Doctors struggle to help older gun owners

(Reuters Health) – Doctors who work with seniors are grappling with ways to prevent gun-related suicides and accidents, often among gun-owning older patients with dementia or depression, according to a recent review article.

People older than 65 have the highest rates of gun ownership, depression and suicide in the U.S., and while they’re less likely to be victims of violent crimes, they are more likely to become victims of their own guns, the authors write in the Journal of the American Osteopathic Association.

“Older individuals are a relatively hidden cohort of gun violence victims,” said Dr. Katherine Galluzzi of the Philadelphia College of Osteopathic Medicine in Pennsylvania.

Galluzzi and co-author Ilene Warner-Maron wrote the article in the wake of several mass shootings, when doctors began posting on social media with the #ThisIsOurLane hashtag, saying they were “in the trenches” of gun control in emergency rooms, intensive care units and trauma centers. At the same time, Galluzi said, primary care doctors are in the trenches with older patients.

“Older individuals are more likely to see their providers regularly, which puts us in a unique position of responsibility,” she told Reuters Health by email. “We may serve a primary role in preventing these tragedies from occurring.”

In their article, Galluzzi and Warner-Maron describe two tragic deaths involving seniors with compromised mental health who had guns at home.

In one, a 72-year-old widower who lived alone with his cat was hospitalized after falling down. Scans of his spine showed metastatic prostate cancer, but he rejected treatment, saying he wanted to get home as soon as possible, had lived “long enough” and was “worried about the cat.”

A social worker said he seemed despondent but was focused on going home. A psychiatric evaluation found he had major depression but was competent to make decisions. The patient was discharged with antidepressant medication. Two days later, he shot himself in the head.

“When most of us think about gun violence, we tend to think about angry young men, and they are only part of the picture,” Galluzzi said.

In the second case, an 80-year-old man with diabetes, hypertension and kidney disease began experiencing cognitive decline. He lived alone in a senior citizen apartment and received personal care services five days a week through the Area Agency on Aging. The agency assigned him the same home health aide for several months to promote stability and avert confusion.

Still, one morning, he didn’t recognize his health aide and thought she was an intruder. She tried to calm him, but he retreated to his bedroom, returned to the living room with a gun, and shot and killed the aide.

“One of the realities of aging, and illnesses that are more common with age, is that our abilities change,” said Dr. Hillary Lum of the University of Colorado School of Medicine in Aurora.

“Activities that we’ve done our entire lives, such as driving, managing our own finances, and owning and using a gun, can also be affected,” Lum told Reuters Health by email.

Galluzzi noted that the American Osteopathic Association passed a resolution that supports doctors in talking to patients about gun safety and calls for funding for the CDC and National Institutes of Health to research gun violence.

“Physicians are already doing so much on the front lines every day,” said Sonali Rajan of Columbia University in New York City. “This is one way to bring together the prevention and treatment sides of their practice.”

SOURCE: bit.ly/2QEJKXH Journal of the American Osteopathic Association, online November 20, 2018.

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