Let’s Talk About Firearms: Perspectives of Older Veterans and VA Clinicians on Universal and Dementia-Specific Firearm Safety Discussions

ABSTRACT

Objectives

Veterans experience high rates of fatal and non-fatal firearm injuries. This risk may be compounded among Veterans who are rural-residing, aging, and/or experiencing cognitive decline or dementia. Firearm safety discussions are not broadly implemented across Department of Veterans Affairs (VA) healthcare settings due, in part, to concerns of causing Veterans to disengage from care. This study examines perceptions about firearm safety discussions to inform healthcare-based harm-reduction efforts.

Methods

We conducted interviews with 34 Veterans (median age 70) and 22 clinicians from four VA facilities that treat high rates of rural patients with firearm-related injuries.

Results

Most Veterans accepted the idea of universal firearm safety discussions at the VA. Some reported they might not be forthright in such discussions, but raising the topic would not stop them from engaging with VA care. Veterans and clinicians unanimously endorsed firearm safety discussions for older patients experiencing cognitive decline or dementia.

Conclusions

VA patients and clinicians are amenable to firearm safety discussions during healthcare visits and especially endorse the need for such discussions among high-risk populations.

Clinical Implications

Universal firearm safety discussions could be incorporated into standard VA practice, particularly for Veterans experiencing cognitive decline or dementia, without risking Veteran disengagement from care.

KEYWORDS:

• Dementia
• firearms
• lethal means counseling
• older adults
• veterans

Disclosure statement

No potential conflict of interest was reported by the author(s).

Clinical Implications

• Older Veterans and VA clinicians are amenable to universal firearm safety discussions in the VA, particularly for older Veterans experiencing dementia or other cognitive decline.

• Veterans do not endorse the belief that firearm safety discussions would turn them away from VA care.

Additional information

Funding

This work was supported by funding from the United States Department of Veterans Affairs Office of Rural Health, Veterans Rural Health Resource Center – Portland, under Grant (OMAT #15528).