Belated diagnoses of dementia are too common, according to Dr. Melissa Henston, a geriatric psychologist in Denver who administers cognitive exams that can confirm impairment. She said many of the patients she sees have moderate or even severe dementia before being diagnosed.
“There’s denial and a false belief that a lot of cognitive problems are just normal for age,” she said. “These conversations that need to take place never take place until it’s too late.”
For Alzheimer’s disease and other dementias, there are limited treatments and no cure. About one-third of people with the disease become combative during the course of their illness, according to the Alzheimer’s Association. And more than 20 percent who develop dementia become violent toward their caretakers, a 2014 study showed.
Advocates have long warned patients and families about the potential risk of guns, said Beth Kallmyer, the Alzheimer’s Association vice president of care and support.
“The reality is, there’s no way to know who’s at risk for becoming agitated or even violent,” she said.
‘We Need To Pay More Attention’
In Minnesota, Sharon Van Leer, the 70-year-old director of diversity and inclusion at Mitchell Hamline School of Law, said she never would have predicted the phone call she got from police nearly three years ago.
Her father, Kenneth Bowser, a 90-year-old Army veteran and retired postal worker, had been living for many years with his oldest son, Larry, 65, in the St. Paul suburb of Maplewood.
At 5:30 p.m. on Sept. 12, 2015, Kenneth Bowser dialed 911.
“Who is bothering you?” the dispatcher asked him, according to a transcript of the call.
“My oldest son, oldest son and I shot him, I shot him,” Bowser replied. “He’s laying there dead, dead.”
“Where is the gun?” the dispatcher asked.
“The gun is in my hand,” Bowser said.
Van Leer said she believes her father never intended to be violent: “Daddy was never like that.”
In the 911 call, Bowser appears confused. “I’m 70 — uh, 100 — 91 years old,” he said. “I’m paralyzed on one side.”
Bowser, who had not been diagnosed with dementia before the shooting, was confirmed to have Alzheimer’s and deemed not competent to stand trial.
Now Van Leer drives 90 minutes most Sundays to visit her 93-year-old father in a locked, state-run nursing home where he’s set to spend the rest of his life. Staff wheel him out to a windowless visitation room, where Van Leer and her sister spoon-feed him nutrition shakes and give him back rubs.
Van Leer said she had noticed some signs of decline before the shooting — he would leave bacon on the stove and burn it, or forget where he put his cigars. But because she did not live with him, she said, she didn’t realize how far his dementia had progressed.
“We need to pay more attention, as our parents get older, to the changes,” Van Leer said. “They can disguise it really well.”
Removing guns from the home is the best way to prevent violence, the Alzheimer’s Association and other experts advise. But Dr. Diana Kerwin, director of the Texas Alzheimer’s and Memory Disorders program at Texas Health, said that’s not the answer for all families.
“I don’t do a blanket ‘guns are bad, you can’t have guns in the home,’” she said.
Instead, she advocates storing guns safely — locked up, unloaded, with the ammunition kept separate from the guns. Firearms can also be disabled or, in some cases, replaced with a decoy, although that raises the risk of them being mistaken for a real weapon in an emergency.
“We had one patient with a gun with rubber bands that he would shoot and he was fine with that,” Kerwin said. “He was used to shooting varmints. You try to help them maintain the lifestyle they always had.”
Hair-Trigger Tempers
Families walk a fine line, balancing independence with safety.
Christal Collins, a 50-year-old massage therapist in South Carolina, never got along with her dad. He beat her and her mother before the couple divorced, she said. But when he nearly died from spinal meningitis in 2013, Christal agreed to take him in — along with his small arsenal.
Bill Collins, a retired heavy-equipment operator and Army veteran, was so attached to his guns that he kept a .22-caliber pistol in his pocket day and night, even while he slept. On Saturdays, he’d load it with rat shot and fire the tiny pellets at snakes as he mowed the lawn. On Sunday mornings, as he watched Shepherd’s Chapel sermons on TV, he’d clean the gun and reload it with Magnum bullets.
Bill also kept a cabinet stocked with three handguns, three sawed-off rifles, three hunting rifles and a thousand rounds of ammo. While he had stopped hunting, he told his family he didn’t want to be caught without a gun when the “race war” broke out.
As he grew older and sicker, Bill shuffled around the house in slippers and didn’t seem as physically threatening, Christal said. But his bouts of aggression and paranoia grew worse, and in November 2014, after Bill had gotten lost for two hours at a local convenience store, his doctor said he was showing signs of dementia.
Christal considered sending her father to an assisted living complex, but when he found out he couldn’t bring his guns or knives, he refused to go. And she swore she would never put her parents through the neglect she saw when she worked at a nursing home. So she stayed in the house with him, in a rural, swampy stretch of Conway, S.C., not far from Myrtle Beach.
Christal tried to limit her father’s access to guns. One day, she slipped the key to his gun cabinet off his keychain — a difficult feat, since he slept with the keychain hooked to his belt. It was “war” in the house for three days, she said, as he hounded her and accused her of stealing the key. He then busted the original lock with a hammer and screwdriver and installed three new padlocks.
Bill also slept with a loaded .357 Magnum under his pillow.
“There was no gun safety,” Christal said. “Every time I tried to talk about it, it would be a fight or an argument or a problem.”
On June 14, 2015, a Sunday, her father started “cussing and ranting and raving,” accusing someone of stealing things from his room, she said. Bill, who was 75, raised his hand to hit Christal — something he hadn’t done in his old age — and her fiancé, Allen Holtzman, stepped in to intervene.
In a flash, Bill pulled the .22 pistol out of his pocket and fired at Holtzman’s chest, knocking him down to the couch.
“Dad, you shot him!” Christal yelled in disbelief. Then she saw him put the gun at the base of Holtzman’s skull. She knocked it away just as he fired.
“Wrong damn shells!” Bill declared in disappointment, discovering he had fired rat shot.
Bill aimed the gun at Holtzman’s 20-year-old daughter, and then at Christal. He had a look in his eyes “like the lights were on but nobody was home,” Christal recalled. She dragged Holtzman, who was bleeding from over 200 rat pellets, toward safety in their bedroom, as more pellets flew behind them.
As Christal talked to a 911 dispatcher on the phone, she heard two bangs. The first was her father slamming the door to his room. The second was her father taking the gun and, after replacing the cartridges, shooting himself in the head.
Some argue that people should have the right to end their lives on their own terms instead of suffer through the debilitating decline of dementia. But Christal said she hates that her father harmed others along the way. And the aftermath of a suicide can be horrific, she said.
“When you clean your dad’s brain matter off the wall, the pillow, the carpet …” she said, trailing off in tears, the trauma still raw nearly three years later, as she sat with her fiancé in their double-wide trailer home.
Holtzman, a 42-year-old construction worker, shrugged off his own injuries, saying the pellets just burned. But Christal said they were lucky her father forgot to change the ammo.
“Allen, you would’ve been dead,” Christal said.
Christal said if she had to do it again, she would have removed the guns from the home.
Though, she reflected, “I honestly don’t know if we could have taken them away.”
Giving Up The Guns
For families grappling with such decisions, one option is to establish a “gun trust” that outlines how the weapons will pass to family members once a person becomes incapacitated or dies. These trusts may make it easier for people who must give up firearms in order to move into a nursing home, for instance, said David Goldman, an estate-planning lawyer in Jacksonville, Fla., who said he has drawn up over 20,000 gun trusts. But the process works best when the gun owner complies.
“They rarely want to give up their guns,” Goldman said. Another obstacle is that gun trusts must be drawn up before dementia becomes too advanced.
Ideally, families should discuss firearm access soon after a diagnosis of dementia and consider setting a “firearm retirement date,” akin to an advance directive for guns, Betz and colleagues advise. It’s similar to discussions about taking away the car keys when driving becomes dangerous, she said.
“One of the tricky things is, for driving, there are some assessments you can do,” Betz said. “They’re not perfect, but they’re helpful. There isn’t anything for firearms.”
Doctors who routinely ask dementia patients about driving should also ask about guns, Wintemute said. Too often, though, they don’t.
“Docs say: ‘I don’t know enough about the risks and benefits, I don’t have the time,’” Wintemute said. “Only about one-third do it with any frequency.”
Critics of gun restrictions like Przebinda argue that the essential difference between driving and guns is that one is a privilege and the other is a protected constitutional right.
“The two are not the same,” he said. “You do not have a right to conveyance. You have a right to self-defense, you have a right to protecting your home and your family that’s intrinsic to you as a human being.”
He balks at any formal assessment of firearm use among people with dementia, saying it could lead to “a totalitarian system that decides when you can have rights and when you cannot.”
Instead, the decision should be left to families, Przebinda said. “People who own guns know what measures are available to them.”
Even that knowledge, however, may not be enough. Dee Hill of Oregon said it was “strictly an accident” that her husband, the retired sheriff, shot and critically wounded her. To this day, she doesn’t regret showing him the guns.
“That sounds stupid, but, no, I don’t,” she said. “He spent darn near 40, almost 50 years in law enforcement and a gun was always with him, and so to deprive him of not even seeing them, in my heart of hearts, I couldn’t deny him.”
For Verg and Delmar Scroughams of Idaho, the dilemma of keeping guns in the house remains. In a lucid moment in May, Delmar acknowledged that the weapons he’s had all his life could be dangerous.
“I got a disease I don’t know the name of and, eventually, anything could happen,” he said.
Such moments of awareness are becoming rare, Verg admitted. Soon, Delmar may no longer recognize her. As his condition worsens, she said, it’s up to her to make sure no one is harmed.
“I would feel extremely responsible,” she said. “It would be my fault.”
KHN’s coverage of these topics is supported by Gordon and Betty Moore Foundation, John A. Hartford Foundation and The SCAN Foundation
jaleccia@kff.org, @JoNel_Aleccia
heidid@kff.org, @Heidi_deMarco
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