A growing number of older adults living with cognitive decline continue to have access to firearms, prompting public health experts to seek ways to reduce the risk of injury and death among this vulnerable population.
A recent case highlights the concerns. A 72-year-old retired health administrator near Seattle, who had mild cognitive impairment—a condition that can precede dementia—and depression, reported owning two firearms: a shotgun and a .45-caliber pistol. Both were kept unsecured in his bedroom, with the pistol loaded in a nightstand drawer. The man retained the guns largely for self-protection, reflecting a common theme among older gun owners who view firearms as integral to their sense of security.
Experts emphasize that this combination of cognitive challenges and firearm access presents an alarming risk. Studies estimate that at least a third of individuals with dementia live in homes with firearms, and the majority of gun deaths among older Americans result from suicide rather than homicide or accidents. According to data from the Centers for Disease Control and Prevention, firearms were responsible for 8,226 deaths among people aged 65 to 85 in 2024, averaging nearly 23 deaths daily.
Research indicates that persuading older adults to relinquish firearms is often difficult because guns represent more than just tools; they are tied to identity and autonomy. “You’re taking away their identity as a protector,” said Kelsey Cornick, a researcher at the University of Washington’s Center for Firearm Injury Prevention. Instead, harm reduction strategies focusing on safe storage—unloading guns and securing them with locks or lockboxes—have shown more success. Programs distributing free safety devices have been implemented to promote these practices.
Attention is also turning to those with early signs of cognitive decline who have not yet received a formal dementia diagnosis but experience worsening memory or confusion. A survey conducted across seven states found that a third of adults over 65 reporting such subjective cognitive decline had firearms in their homes, and about a quarter of those did not securely store their weapons. These individuals may be at elevated risk of suicide, accidental discharge, or unintended shootings of family members and caregivers.
Health professionals face challenges initiating conversations about firearm safety with older patients. Only a small fraction of caregivers—approximately 5 percent in one study—reported discussing firearm risks with medical providers. Patients may withhold information about gun ownership due to fears of confiscation, though most states do not have laws mandating gun removal based solely on a dementia or depression diagnosis. Families, too, often hesitate to address firearm concerns to avoid conflict that could strain relationships.
In response, researchers and clinicians are developing resources to aid these discussions. Initiatives include video guides for clinicians, community-based safety programs distributing locking devices, and online tools like Safety in Dementia that assist caregivers in planning for firearm access as cognitive abilities decline. The Firearm Life Plan, an online resource used by nearly 16,000 people since 2022, helps gun owners document preferences for handling firearms when they can no longer manage them safely.
Some experts advocate integrating firearm safety assessments into routine care. Dr. Lena Makaroun, a geriatrician at the University of Pittsburgh, proposes including such discussions in annual Medicare wellness visits, a setting that reaches a significant portion of older Americans. “That’s something we can all get behind,” she said. “It’s nonpolitical. Firearm owners by and large are very invested in safety.”
Despite these efforts, the consequences of inaction can be dire. Dr. Makaroun recalled a patient in his 80s who, after receiving a dementia diagnosis and without evident signs of depression, died by suicide with a firearm shortly thereafter. Such cases underscore the urgency of addressing firearm safety proactively among older adults experiencing cognitive decline.