Extreme Risk Protection Orders and Persons with Dementia in the State of Washington
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J Gen Intern Med DOI: 10.1007/s11606-020-06273-4 © Society of General Internal Medicine 2020
INTRODUCTION
Extreme Risk Protection Order (ERPO) laws allow for restricting firearm access among individuals who are at substantial risk of harming self or others. ERPOs are court orders requested by “Petitioners” to prompt the “Respondent” to surrender firearms and to prohibit purchase of new firearms. Additionally, ERPOs prevent renewals or requests for new concealed carry licenses.1 With appropriate evidence of concerning behavior, family members, household members, or law enforcement officers in Washington may request an ERPO.2 Particularly vulnerable to firearm injury are the millions of persons with dementia (PWD) living in the USA. Between 40 and 60% of this population has a firearm in home.3 PWD may exhibit combative behavior; in addition, depression is among the most common symptoms, putting them at high risk for suicide.3, 4 One retrospective study found that among veterans with dementia, the majority of suicides (73%) involved the use of a firearm.5 There is scant evidence for guidance6 related to firearm safety among PWD. Unfortunately, firearms often remain accessible beyond a point that is safe for the individual, household members, and visitors such as children. In this case, ERPOs may be a useful tool to remove firearms when there is evidence of danger. There have been no studies reported on dementia and ERPOs. We describe a case series of ERPO filings due to dangerous behavior in the context of age-related cognitive decline, dementia, or Alzheimer disease in Washington between December 2016 and May 2019.
METHODS
We identified all ERPO filings and associated county court records in Washington between December 8, 2016, and May 10, 2019.2 We narrowed our sample to include This article has not been published or presented in any format. Received July 21, 2020 Accepted September 25, 2020
cases with a mention of cognitive decline, dementia, or Alzheimer disease in the narrative of ERPO petitions or associated court documents. We report brief narrative summaries of each of the cases, ascertained through publicly available court data. The study was approved by the University of Washington Institutional Review Board.
RESULTS
During the study period, 237 individuals had an ERPO filed for them as a respondent; of those respondents, 9 (4%) were PWD, all of whom were men. One of the Respondents was Black and eight were White. Two had family members as Petitioners; the rest were law enforcement entities. ERPOs were granted for six, which resulted in the prohibition of firearms for one year. Five respondents had contact with law enforcement and/or adult protective services due to violent or erratic behavior prior to the ERPO petition filing. All but one of the individuals kept a firearm on their person or in an unsecured location; one individual kept firearms in a locked safe. A brief narrative summary of the nine cases is presented in Table 1. Common themes in the nine cases included a pattern of paranoid behavior
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