From the Editor: Having the Hard Conversations
For families and physicians, many conversations with or concerning patients with cognitive impairment are difficult. The subjects are hard to broach and the tone can become contentious; no one wants to have these talks. This is especially true when they concern what might be perceived by patients as a revocation of privileges or infringements on autonomy. Families may struggle with decisions about when to take away the car keys as older adults approach the point of posing a threat to themselves or others. An even more challenging conversation these days revolves around the already controversial topic of gun ownership.
Family members of those with Alzheimer’s disease or other dementias may be reluctant, even fearful, to bring up the subject, let alone insist that their loved ones relinquish their guns. And when families fail to raise the issue, it’s often left to providers to step in—a role that patients may perceive as interference or unnecessary policing of their rights. When age and illness have already taken so much away from them, further erosion of their independence may be exceedingly painful.
For many, gun ownership is a key part of identity going back decades. For some, retaining firearms is an assertion of perceived rights, and for others, it’s fundamental to their need to protect themselves and their families, even if their ability to do so has become questionable. And to suggest that they may be not only incapable of protecting their families but, in fact, actually putting their families at risk is likely to add insult to injury.
Sometimes it’s the family member who needs to be encouraged to take steps to remove firearms from the home. Convinced their loved ones would never harm them, they may fail to appreciate the consequences that could result when an individual with confusion, delusions, and paranoia—possible features of dementia—handles a gun.
However challenging, it’s talk that’s essential. A large percentage of individuals older than 65 live in a home in which a firearm is present. Kaiser Health News has reported on more than 100 cases in which individuals with dementia have used firearms to kill or injure themselves or others.
In this issue’s cover story, Kathy A. Miller, a caregiver coordinator at Long Term Care Authority of Enid Area Agency on Aging in Enid, Oklahoma, explores this important issue and the provider’s role. It’s up to clinicians to start the conversation.