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

Marian E Betz^{1

2

3}, Shannon Frattaroli⁴, Christopher E Knoepke^{2

5

6}, Rachel Johnson⁷, Annette Christy⁸, Julia P Schleimer^{9

10

11}, Veronica A Pear⁹, Megan McCarthy², Reena Kapoor¹², Michael A Norko¹², Ali Rowhani-Rahbar^{10

11}, Wenjuan Ma¹³, Garen J Wintemute⁹, Jeffrey W Swanson¹⁴, April M Zeoli^{15

16}

Affiliations

¹ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
² Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA.
³ VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA.
⁴ Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁵ Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁶ Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁷ Center for Innovative Design & Analysis, Department of Biostatistics & Informatics, Colorado School of Public health, Aurora, Colorado, USA.
⁸ Department of Mental Health Law and Policy at the de la Parte Florida Mental Health Institute, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA.
⁹ Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA.
¹⁰ Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA.
¹¹ Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.
¹² Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
¹³ Center for Statistical Training and Consulting, Michigan State University, Lansing, Michigan, USA.
¹⁴ Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁵ Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, Michigan, USA.
¹⁶ Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA.

PMID: 37688772
PMCID: PMC11229607
DOI: 10.1080/07317115.2023.2254279

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

Marian E Betz et al. Clin Gerontol. 2024 Jul-Sep.

. 2024 Jul-Sep;47(4):536-543.

doi: 10.1080/07317115.2023.2254279. Epub 2023 Sep 9.

Authors

Affiliations

¹ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
² Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA.
³ VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA.
⁴ Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁵ Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁶ Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁷ Center for Innovative Design & Analysis, Department of Biostatistics & Informatics, Colorado School of Public health, Aurora, Colorado, USA.
⁸ Department of Mental Health Law and Policy at the de la Parte Florida Mental Health Institute, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA.
⁹ Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA.
¹⁰ Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA.
¹¹ Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.
¹² Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
¹³ Center for Statistical Training and Consulting, Michigan State University, Lansing, Michigan, USA.
¹⁴ Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁵ Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, Michigan, USA.
¹⁶ Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA.

PMID: 37688772
PMCID: PMC11229607
DOI: 10.1080/07317115.2023.2254279

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.

PubMed Disclaimer

Conflict of interest statement

Disclosure statement

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

Figures

**Figure 1.**
Outcomes of ERPO petitions among respondents aged ≥65 years (n = 672), by documented presence (N = 92) or absence (n = 580) of cognitive impairment.

See this image and copyright information in PMC

References

1. Alothman D, Card T, Lewis S, Tyrrell E, Fogarty AW, & Marshall CR (2022). Risk of suicide after dementia diagnosis. JAMA Neurology, 79(11), 1148–1154. 10.1001/jamaneurol.2022.3094 - DOI - PMC - PubMed
1. Barnard LM, McCarthy M, Knoepke CE, Kaplan S, Engeln J, & Betz ME (2021). Colorado’s first year of extreme risk protection orders. Injury Epidemiology, 8(1), 59. 10.1186/s40621-021-00353-7 - DOI - PMC - PubMed
1. Betz ME, McCourt AD, Vernick JS, Ranney ML, Maust DT, & Wintemute GJ (2018). Firearms and dementia: Clinical considerations. Annals of Internal Medicine, 169(1), 47–49. 10.7326/M18-0140 - DOI - PMC - PubMed
1. Betz ME, Miller M, Matlock DD, Wintemute GJ, Johnson RL, Grogan C, Lum HD, Knoepke CE, Ranney ML, Suresh K, & Azrael D (2021). Older firearm owners and advance planning: Results of a national survey. Annals of Internal Medicine, 174(2), 279–282. 10.7326/M20-2280 - DOI - PMC - PubMed
1. Betz ME, Polzer ER, Knoepke CE, Prater LC, Simonetti JA, Lee TM, Meador LE, Nearing KA, & Bowers B (2022). Cars, guns, aging, and “Giving up the keys”. The Gerontologist, 63(4), 717–730. 10.1093/geront/gnac142 - DOI - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

K23 HL153892/HL/NHLBI NIH HHS/United States

LinkOut - more resources

Full Text Sources
- Atypon
- PubMed Central

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources