He was 72, a retired health administrator who lived alone near Seattle. Laura Prater, a firearms researcher at Ohio State, was interviewing him via Zoom.
She’d administered a questionnaire that indicated he had mild cognitive impairment, which is often, but not always, a precursor to dementia. His doctor had also diagnosed him with depression. As part of a study of firearm safety for older adults, Dr. Prater asked if he kept a gun in his home.
He did. He still owned the shotgun he had used for bird hunting, though he hadn’t hunted in years, and he had recently acquired a .45-caliber pistol.
“He kept it unloaded in his night stand drawer,” she learned from their discussion. “The shotgun, he propped up by his bed,” unloaded, but with the shells atop the night stand.
“He saw them as a practical tool for protecting himself, because he lived alone,” Dr. Prater said. She viewed the situation differently: An older person whose diagnoses put him at risk of confusion and suicide kept two unsecured guns within arm’s reach every night. “It was alarming,” she said “But not uncommon.”
Facing a growing population of older adults with dementia and with firearms in their homes, public health experts have worked for years to address the threat guns pose to their owners and others. At least a third of people with dementia have access to firearms, researchers estimate.
Persuading them to relinquish their weapons can be a losing battle. Owners cite protection as a key reason for having firearms, so “you’re taking away their identity as a protector, removing a part of who they are,” said Kelsey Conrick, a researcher at the Center for Firearm Injury Prevention at the University of Washington.
The most effective strategy, studies show, follows a “harm-reduction” approach: discussing the risks, focusing on safe storage, with guns unloaded and locked, and providing devices like trigger locks and lockboxes for free.
“Older adults experience a great amount of harm from firearms,” said Dr. Lena Makaroun, a geriatrician and researcher at the University of Pittsburgh School of Medicine. According to data from the Centers for Disease Control and Prevention, 8,226 Americans ages 65 to 85 died from firearms in 2024 — almost 23 people each day.
That death rate isn’t much higher than the overall rate, but homicides are higher among the young. More than 90 percent of gun deaths among older people are suicides.
Researchers hoping to reduce those numbers are now looking at older people who, like the retired administrator, haven’t received a dementia diagnosis but are experiencing worsening confusion or memory loss.
A survey in seven states found that a third of those 65 and older with such “subjective cognitive decline” reported having a gun in their households, and a quarter of them hadn’t securely stored them. That was a higher proportion of nonsecure storage than among those with normal cognition, though the difference was not statistically significant.
“We worry about these people getting confused and having quick, unfettered access to a firearm,” said Dr. Conrick, the lead author of the paper. Like those diagnosed with dementia, they could be at higher risk for suicide, unintentional discharge of a firearm or mistaken shootings of family members, visitors or home care workers.
Because these patients’ current impairment is less severe, health care professionals can initiate earlier conversations about access and storage, while the patients can still make decisions. “Allowing people to make their own choices is a win in my book” and more likely to reduce risky practices, Dr. Conrick said.
It can be difficult for those who don’t use or own firearms to grasp the fierce attachment many gun owners feel, a bond that can intensify over time.
“With aging comes a sense of vulnerability,” said Dr. Marian Betz, an emergency physician and director of the Firearm Injury Prevention Initiative at the University of Colorado Anschutz. Older gun owners “fear being victimized, which can be a valid fear,” she said.
Guns make them feel safer, even if they’re not: An often cited meta-analysis from 2011 reported that a firearm in the home raised the risk of suicides and accidents, with “no credible evidence” of deterring crime or reducing injuries from intrusions or altercations.
Still, “numbers don’t always motivate people’s decisions when they’re related to fear or risk,” Dr. Betz said.
She led a study published in 2020 that found that among caregivers for people with dementia, only about 5 percent said a health care professional had ever discussed firearm safety with them.
In fact, patients may not tell their doctors they own guns, partly because of a misconception that disclosing depression or dementia could lead to having their weapons confiscated. (Those conditions by themselves don’t require medical personnel to take such action. Even if they wanted to report a hazard, only 22 states and Washington have extreme risk protection order laws that can temporarily restrict firearm access.)
Families, moreover, can be reluctant to confront their senior members about household firearms. When researchers interviewed 50 people who were caring for someone with dementia, many of the caregivers had seen reckless behavior or near misses that frightened them.
But they also feared the discord that was likely to arise if they urged resistant older gun owners to get rid of their weapons or store them securely.
“Caregivers worry about that conflict alienating them from the person with whom they will have to navigate many changes” in the years ahead, said Chris Knoepke, the study’s lead author, a health services researcher at the University of Colorado Anschutz.
Firearms researchers are working on several fronts to help doctors and families tackle this potentially volatile issue.
Dr. Prater and her team, for instance, are preparing videos to guide clinicians through safe storage discussions. Dr. Conrick’s Pathways 2 Safety program, which works with community agencies to integrate firearm discussions into routine health care, has distributed more than a thousand locking devices since March.
At the University of Colorado, Dr. Betz has developed Safety in Dementia, an online tool that helps caregivers prepare for decision making about firearms and other hazards. Another tool kit, the Firearm Life Plan, allows owners to document what should happen once they can no longer use firearms responsibly. Almost 16,000 people have used it since 2022, according to the university.
Firearm safety discussions should become part of an annual Medicare wellness visit, Dr. Makaroun and her co-authors proposed in a recent New England Journal of Medicine editorial. Those visits reach about 60 percent of beneficiaries and emphasize safety and prevention.
“That’s something we can all get behind,” she said. “It’s nonpolitical. Firearm owners by and large are very invested in safety.”
Dr. Makaroun has seen what can happen when firearm safety is unacknowledged and unaddressed in older adults with declining cognition. In 2019, a patient in his 80s with memory loss was referred to her clinic for assessment.
Cognitive testing determined that “he had impairment consistent with dementia,” she said. “I shared this with him and his son.”
They talked through how to manage symptoms and what treatments might slow the decline. She ordered bloodwork to rule out other causes, like thyroid problems.
“It’s a scary diagnosis to get, so I explained that we would be with them every step of the way,” she said. The man “didn’t really exhibit any signs of distress, he just took it in.” Testing had not found that he suffered from depression.
The next day, when Dr. Makaroun called with the blood test results, his son answered the phone. “He had found his father in the basement the night before,” she said. He had died of a gunshot wound to the head.
The New Old Age is produced through a partnership with KFF Health News.
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