My father was one of some 60-plus million Americans over 65, an age demographic on track to make up nearly a quarter of the US population by 2054. Of this population, it is estimated that nearly 7 million currently suffer from Alzheimer’s or related dementias, and in 30 years, that number will grow to more than 13 million. Of those elderly with dementia, as many as half of them will live in a home with a gun.
My father and mother had more or less crash-landed in Billings in the spring of 2020, after a hard run through the early and twisted depths of my father’s dementia in the southern deserts of America. Until then, none of us kids — there are eight of us — really understood what they were going through. A resilient and private person, my mother had been run ragged by my father, scared of his increasingly delusional jealousies and controlling aggressions.
Once we reconnected with them, we were shocked by the condition of their life and his hallucinations and bizarre behavior. We reassured our mother and one another that this was happening to him, too. An illness, not something he had chosen. But until then, our mother had been living in that slow-boil metaphor of not really understanding just how out of whack and desperate their lives had become. And yes, he had several guns in their motor home. Firearms had been a constant and significant part of his life and his identity — he had possessed and carried them his entire life. They factored largely in his aggressions, too.
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When the surgeon general made his public health declaration about gun violence last month, his accompanying report twice identified people with dementia as being among those who could get unauthorized access to unlocked guns. The report states that roughly 13 out of 100,000 people over 65 committed suicide with a firearm in 2022, a rate 15 percent higher than it was a decade earlier.
But we didn’t know any of this in the summer of 2020, when we gathered in Billings to try to help our parents. Nor were there any obvious tools or resources or legal avenues for dealing with a man suffering from dementia in a home full of guns.
My father’s dangerous delusions
Researchers, physicians, and public health experts have been working hard to get information and tips about firearms and dementia to the general public. Dr. Emmy Betz, professor of emergency medicine at the University of Colorado, says progress is being made, albeit slowly, with the help of firearms enthusiasts, sellers, and associated groups who are raising awareness.
“The more we share these stories,” says Betz, an emergency room doctor with deep expertise in firearm injury prevention and dementia, “the more people will realize how unfortunately common it is. For some families, maybe it’s about taking away the car keys . . . but obviously when [the conversation] is around firearms, the potential lethality is just so much higher.”
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There are a lot of “confusing legal questions” around firearms in these situations, Betz says. To help families deal with dementia, she says, the best thing is to have a conversation about what to do with the guns before a parent is too far gone to have it. Betz and other experts have developed the Firearm Life Plan to help families have that conversation.
My family, including my mother, just hadn’t thought to have any conversation about firearms when my father first started showing signs of dementia. And once we did realize the danger, it was too late for a conversation about it. We just had to act.
“He’s down by the river and he’s got that .45 on his hip,” my mother called to tell me. “Maybe it’s not loaded.”
“No,” I said, “if he’s carrying it, it’s loaded.”
This was a couple of days after I had scoured their bus for ammunition and gathered a bagful. Somehow, since then my father had found or bought more. People with dementia can still be effective problem solvers, and my father was one of them, even though he was experiencing full hallucinations and was increasingly agitated.
My parents’ neighbors, whose land they were parked on, were worried about his access to guns, too. Especially since he had been telling them about “John,” a man he believed to be having an affair with his wife.
The next day, with permission from my mother, my brother distracted our father with a trip to the river, and I searched for all his guns. When I found the .45 semiautomatic in an open box next to a chair and pulled the slide back, a bullet popped out of the chamber. The gun was ready to fire. I instantly felt dread and disappointment, not in him but in the fact that I really did have to take his guns.
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Guns anchored my father’s sense of safety and independence as a hunter. They were integral to his life as a Montana cowboy, a country music musician, and a road construction company owner. But I simply couldn’t leave them with him. My father was being dealt one defeat after another, both imagined and real, and I felt sorrow for him.
I didn’t know for sure he was a safety risk, but I also didn’t know he wasn’t, because dementia is profoundly disorienting for everyone. Even when he seemed as if he knew what was happening around him, he would say something that showed he wasn’t connected to the world, such as calling me John. I realized to my shock and horror that my father thought that I was his wife’s paramour, the guy sleeping on their couch.
No good legal options
“If you are not in your right mind, and you have a delusion that the kid knocking on the door is the devil or a robber, of course it’s dangerous,” says Fredrick Vars, a professor at the University of Alabama law school and author of the 2017 paper “Not Young Guns Anymore: Dementia and the Second Amendment.”
And without an advance directive, he says, one can take a gun away “surreptitiously,” but that is problematic. “You are violating the autonomy of someone who at least some of the time, maybe, has decision-making capacity or would be safe with a gun. Even if the person doesn’t have decision-making capacity, that’s not good enough. They have to be dangerous in the moment” for a judge to want to take the gun.
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Because of these strict legal constraints, Vars has been working to get states to adopt Donna’s Law for Suicide Prevention, which would establish a legal way for people to ask in advance that they be turned away from buying guns if a time comes when they cannot be trusted with them.
One of the most comprehensive reports about guns and people with dementia, by Kaiser Health News and PBS, found over a four-month investigation more than 100 cases across the United States “in which people with dementia used guns to kill or injure themselves or others.”
That 2018 report’s findings about gun-perpetrated homicide and suicide presaged Murthy’s public health warning about firearms violence and those afflicted with dementia.
Surveys of caregivers of people with dementia also make clear that they have a preoccupation with firearms, particularly unintentional firings. Such accidents were a top concern among those interviewed, but fear of instigating a battle with the gun owner often meant inaction.
I can relate. I didn’t think my dad would necessarily fire on someone intentionally, but if my father’s gun had accidentally discharged, the bullet could have struck anyone — the walls of an RV won’t stop a .45 caliber bullet. I didn’t relish the prospect of confronting my father about this concern, but we decided as a family that it was worth the risk of a conflict with him to take his guns away.
Desperate measures
As Murthy’s advisory about gun violence makes clear, one thing compounding the problem of an epidemic of firearm deaths in America is that data about how guns are used and misused in America has not been collected for decades. Funding for research has been severely lacking. The NRA works hard to make sure such data is not collected. Consequently, we don’t really know how much of a danger gun holders with dementia are.
“Historical underfunding for firearm violence prevention research has created challenges for expanding the evidence-base and implementing life-saving policies,” the surgeon general’s advisory states.
The dearth of data is rooted in the political firestorms that flare any time guns and regulation are mentioned in the same sentence.
“I don’t think policy is the only way we’re going to fix this,” ER doctor Betz says. “I think the reason we are moving forward is there has been an incredible amount of work over recent years in developing and testing different kinds of interventions for different communities.”
For example, says Betz, normalizing safety practices by using language that will speak to gun owners is an important step. “What I would really like to see is a broader cultural change that’s not even specific to the dementia issue. The first is that a gun should always be stored securely and inaccessible to unauthorized people. I think of that as like putting your seat belt on every time you get in the car because you don’t know what that day is going to bring.”
My family didn’t get that far with my dad. Our father’s situation was beyond “normalizing” conversations about gun safety. Still, I am bothered by the fact that I didn’t have a legal right to take my father’s guns, to which he had a Second Amendment right.
One legal tool available to family members of people with dementia is the Extreme Risk Protection Order, known colloquially as a “red flag” law. Unfortunately, ERPOs are very hard to obtain. Massachusetts, one of 21 states that have ERPO laws, adopted its version in 2018. Since that time, only 66 petitions have been filed, with mixed outcomes. A 2020 study of ERPO actions in Washington state found that of 237 filed, nine were for gun owners with dementia, and of those, only six were granted for the removal of firearms, and then only for one year.
Another potential but difficult-to-get tool for taking firearms out of the home of a loved one with dementia is a custodial appointment. This wasn’t possible in my family for a range of personal, complex family reasons — not the least of which was that our father would never have agreed to one. We also lacked the knowledge and resources to take legal custody of our father in the time frame available to us.
A son’s dilemma
As my eyes came into focus the morning I found my father rooting around in the step well, I saw that he was dressed in jeans and a button-up shirt. My parents’ dog wiggled next to him at the top of the steps, ears perked, tail swishing. At first, I figured my father must be trying to get the door open to let her out.
I had taken my mother, Colleen, to a hotel the night before so she could get some rest after months of being on her last nerve. My father would occasionally ask where she was, and I would say the same thing: “Don’t worry. She’s just getting some rest and will be back first thing in the morning.” I didn’t think he knew who I was, but the information seemed to make sense to him.
At one point that night, my father came into the living room and sat down in a chair next to me, newly changed into a clean baseball-style cap and clothes, shirt cuffs turned back one easy fold, gold watch, freshly shaved face gleaming. A man of the world, ready to go it alone.
“So,” he said, “you and Colleen are hitting it off pretty good.”
I was stunned. He didn’t look at me. His hands folded, he was a jilted man, nodding slowly with pursed lips. He seemed to be anticipating a fight.
“Yeah, she’s my mother,” I said, “so we hit it off pretty good.” I realize I could have given a better answer, one that took into account that I was dealing with a man in the grip of a disease that was robbing him of his mind.
His face shattered, a startled reaction at the realization that he was speaking to his son.
“And you are my father,” I said. “I’m Junior.”
“You are? Oh, I — " It broke him down. “I guess — I’ve been — my memory ain’t what it used to be. It’s — embarrassing. Don’t say, ‘I’m your son.’ Just say, ‘Dad’ and maybe say your name.”
“Okay, Dad,” I said. “I’ll be here tonight to hang out with you, Dad. I’ll pick up Mom first thing and bring her home.”
I thought that calling him Dad repeatedly was working. Then I slept until he started wandering around naked, which didn’t trouble me; he wouldn’t wander around naked in front of a stranger, would he? We were father and son getting through a long, anxious night together. I felt relief.
Then came the scraping at the step well.
I felt a chill, dread, and almost terror when I realized what he was doing.
He was digging for the .22 semiautomatic pistol that he’d had stashed there for years and that I’d taken a few days before. My mouth went dry. I swung my feet over onto the floor. “Good morning, Dad,” I said loudly, cheerfully. I had slept in my clothes and slipped into my shoes. “How’s it going, Dad?”
He stood up and pulled his belted pants up, like ‘Hey, nothing going on here.’ He nonchalantly stepped up out of the well, shooed the dog away. “Going just fine.” He sat and smiled a cold smile of violence I’d seen plenty during my life with him. He could be loving and kind, but he also grew mean and violent when he felt insulted or threatened.
Right then, I felt profound relief that I’d removed all the guns from my parents’ home.
A sheriff’s deputy had joined us when I brought my mother back to the RV that morning, and with the deputy’s help, we took my father to the hospital. I never saw him again. My mother remained by his bedside until he died a few days later.
“This is where a part of me wants to yell at lawmakers,” Betz said after hearing my story. “It’s time for us to be grownups and have a conversation, and it might be that we have to find some compromises. But there are families out there who are facing these tough situations, and I don’t think it’s fair to just be paralyzed.”
This article was updated on July 24 to correct the description of what Donna’s Law for Suicide Prevention would do.
Jake Berry Ellison Jr. is a freelance journalist who has written for The New York Times, NPR, Esquire, the San Francisco Chronicle, and other publications. For 25 years, he was an editor and reporter at newspapers in the Pacific Northwest, including a decade at the Seattle Post-Intelligencer.
