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home / 世界杯决赛2022

drummond: it's time to talk about dementia, firearms and suicide

a diagnosis of cognitive impairment does not necessarily preclude safe gun ownership — but doctors aren't trained to discuss these issues effectively with families.

by dr. alan drummond

mar 20 2023
read time 4 minute read
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a rifle owner checks the sight of his rifle at a hunting camp property in rural ontario. sean kilpatrick / the canadian press
canada’s population is rapidly aging and with that change in demographic comes the sad and stark reality of increased numbers of canadians suffering with dementia.

the other known change in demographics is the overall increase in civilian ownership of firearms. since the mid-1990s there has been an estimated doubling of the number of firearms in private ownership.

when the rise in the number of patients with dementia and firearm ownership intersect, we risk the very real potential for preventable tragedy through inappropriate access to firearms, injury and death. the number of firearm suicides in canadians with dementia is not specifically tracked and so we cannot accurately count the toll.

canadians 65 and older currently account for approximately 20 per cent of the population and that number is expected to increase to 25 per cent by 2036. a recent report from the alzheimer society of canada predicts that nearly one million people in the country will be living with dementia by the end of this decade, a 65-per-cent increase in the number from those living with dementia in 2020.

with respect to firearm ownership, according to the small arms survey , canada has one of the highest rates of gun ownership in the world. it is known that 2.26 million canadians had gun licences by the end of last year, representing seven per cent of the country’s adult population; 20 per cent of canadian households owned a gun. hard data is difficult to obtain, especially since the firearm registry was cancelled by the stephen harper government, but it is estimated that there are more than 20 million guns in private possession in canada. there are wide regional variations in firearm ownership with more rural provinces having generally higher rates of firearm ownership.

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canada has one of the highest rates of firearm suicide in the industrialized world. of all firearm deaths in canada, 75 per cent are due to suicide.  u.s. studies have shown that a total of 91 per cent of all firearm deaths in older adults are suicides and firearms are the most common method of suicide among people with dementia. dementia itself may also be a risk factor for suicide.

study after study in the international literature has conclusively shown that access to firearms increases the risk of suicide and that a reduction in such access reduces that risk.

suicide is now clearly identified as an impulsive act . among people who made near lethal suicide attempts, 24 per cent took less than five minutes between the decision to kill themselves and the actual attempt, and 70 per cent took less than one hour. using a gun to attempt suicide is particularly lethal with at least a 90-per-cent success rate as compared to other methods.

further, a suicidal crisis is often temporary, and most people who attempt suicide never repeat it. in fact, more than 90 per cent of people who survive a suicide attempt do not go on to die by suicide; the prevalent myth of method substitution is unfounded. thus, the ability to restrict access to firearms for those who are contemplating suicide will save lives.
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there are, potentially, a lot of homes in canada faced with the difficult situation of caring for a loved one with dementia, and in which firearms are readily accessible. this places the loved one, the family and the community at risk. it can be surmised that this is probably more particularly true in rural communities in which there is a higher rates of firearm ownership, less access to psychiatric and specialized geriatric care and where there is also the complication of cultural issues around hunting and farming.
as with removing a driver’s licence from an aged loved one with dementia, a conversation around when it is no longer safe to have and use firearms is equally problematic.

despite an increasing emphasis on a national seniors strategy , a national suicide prevention program and a heightened awareness of the demands of dementia on family dynamics, little is being done to help families decide as to when it is time for their aged parents to give up their guns.

a diagnosis of cognitive impairment or dementia does not necessarily preclude the safe ownership of a firearm, but in cases where a person with dementia experiences significant behavioural changes such as aggression or paranoia, then it probably is time for the firearms to be removed from the home. health professionals are of little help in this regard as they are not generally taught to incorporate discussions around firearm ownership as part of a health promotion strategy.

family and emergency physicians frequently encounter persons with dementia and their families during periods of crisis and yet we seldom, if ever, ask about access to firearms and if there are any concerns with respect to access or suicide. most physicians would not know about the role of the provincial chief firearms officer and less about the proposed red flag law legislation . we thus fail in our responsibility to keep a patient safe.

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in canada, much of the current discussion around gun control relates primarily to urban gang crime, mass shootings and bans on handguns and assault rifles. the public health issues surrounding inappropriate firearm access are discussed — including suicide prevention and intimate partner violence — as if they are afterthoughts.
it is time to begin a national conversation of our aging population, dementia and firearm access. this means increasing public and professional awareness of the risks of firearms and dementia.
alan drummond is co-chair of public affairs, canadian association of emergency physicians.
 

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