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Age Matters: Guns and the elderly

Age Matters: Guns and the elderly

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Is the answer always 'more guns'? (copy)

Dear Dr. Camardi

You were my doctor when we lived in Virginia before we moved to take care of my parents, and I remember during that time you got into it with some old-timer who was our neighbor about taking his gun collection away because he almost killed somebody.

Well fast forward a bit and I’m sick and damn well tired of people telling me what rights they have, all the time dumping on my rights to live my life right. My smart-a— sister who lives three states over got some dumb-a— lawyer to tell me I can’t take a gun away from our father, who lives with us. He’s 86, with all the grief that comes with it.

I mean, he can’t drive no more because he used to get lost half the time coming back from church and he can’t pay his own bills for years because he screwed that up and now, he almost damn well killed my son because he forgot he chambered a round one time and was showing it off to him and don’t you know it went off almost in front of his face!

I go and tell my sister all this, before he tells her some other story, but he got to her first with some sob story and she says I can’t take the gun because he has a right to it and she’s got a lawyer! Now I’m afraid for him and anyone else in this house and she’s telling me what to do. Now I want you to say something like you did before about this because it’s just plain not right.

Morgantown, West Virginia

More so than ever in our society we are torn apart over the issue of defending our rights as citizens. Too often it’s presented as a clear-cut issue by the individual based on the statement, “I have a right to [fill in the blank]” The problem ensues when those rights compete between people as a battle for supremacy of a group instead of understanding and compromise within a society.

When I am faced with this struggle, I go back to the medical ethics course I gave in the 1990s, in which I explored the concepts of legalistic rights and moral ethics in patient care and society. As in this example, the person has a right to have a gun and concurrently the moral obligation to operate it without putting others at risk. If the person cannot function within this simple construct, the gun must be removed from the person’s possession or modified so as to obviate the risk.

The problem has always been to identity the time frame when an elderly’s person judgment has been so effected by the aging process that firearm possession must be restricted. This problem is a critical one given the demographics we currently face in this country. By some estimates over 5 million people in America are affected by dementia in some way. Expectations are such that this estimate is expected to approximately double over the next 25 years.

Given that about one-third of those older than 65 own a gun and, additionally, some 15% may have access to firearms by living in a household that owns them, one can see the dimension of the problem.

As a sidebar, keep in mind that the incidence of depression in the elderly is quite high and the risk of gun violence is not only to others but to the persons themselves. As such, there is the very high risk of suicide that has to be taken into account.

So, the question now becomes, where should an intervention occur for the good of all concerned? Personally, I would evaluate the patient in depth and analyze the situation thoroughly and then … go with my gut instincts! I know that’s not very scientific but I have seen so many patterns of risk that listening to my instincts never failed me in protecting the people I cared for.

Objectively speaking, if I were to define patterns that would raise red flags, it would center on memory decline impacting daily living activities and grading toward failure to recognize familiar places, persons or things. This leads to profound irritation, anger and fear as the patient loses a perceived grip on reality. This can lead to misinterpreting situations that might trigger the erroneous impulse to defend oneself, without understanding the implications. The problem is, a gun fatality could occur anywhere in that behavioral trajectory.

So, listen to your gut and begin firearm possession and safety discussions with the patient and her family. This is why I always included a question about the firearms possession during the intake physical. That question surprised many when I asked it, but it is stunning the number of people with access to weapons at home.

In the case you referenced above, we compromised after long and heated discussions, to alter the firing mechanism, rendering it harmless. The functional word here is “compromise.” There is always a way to resolve conflict if we step back, take a deep breath, think of the greater good and work to find it. With careful forethought, these are preventable injuries. I’ve cleaned out enough gunshot wounds and know that life is too precious to end at a gun’s business end … and when it does, all that’s left is aching regret.

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