CSTS podcast series
Let’s Talk About Your Guns
Episode 1: Dementia and Gun Safety

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NOTES

AUDIO
KAREN MEUSHAW: My dad was always very safe with hisguns.
He did have guns throughout his whole life. He went hunting alot. However, he was always very good about securing them.
I never saw them except when he would go on his hunting
trips.
So I knew he had guns, my children knew he had guns, but
he always kept them locked up.
But as he approached his late 70s dementia really changedhim.
We then realized maybe the guns are not being stored how
we think they're being stored.

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KAREN MEUSHAW: My mother is not in the best of healthand I was helping to take care of the home.
One time I was changing the bed sheets and cleaning up hisroom. As I went into get his sheets to launder them, I found aloaded gun under his pillow.
And that's when I started to find guns around the house.

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KAREN MEUSHAW: They were everywhere. They werewrapped in an old box in a bag, in his closet in a shoe.
1One was hidden in a little crawlspace in the ceiling. Found
another one in a bin of antique stuff that my mom had.
He had a chair in his room, and next to it was like a little
bookshelf, and he had a tissue box. And behind that, there
was a loaded gun.
They were just everywhere. They were not stored at all in asafe place.
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KAREN MEUSHAW: We were involved with the Alzheimer's
Association because he had been officially diagnosed at thispoint. So they were able to broach the topic with him.
They had a direct conversation about guns and safety.
They made it seem like it was just a conversation that they
have with everyone that comes in.
But it fell on deaf ears.
He still believed he was fine.
He would never mistake the police for a bad guy because
they had a gun.
He would never not know his family.
So that point, I realized that there's a lot more to come.

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KAREN MEUSHAW: Over the course of time, his dementia
became much worse.
Eventually, it became not only memory issues, but paranoia.
And that's when we noticed the biggest change in him.

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He would go outside to shoot the gun in the air at night, if heheard a noise or if he thought there might be someone aroundbecause he was protecting himself and he was scaring things
away. And that's extremely worrisome.
And since we only lived down the road, we would come up atnight to check on them. That could be us he could shoot.
I felt at that point, very hopeless.
If he did something wrong, that would be the worst thing hewould ever want in his life.
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Transition to
new beat
DR WEST: Karen Meushaw’s worry was not uncommon. Her
father was one of the more than 81 million 1 Americans who
own firearms. A third of them are over the age of 65 2.

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DR WEST: What happens when an older adult begins todevelop dementia and they have firearms in the house? And
what’s the best way to help that person avoid a potentially
dangerous situation? This is a tough conversation. But
having it could save a life.

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DR WEST: I’m Curt West: psychiatrist and scientist at theCenter for the Study of Traumatic Stress at the Uniformed
Services University. Today, in NAME OF SERIES we’ll
explore some of the challenges that Karen faced in trying to
get her father to store his guns safely. We’ll also talk to Dr12

https://americangunfacts.com/gun-ownership-statistics/
https://www.pewresearch.org/social-trends/2017/06/22/americas-complex-relationship-with-guns/
3Emmy Betz, an emergency-room physician and public healthresearcher who studies firearm safety in older adults.
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DR WEST: Firearm safety in the home is built around fiveprinciples. Weapons should be stored unloaded. They should
be taken apart or stored with a disabling device engaged.
They should be stored in locked containers, and ammunition
should be stored in a separate locked container. Finally,
firearm safety in the home involves having a plan in advancefor storing guns in an alternate location during times of crisis.

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DR WEST: The conversation today is about how theseprinciples may suffer when a firearm owner experiences
cognitive decline. This might be a parent or grandparent, or ahunting buddy… really anyone in your life.
We’ll talk straight about how to have tough conversations withfriends and loved ones who might no longer be able to keep afirearm safely.
Because this podcast isn’t about whether you are for oragainst firearms. It’s about how to have open and honest
conversations about safe storage. Conversations that may
save a life.

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Transition to
new beat
DR WEST: So, Karen, tell me about your dad. Help me
understand what kind of person he was.

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KAREN: The dad that I remember before dementia, was aman who was a hard worker.
4There's a country song about daddy's hands and the hardworking. And that was my father. He was always doing
something. He got up very early in the morning to go to work.
On weekends, he would pick up extra shifts at his job on
Saturday, but come home, and gardening was the love of hislife. He had a huge garden and was well known for his
tomatoes. We used to laugh and say he was organic before
organic was cool.
He was able to provide a good home and a sturdy, steady um
financial backing for his family. And that was something hetook great pride in.
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DR WEST: Why do you think the issue of guns was so difficult
for your dad?

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KAREN: Relinquishing the guns was a huge struggle for him
because he was losing control over a lot of things.
He wasn't able to drive anymore.
And I was doing so much of the work around the house that
he used to do.
So the guns were something that I think made him feel more
powerful, and more able to defend himself and take care ofhimself.
He was always the man of the house. And even though hewasn't someone who carried guns to protect himself on anormal basis, in his older age, feeling weak, feelingvulnerable, having a bad knee, arthritis, I think that just gave
him that power.

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DR WEST: Thinking about the conversations that you tried tohave with your dad about his firearms, about safety, what was
the hardest part of it?

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KAREN: Well, the hardest part of any conversation with mydad was trying to confront the fact that he had Alzheimer's
without diminishing who he was as a human.
He didn't want anyone to know. So by talking about this, youwere making him less of the man he used to be. So you're not
only losing your independence, but it's hurting your pride.
Because now you're no longer able to make decisions, so
your family says. But in your own mind, you feel perfectly fine.

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Transition to
new beat
DR WEST: Karen isn’t the only person who has struggled withthese issues. Dr Emmy Betz researches how older adults
make decisions about guns for more than x years. She’s
heard stories like Karen’s before.

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DR BETZ: We know that about 30% to 35% of adults aged 60
and older own a firearm themselves, and then another 10% to
15% live in a home with a firearm.
Then if you sort of overlay rates of dementia, a large
proportion of older adults in the community, including thosewith early cognitive impairment, likely have access to guns.

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DR WEST: Can we take a minute and think through what aresome of the risks associated with older adults and impairment
and firearms in the home?
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DR BETZ: In the context of cognitive impairment, you have tothink about unintentional or intentional harm towards others.
We know many caregivers do experience some kind of
assaults with a person with dementia who they care for. Andso, if a firearm is present, that raises the risk certainly of asignificant outcome. But many people don't realize that the
majority of deaths related to firearms in older adults are
suicide.

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DR WEST: That's an interesting point. Suicides represent thegreater risk… yet we worry about confrontations withperceived intruders.

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DR BETZ: Yeah. And we've actually done some work, somesurveys with caregivers who are gun owners themselves,
trying to understand sort of what they perceive. And we saw
that, that they thought accidentally harming other people was
the most likely thing to happen and they saw suicide as alower risk. But of all firearm deaths in older adults, 91% aresuicide. So, suicide is by far the leading risk and the leading
type of firearm-involved death in older adults.
Suicide, particularly with a firearm is particularly traumatic forfamily members. And so, I don't think it's an outcome weshould ever be wanting. Even if a family member says, "My
dad never would have wanted to live this way," it's still
important that we be talking about how to prevent those gun
suicides because of the trauma that they can, you know, haveon the whole community around them.

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27.

DR WEST: Thinking some more about Karen's story, shewasn't initially trying to get her dad to give the guns up. She
was trying to get him to secure them and yet, she met withresistance is there success in getting older adults that arestarting to develop impairments? Is there success in getting
them to lock them up?

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DR BETZ: We don't have great data, I think, on the actual
outcomes in terms of how effective our interventions are.
There's a lot of work still to do.
What we hear from older adults is that they really wannamake the decisions themselves, which is why theseconversations ideally would start early before there's
impairment.
Ideally, the process can start sooner rather than a caregiversuddenly being faced with a kind of small arsenal of weapons.

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DR WEST: So, you know, this podcast series is about
conversations about guns and safety. Thinking about older
adults, who would you say are the people who should behaving these conversations about firearms and safety?

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DR BETZ: Very often, these might be conversations thatpeople prefer to have with, say, their hunting buddies. You
know, we heard a story from a man who goes hunting every
year with the same guys and one year said to them, "Youknow what, I'm not gonna go this year. I don't wanna get up
early and I also just feel like I'm not as safe with the gun as I
used to be, but I'll meet you for beer afterwards," right, but

8had that conversation with the people he really trusted.
Certainly, family members… I would love to see theseconversations also in things like estate planning with lawyers.
And then the last one I'll mention is health care providers. I
think health care providers absolutely should be bringing up
these topics with families and older adults. So, in one study
we did of caregivers, 80% said physicians should be talking
about firearm safety in dementia but only 5% said they had
ever had one of those conversations. So, absolutely, doctors
and other providers should be bringing these things up. Also
recognizing they're not looked at as the experts on the topic
and that's okay. Like, I think, it's important for doctors toprovide some other context around when is it time maybe to
make some decisions and then recognize that people may
look to family, friends, communities, retailers, and so forth to
get the actual advice about what to do.
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DR WEST: You mentioned the components of meeting themwhere they are and then gently nudging them in the directionthat helps them make safer choices. Can you talk a little bit
more about that and the types of pieces that are an importantpart of these conversations?

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DR BETZ: Absolutely. I see the goal of these conversations
ultimately in my view as a physician. The goal is to prevent
injuries and deaths and emotional trauma surrounding all of
that. So then, we need to recognize there are a lot of ways to
get to that point, and that's where I think we can allow andencourage choice and autonomy in individuals and in theirfamilies. So, I think it means helping someone, you know,

9think about their own values and preferences. So, do you stillwant guns in the house? Do you still feel like you need one?
Why? Is it for protection? Well, could we get you an alarmsystem instead? What are your fears? What are yourconcerns? You know, how do you think about passing theseon? Do you wanna pass them on to family members? Are you
interested in selling them because they're worth money? You
know, what is it that you would like to see happen with yourfirearms?
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DR WEST: One of the things that you've suggested thatpeople consider in having these conversations about firearms
and safety in older adults is using what's called a Firearm Life
Plan. Can you talk a little bit more about that?

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DR BETZ: Yeah. The Firearm Life Plan is something that wedeveloped based on our work with older firearm owners andfamily members, based on what they told us that they wanted
and needed.
It's a two-part process. So, the first part is what's called a
Firearm Inventory, which is basically a worksheet you fill out
for yourself to have a record of your firearms, where they are,how they're stored, but as importantly, what you want tohappen to them and when.
So, you know, maybe it's I want this hunting rifle to go to my
grandson when he turns 18, I wanna donate this historic
antique to the local museum, I want these ones taken to law
enforcement so they're out of circulation…

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That's sort of the practical part. And then step two is the also
important emotional part, which is what's called a Legacy
Map, which is a document that has prompts for you to think
about what do firearms mean to you, what has it meant to bea firearm owner to leave some of those memories for yourfamily or for future generations.
We heard over and over again from older adults that for manyof them, firearms have been a big part of their life. And so, theFirearm Life Plan is basically an acknowledgment, arecognition that planning ahead and being ready for thenegative things in life is part of what being a responsible gunowner means. And so that sort of planning for the future andplanning for things, even the things you hope never will
happen, like dementia, is part of being responsible.
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DR WEST: So, a life plan is really a tool to start a
conversation and structure that conversation.

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DR BETZ: Yeah. And having some things documented about
what you want to happen. One of the other things, the reason
it's not called...it doesn't have aging in the title or older adult inthe title is because we also heard loud and clear from older
adults that it's not about age, it's about function. And we hearthat in many other areas too, like driving and so forth. There
are people in their late 90s who are very competent to do
things still and there are people in their 30s who probably
maybe had a brain injury or something else and should not be
driving or should not have access to firearms. So, it's an
acknowledgment that things can change over our lifetime.

11And yes, these conversations become more important for
older adults given, again, unfortunately, that we all die
someday. But they can be useful really across the lifespan interms of thinking about what it means to be responsible.
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DR WEST: How do you know when it's time to start to invoke
this life plan or start to execute it. Is there good guidance on
how to, you know, how do you have...how do you say, "Okay,
remember that life plan that we made, I think it's time to go?"38.

DR BETZ: So the question when to do this and how, I think
there's a lot of parallels between firearms and driving, in termsof thinking about activities that potentially could harm otherpeople but become more difficult with age. It's like, "Okay,
you're 65, it's time to, talk about are you gonna retire and talkabout your guns and sort of talk about what you're gonna doin 10 years if you can't drive." And that's sort of looking really
far in the future.
I think there are other things that certainly should bring theconversation up sooner. A diagnosis of cognitive impairment,a diagnosis of another significant medical condition. The
cognitive piece is the biggest worry because people often
don't have the insight to self-restrict in the way they need to.
So, we see that in driving as well, that they may not realize
they shouldn't drive anymore and they start driving and then,
you know, forget where they're going. So, if family are seeing
clear impairments like significant memory problems andparticularly behavioral symptoms, so agitation, notrecognizing people, those are the kinds of things that are, like,12

big red flags that really need more urgent or emergency kindof action.
And then talking about death, talking about suicide also
should raise concern for suicide risk. It is normal to anticipate
or think about death as one ages or becomes ill, but a sort ofpreoccupation with death is not a normal part of aging. And
so, we need to recognize that depression, etc., are treatablein older adults as well, and suicide prevention is important.
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DR WEST: So, there may actually be an inflection point at
which time as the cognitive impairment proceeds where it ismaybe less of a conversation and it's just about following
through on the plan. And how is that communicated in an
effective way, in a caring way?

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DR BETZ: It's such a hard question and I think blaming things
on the disease process instead of the person can be really
important. So, acknowledging, for example, mom, dad, you've
always been the protector or you've always been really safe,
but the dementia is getting to the point where we really feellike you can't be safe anymore. Putting it in that context aboutthat it's, again, not the person and acknowledging how hard it
is.
Another thing that will vary family to family is what the plan
actually is obviously, especially if a family or a caregiver
doesn't wanna keep the firearms or isn't comfortable withthem. Those might be very different sort of conversations
about what's happening. And, for example, if a family has
decided to keep the firearms and they say, "Hey, dad, I'm

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gonna go store these at my house now because we reallyneed them or we wanna use them," that might feel better tothe older person with dementia than, "Hey, dad, we're gonna
sell these all."41.

DR WEST: What makes it hard to have this conversation withsomeone that's important to you?

42.

DR BETZ: I think it's a mix of the logistic nightmares, like, oh,
my God, what do we actually do legally? Where are the guns
stored? What are we gonna do with them all? Am I allowed to
do anything? Sort of all those, like, I put in the logistics
bucket. And the incredibly huge emotional piece of this is
uncomfortable, I don't wanna bring this up, I don't wanna
offend my parent. How am I supposed to know if they're safeor not? He's gonna be mad. Like, he's my dad, how do I talk...
I mean, it's sort of just layer upon layer of complex emotions.
And so, I think when you get those things together, it's not
surprising to me that people are really hesitant to have theseconversations, even if they recognize that they need to.

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DR WEST: One of the things that I also was just interested to
get your thoughts on was that Karen related pretty clearly that
she had to take it upon herself to be, I guess, the bad personin this whole scenario.

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DR BETZ: Oh, it's so hard. And I will just say my heart goesout to Karen and all of the individuals in situations like hers.
I remember we heard from one of the family members who we
had in a focus group saying what if I took away her gun and14then someone broke into her house and hurt her? I could
never live with myself if I had taken away her means ofprotection. And so, how do you work around that to support
the family member and the older adult to have safe outcomesbut also emotionally feel good about it so that there's not theguilt or anger or regret or any of those things.
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Transition to
new beat
DR WEST: For Karen Meushaw, the years of emotion andworry finally ended when she moved her parents into asmaller home.

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KAREN: When he moved from the larger house to the smaller
house, I just had to be tough. I just had to say, "You know
what, he can't reason. He's not listening. We just need to takethe guns." And then my mother, he was back in his room, andmy mother went back and said, "She's taking them one way
or the other. And I think she's gonna take them by force. And
if you don't give them up, she's calling the police." I know thatvery much hurt him. It didn't just anger him, but it was hard to
do because you're really taking another part of his
independence, a part of something that he valued.
At first, he was constantly looking for the guns, but over thecourse of time, his dementia became much worse where hecompletely forgot he had guns. The next doctor's appointment
the doctor asked, "Do you have any guns in the home?"
Which they always do with the geriatric visits. And he said, "I
don't know, ask my daughter. I'm not really sure if we do ornot." So by that point, he had completely forgotten about it.
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48.

DR WEST: And so there was no more confrontation after that.

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KAREN: There was no more confrontation about guns.

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DR WEST: And so, is there some key piece of advice that you
have for someone else who finds themself in this situation?

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KAREN: Probably the most important thing I would say toanyone in this situation is, trust your own feelings. You know
your parents or you know whoever, your grandparent, better
than other people do. And you need to stand up and do
what's right for everyone else and for them. And don't beafraid to make decisions that are hard. Think about what that
person would want you to do before their brain aged or before
their brain became cognitively impaired, whatever thesituation would be. Do what they taught you, live by theexample they set for you prior to that.

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Transition to
new beat
DR WEST: Seeing people we care about go through cognitive
decline is hard. Worrying about them having access to guns iseven harder. Having that conversation with them about
making safe storage decisions or even passing their guns on
to someone else is a tough conversation… but it’s one thatcan save someone’s life. Thank you to Dr Emmy Betz and
Karen Meushaw for participating in this discussion.

54.

DR WEST: You’ve been listening to Let’s Talk about Your
Guns. This podcast is made possible by The Henry M.

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Jackson Foundation for the Advancement of Military Medicine
and is produced by the Center for the Study of TraumaticStress at the Uniformed Services University in collaboration
with Podville Media.
55.

DR WEST: To learn more about our mission and for
additional resources, please visit cstsonline.org.

56.

DR WEST: Be sure to subscribe to the show on your favorite
podcast app and leave a five-star review.
Thank you for listening.

57.

PRESENTER: The views expressed are those of the
speakers and do not necessarily reflect the views, opinions, or
policies of the Uniformed Services University, the Departmentof Defense, the US Government, or The Henry M. JacksonFoundation for the Advancement of Military Medicine, Inc.

58.

PRESENTER: Mention of trade names, commercial products,
or organizations does not necessarily constitute or imply
endorsement by the Uniformed Services University, theDepartment of Defense, or the US Government or The Henry
M. Jackson Foundation for the Advancement of Military
Medicine, Inc.

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