Firearms, Dementia, and the Clinician: Development of a Safety Counseling Protocol

J Am Geriatr Soc. 2020 Sep;68(9):2128-2133. doi: 10.1111/jgs.16450. Epub 2020 May 1.


Objectives: Using available literature, our aim was to design a firearm safety counseling protocol tool for dementia patients.

Design: We conducted a literature review on firearm safety counseling by healthcare providers using several databases to inform the creation of our evidence-based protocol.

Setting: Roughly 5.7 million Americans currently live with some form of dementia with approximately 60% of persons with dementia (PWD) owning a firearm. The mental deterioration associated with dementia creates an opportunity for firearm abuse, misuse, and injury. Patient and family safety counseling from a healthcare provider is one potential opportunity for reducing the level of danger. This literature review identifies the available clinical guidelines for firearm safety for PWD and creates a firearm safety counseling protocol based on existing literature.

Participants: Persons with dementia and their families or care takers.

Measurements: Databases were searched using variations of the terms "Firearms," "Dementia," and "Alzheimer's disease." Studies were included for review if they provided either recommendations or guidelines for healthcare provider's counseling around firearm safety for PWD or their families.

Results: Search terms yielded 456 articles, of which 12 met inclusion criteria. Using the available literature, we developed a firearm safety counseling protocol that provides measurable means to assess risk and offer harm mitigation strategies for patients and their families. Mitigation strategies are based on Clinical Dementia Rating scale assessment at time of patient interaction and results of risk assessment.

Conclusion: Providing standardized and effective clinical guidelines to healthcare providers who interact with firearm-owning PWD can act as a means to reduce firearm injury and violence. The protocol proposed in this article needs further testing and validation to determine if it will help reduce firearm-related events in PWD.

Keywords: dementia; firearm safety; physician counseling.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Counseling*
  • Dementia / psychology*
  • Firearms*
  • Health Personnel / psychology*
  • Humans
  • Ownership*
  • Patient Safety*
  • United States
  • Wounds, Gunshot / prevention & control