Anticipatory firearm safety planning among older adult firearm owners: Attitudes toward physician involvement

BACKGROUND: Firearm access in the setting of cognitive decline represents a critical but underrecognized risk for suicide, homicide, and unintentional injury. Despite this, anticipatory firearm safety planning for individuals at risk of dementia remains poorly studied. Understanding patient perspectives, particularly regarding physician involvement, may identify opportunities for upstream injury prevention. METHODS: We conducted a cross-sectional survey of adults aged ≥60 years with firearm ownership or household firearm access, recruited from inpatient and outpatient settings at a single Level I academic trauma center (2023-2025). The survey assessed demographics, firearm practices, prior discussions regarding firearm management in anticipation of dementia, and attitudes toward physician involvement. Unadjusted and multivariable logistic regression analyses were performed to identify factors associated with prior planning and opposition to physician involvement. RESULTS: Among 105 participants, 21 (20%) reported prior discussions regarding firearm management in anticipation of dementia. Following survey participation, 70 (66.7%) reported intent to initiate such discussions, representing a 142% increase. When asked about physician involvement, 40 (38.1%) were open, 51 (48.6%) opposed, and 14 (13.3%) were undecided. In multivariable analysis, married participants were more likely to oppose physician involvement (adjusted odds ratio [aOR] 3.12, 95% CI: 1.20-8.16). In sensitivity analysis including undecided respondents, loaded firearm storage (aOR 2.51, 95% CI: 1.01-6.22) and above-basic firearm experience (aOR 2.79, 95% CI: 1.11-7.01) were also associated with opposition. CONCLUSIONS: Most older adults with firearm access have not engaged in anticipatory firearm safety planning related to dementia; however, brief exposure to this concept may substantially increase intent to do so. Physician involvement is not universally accepted, highlighting the need for patient-centered approaches that respect autonomy. Anticipatory firearm safety planning represents a promising, underutilized strategy for injury prevention in aging populations at risk for cognitive decline. LEVEL OF EVIDENCE: Level V.