Tuesday, August 5, 2014

Dementia and Guns: Crazy Legislative Strategy

When Gov. Nathan Deal signed Georgia House Bill 60, called the Safe Carry Protection Act last spring, the new law, which went into effect July 1, sharply contrasted with another document the governor signed recently—Georgia Alzheimer’s and Related Dementias Plan (GARD).

While House Bill 60 creates an environment where licensed gun holders can carry a weapon into any establishment, as long as the property owner has not banned them, the state’s gerontologists and service providers in aging worry that it could lead to unintended public risk as the rapid aging of the population increased the prevalence of people with dementia.

In a 2011 case in Nashville, Tenn., for example, Freeman Stafford, a 91-year-old World War II veteran with dementia, shot his daughter in the stomach. Police stated that Stafford appeared to be unaware of the shooting when they arrived. Family members told police they didn't realize the man still had a gun. He kept the revolver, given to him 25 years before, in a shoebox beside his bed.

House Bill 60 places the onus on facility managers to prohibit guns on their premises. For example, anyone bringing a gun into a church that prohibits them could pay a fine of up to $100.

The gun law not only applies to such places as restaurants or shopping malls, but licensed guns are now legal in places populated by frail and cognitively impaired older adults – county area agency on aging offices, adult day care centers, long-term care facilities and hospices.

Bipartisan Alzheimer’s Plan

It is ironic, then, that during the same recent legislative cycle, Georgia’s Department of Public Health developed and published the Georgia Alzheimer’s and Related Dementias Plan (GARD)—which Gov. Deal signed on June 23.

The GARD process is a sober recognition of the public health impact of dementia in our aging society. As families well know, paranoia and suspicion often occur with dementia. In addition, long-term care workers are developing practices to contain the aggressive behaviors of people with dementia.

The plan is the product of a six months consultation process that brought elected officials from both political parties together with patients, families, advocates and 50 experts representing education, health care, public safety, financing, housing and transportation.

The depth and breadth of this plan shows how effective state and local government can be when acting in concert with its constituents.

This is a national issue given the rapid aging of the baby boomers and increased longevity of their elderly parents. Georgia is one of more than 40 states that have enacted or are developing an organized response plan to meet the public health challenge of a dementia epidemic.

In Georgia alone, 120,000 older adults were diagnosed with dementia in 2010 — projected to reach 160,000 by 2025.

Experts also estimate that half of those living with dementia are currently undiagnosed. In fact, over 14 percent of Georgians ages 60 or older report that they have been increasingly experiencing confusion or memory loss.

Now that the state has a plan, the GARD will help to implement and oversee it. This is the genius of the GARD process and a shining example of the effectiveness of Georgia’s Council on Aging and the Coalition of Advocates for Georgia’s Elderly (CO-AGE). Since 1977, CO-AGE has met annually to identify legislative and budgetary priories for Georgia and its older adult population.

Lessons From VA Shooting

During its July 2014 meeting, CO-AGE celebrated the achievement of GARD. In the midst of this celebration, Georgia’s network of area agencies on aging (known as AAAs) took up the issue of Georgia’s new gun law. The AAA’s intend to bring this issue to the Georgia Gerontology Society held this week to advocate for a legislative amendment to exempt AAA offices and senior centers from the gun law.

Georgia’s AAAs have learned from the Veterans Health Administration (VA) that it is important to get in front of this issue. The VA launched a public awareness campaign about gun access by dementia patients after an 83-year-old veteran pulled a pistol from his pocket in August 2000 and shot a doctor in a VA hospital emergency room in Salisbury, N.C.

It is only now, that the work of the VA is entering the civilian world of public safety.

By taking up this issue, the Georgia gerontology community will become leaders in shaping a public health response to the issue of dementia and guns.

Some may ask whether there is really an extensive issue. According to materials developed by the Georgia AAA, the symptoms of dementia may cause a person to use a gun inappropriately or trigger a catastrophic reaction by another person with a gun.

Last year, for instance, Joe Hendrix, 34, shot and killed what he thought was a late night prowler. It was actually a man of 72 with advanced Alzheimer's disease in Walker County, Ga.

Hendrix killed Ronald Westbrook after the older man had walked--lost and confused--about three miles to the shooting scene from his home. With his two dogs, Westbrook wandered while wearing a light jacket and straw hat as the wind-chill temperature hovered around 20 degrees.

Following the shooting, Westbrook was found clutching letters taken from another mailbox along the road, the sheriff said. Westbrook had awakened Hendrix and his fiancée at 3 a.m., when he rang the doorbell and turned the doorknob. Hendrix has not been charged.

Legislative Strategy Questioned

Although Georgia’s gerontologists are examining legislative strategies for banning guns from locations directly concerning the seniors and staff members they serve, if successful their initiative would leave our children and their parents in public spaces vulnerable to gun violence.

When asked about this limited approach, one gerontologist responded, “I understand people who want to own guns for hunting. I kind of get those who want them in their home for protection -- even though it is irrational since they are more likely to shoot a friend or family member versus a criminal intruder. But there is at least a patina of logic there.”

He continue, “What I don’t get is the desire by many to return to Hollywood’s version of the wild west where everyone had guns on their hips wherever they went. [This is an] interesting, approach to put at least a dent in legislation [and it] is likely to pass.”

Toni P. Miles, MD, PhD, director of the University of Georgia Gerontology Institute. She was a member of the GARD Task Force. Miles is the author of Health Care Reform and Disparities: History, Hype, and Hope (ABC-CLIO), 2012.

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