Extreme Risk Protection Orders in Older Adults in Six U.S. States: A Descriptive Study

ABSTRACT

Objectives

Extreme Risk Protection Orders (ERPOs) allow a court to restrict firearm access for individuals (“respondents”) at imminent risk of harm to self/others. Little is known about ERPOs use for older adults, a population with higher rates of suicide and dementia.

Methods

We abstracted ERPO cases through June 30, 2020, from California, Colorado, Connecticut, Florida, Maryland, and Washington. We restricted our analysis to petitions for older (≥65 years) respondents, stratified by documented cognitive impairment.

Results

Among 6,699 ERPO petitions, 672 (10.0%) were for older adults; 13.7% (n = 92) of these noted cognitive impairment. Most were white (75.7%) men (90.2%). Cognitively impaired (vs. non-impaired) respondents were older (mean age 78.2 vs 72.7 years) and more likely to have documented irrational/erratic behavior (30.4% vs 15.7%), but less likely to have documented suicidality (33.7% vs 55.0%). At the time of the petition, 56.2% of older adult respondents had documented firearm access (median accessible firearms = 3, range 1–160).

Conclusions

Approximately 14% of ERPO petitions for older adults involved cognitive impairment; one-third of these noted suicide risk. Studies examining ERPO implementation across states may inform usage and awareness.

Clinical Implications

ERPOs may reduce firearm access among older adults with cognitive impairment, suicidality, or risk of violence.

KEYWORDS:

• Cognitive impairment
• dementia
• extreme risk protection order
• firearm
• older adult

Clinical Implications

• Older adults have elevated rates of firearm suicide, and dementia can increase the risk of firearm-related injury or death in certain populations.

• Extreme Risk Protection Orders (ERPOs), available in many states, have been used for older adults with documented imminent risk of harm to themselves (1 in 2) or others (1 in 2). • To date, nearly 1 in 6 ERPOs for older adults involved cognitive impairment.

• In states with ERPOs, clinicians should consider educating families of at-risk patients about ERPO availability.

Acknowledgments

This research was funded by the National Collaborative on Gun Violence Research. The views expressed in this manuscript are the authors’ and do not necessarily reflect the view of the National Collaborative on Gun Violence Research or authors’ employers.

Disclosure statement

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

Data availability statement

A limited dataset, not including data from the state of Maryland, will be made available on Open Science Framework after publication of project-related publications.

Additional information

Funding

The work was supported by the National Collaborative on Gun Violence Research .