1. Hale, Deborah MSN, RN, ACNS-BC
  2. Marshall, Katherine DNP, PMHCNS-BC, NP, CNE

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Firearms are a leading cause of injury-related mortality among older adults, accounting for almost one-third of the annual firearm fatalities nationwide (Carter et al., 2022). Among older adults, approximately 26.7% report owning at least one firearm, and only 39.4% of these owners store their firearm unloaded and locked.


Older adults are at increased risk for injury, violence, and/or suicide occurring with issues such as depression, social isolation/loneliness, stressful life events, and physical illness/functional impairment. Dementia is an independent risk factor for both depression and suicide, especially in the early stages of the disease. As dementia progresses, patients exhibit advanced impairment including increased agitation, paranoia, and aggression. This can increase the risk of violence to others living in or visiting the household, as violence among older adults is more likely to occur at home between known assailants.


Advocacy organizations recommend those with cognitive impairments not have access to firearms, but often a plan has not been made between the patient and caregivers regarding what to do with it if they are unsafe to handle a firearm (Betz et al., 2020). Firearms are not a topic frequently discussed between patients, caregivers, and providers (Betz et al., 2020). In fact, over the course of their healthcare experience, only 3.7% of older adults reported being asked about firearm safety by a healthcare provider in the past year (Carter et al., 2022).


Home healthcare clinicians can play an important role in education and firearm safety. If the patient can safely maintain firearms at the time of the visit, the clinician should conduct an assessment regarding how they are stored. If a patient is unable to safely maintain a firearm, the caregiver should be contacted to assess the situation. Home healthcare clinicians may want to discuss with the patient/caregiver reasons why the firearm may need to be transferred for the safety of the patient experiencing a decline in physical and/or mental functioning. The patient (assuming proper mental and physical capabilities) may benefit from writing down their wishes for potential transfer of a firearm (i.e., under what conditions, where the firearm will be transferred, potential return of the firearm, how it will be stored). Home healthcare clinicians can also provide educational materials on properly locking and securing the weapon, and other aspects of firearm safety from recognized associations and organizations.


Clearly, firearms in the hands of those with impaired functioning causes an increased risk for injury, violence, and/or suicide. Home healthcare clinicians should assess for firearms in the home and provide information to the patient/caregiver on safety measures such as storing the firearm locked and unloaded. Clinician can encourage a plan between the caregiver and patient to remove the firearm at high-risk times and provide information on firearm safety resources or organizations.




Betz M. E., Azrael D., Johnson R. L., Knoepke C. E., Ranney M. L., Wintemute G. J., Matlock D., Suresh K., Miller M. (2020). Views on firearm safety among caregivers of people with Alzheimer Disease and related dementias. JAMA Network Open, 3(7), e207756.[Context Link]


Carter P. M., Losman E., Roche J. S., Malani P. N., Kullgren J. T., Solway E., Kirch M., Singer D., Walton M. A., Zeoli A. M., Cunningham R. M. (2022). Firearm ownership, attitudes, and safe storage practices among a nationally representative sample of older U.S. adults age 50 to 80. Preventive Medicine, 156, 106955.[Context Link]