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

Betz, M. E., Frattaroli, S., Knoepke, C. E., Johnson, R., Christy, A., Schleimer, J. P., Pear, V. A., McCarthy, M., Kapoor, R., Norko, M. A., Rowhani-Rahbar, A., Ma, W., Wintemute, G. J., Swanson, J. W., & Zeoli, A. M.


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.