Firearm safety and suicide prevention in older adults: a primary care clinical framework

Firearm-related injury and suicide represent a critical public health challenge in the United States, with older adults experiencing the highest rates of firearm suicide. Approximately 70 % of suicides among older adults involve a firearm, with white males over age 70 at the highest risk. Despite high household firearm access and unsecured storage, standardized screening and counseling in primary care remain underutilized. Primary care physicians are uniquely positioned to identify clinically vulnerable patients and evaluate lethal means safety through longitudinal relationships during routine encounters. This clinical practice report presents an evidence-based framework for firearm suicide risk assessment, clinical communication, and safe storage counseling tailored to older adults. Clinicians should evaluate key vulnerabilities, including depression, cognitive decline or dementia, substance use disorder, veteran status, living alone, recent bereavement, and serious medical diagnoses. Utilizing nonjudgmental language rooted in motivational interviewing builds trust and reduces defensiveness. Validated clinical tools provide structured guidance for lethal means safety discussions. Recommending practical storage devices, such as biometric safes, rapid-access lockboxes, or cable locks, balances patient autonomy with risk reduction. Incorporating firearm safety discussions into routine visits, like Medicare Annual Wellness Visits, through team-based care and community partnerships makes workflow implementation feasible while respecting local and personal firearm culture. Normalizing firearm safety counseling within routine health maintenance supports whole-person care, preserves patient dignity, and ultimately helps prevent firearm suicide among older adults.