dr. Garen Wintermute at the University of California–Davis.
Gun rights advocates, including Phillips, are sometimes leery of the confiscation approach; they see it as an infringement on a basic right. Phillips plans to keep donating gun locks as long as there's demand for them. He also spreads the word about the gun-safety program among the 200,000-plus customer-members of his Poway Weapons and Gear Range, and at industry expositions around the country. It's a solution, he says, "that keeps the politics out of it."
Given the distressing, often overwhelming realities facing the families of people with dementia, Alzheimer's San Diego is also committed to keeping the divisive politics of the gun debate out of its care program. As historical polling shows, Americans are divided on gun ownership, and Empeño says this divide is often reflected in the families seeking their help. Practical advice is the goal. Guns are now part of a regular safety briefing for families, along with issues such as wandering, access to medicines, and knives left on the kitchen countertop.
"We try not to be judgmental," Empeño says. "No matter where you are on the gun issue, everyone wants the same thing—safety."