Another delicate topic with aging: When is it time to give up guns?

SHOW LOW, Ariz. >> The shooting range here has been Gregg Schnepp’s second home, the place he gathers with buddies who call one another “old fogy” as they send shotgun pellets flying through the air.

But now 70 and receiving treatment for Parkinson’s disease, Schnepp, along with his wife, JoAnne, faces a wrenching, emotionally charged question: When is the right time to give up the gun?

“Shooting is about his only interest in life,” said JoAnne Schnepp, who has avoided broaching the topic with her husband, though she knows his physical and mental abilities are likely to decline. “Then I will have to look him in the face and say, ‘You will get dementia,’” she said. “And I’m not doing that.”

In a nation with widespread gun ownership and an aging population, firearm removal has been added to the burdens of caring for older relatives — alongside seizing the car keys and taking away the checkbook.

Experts in public safety and geriatric care say relatives often lack guidance in navigating these difficult conversations. Instead, they are sneaking guns from the homes of parents with Alzheimer’s, covertly disabling pistols belonging to aging sharpshooters, and in many cases avoiding the topic altogether, something that concerns people working in medicine and law enforcement.

“The number of people who have Alzheimer’s is really exploding in this country,” said Karen Postal, a Boston-area neuropsychologist who has studied the prevalence of guns in the homes of people with dementia and now counsels families on removing firearms. “The possibilities, unfortunately, are endless for some very, very unsafe uses of the gun.”

Concerns are not just hypothetical. In 2014, more than 5,000 people 65 and older committed suicide using a firearm. The same year, at least 200 people in that age group killed someone else, according to the FBI. And while homicides committed by people with dementia are not everyday occurrences, they have convulsed families across the country, with spouses, children and friends falling victim to loved ones who became disoriented, pulled guns from hiding places and then struggled to explain their actions.

Last month, the police say, Rolfe Pilati, 87, killed his wife, before shooting himself at their Virginia home. A son told investigators that Pilati had dementia. In September, a Minnesota man with Alzheimer’s, Kenneth Bowser, 90, fatally shot his son, telling investigators that he feared the son would kill him. In other recent cases, people with dementia have killed or injured friends and relatives in Oregon, Missouri, Texas, Oklahoma and Tennessee.

For many of those people, the weapons were once a source of comfort or enjoyment. But as much as 40 percent of the country’s older population has a firearm in the home, according to the Pew Research Center, and about 11 percent of people 65 and older have Alzheimer’s. The disease can have an ugly trajectory, beginning with memory lapses and ending with the kind of confusion that could result in a caregiver being mistaken for a menacing intruder.

A few law enforcement agencies have begun to recognize this potentially dangerous combination. In Denver, police training now involves learning to work with people with Alzheimer’s, including those carrying firearms. In rural Williams County, Ohio, Sheriff Steven Towns has volunteered to store firearms for aging residents, after hearing that home health aides felt uncomfortable in the presence of disoriented people with guns.

“It’s really been growing in our concern, just because of the number of elderly in our area,” he said.

Conversations around removal can be particularly thorny in places where firearms are powerful symbols of independence. Here in Arizona, they are also entrees into a social world — the shooting range — that buoys hearts and minds long after careers have ended and friends have started to die. For some people, letting go of a firearm can feel like losing a part of oneself, and removal is emotionally fraught.

The Schnepps live in the White Mountains, a rugged, woody region that is popular among retirees and hunters. JoAnne Schnepp, 72, was the caregiver for her father, Harold Phinney, a World War II veteran who kept a handgun and bullets in his office for protection. He also had dementia.

When Phinney began mixing alcohol with nocturnal wanderings and threats of suicide, his wife began to panic. “She was afraid he would use the gun and kill her,” Schnepp said. A plan was formed, and a family member removed the gun from the office. But Phinney noted its absence, went to the local firearm shop, and bought another one.

“It has literally been hell,” said Schnepp, a strong believer in the right to bear arms. “At some point, if you have guns in your life, you need to think about what you’re going to do about that.”

Alzheimer’s, the most common form of dementia, affects 5.1 million Americans 65 and older, a number that is expected to nearly triple by 2050. People with the disease can become aggressive and hallucinate, sometimes lose peripheral vision, fail to recognize loved ones and forget the purpose of an object. While those in the early stages may handle a gun responsibly, the risk of trouble grows as the disease progresses, doctors say.

The few studies that examine gun ownership among people with dementia and other cognitive disorders suggest that families are not removing guns after a diagnosis. In one assessment, which examined 106 patients at a South Carolina clinic, 60 percent of them had a firearm at home. In another, involving 495 people at a Cleveland clinic, 18 percent did.

Perhaps that is because many relatives do not know how to approach the subject. While doctors are legally permitted to give advice about gun storage, they often do not, according to a paper published in May in Annals of Internal Medicine. “Some physicians believe it is against the law to discuss firearms,” the authors wrote. Others are unfamiliar with “what to say during firearm safety counseling and how to say it.”

In Asheville, N.C., Dr. Virginia Templeton runs an outpatient clinic for people with dementia and said 40 percent of clients had a gun at home. She asks about this on an intake form, and counsels caregivers in the appropriate method of removal.

But sometimes family members do not — or cannot — follow her advice. “I’ve had people say, ‘Gosh, I’ve gotten rid of three of them, but I know there is more, and I don’t know where they are,’” she said.

In one case, she entered an examination room to find a patient with dementia wielding a pistol. In another, she received a call from the spouse of a man who had just had his driver’s license revoked. “His wife called and said, ‘I need you to know my husband just left the house and said I’ve got three bullets: one for Dr. Templeton, one for the DMV, and one for my primary care doctor.’”

On a Thursday morning in Arizona, these types of threats seemed far away: At the White Mountain Trap and Skeet Club, the talk was all about safety.

Gregg Schnepp took a bumpy seven-mile dirt road to Rubber Duck Lane, where a forest opens onto an outdoor shooting range. There were his friends — Scott, Larry, Tony, Mike, Tom and Dave — all in their 60s and 70s, all wearing noise blockers and carrying shotguns.

The men joked, took turns shooting clay birds, and assured a visitor that they would alert one another if a member became unfit to shoot.

“It would be a tough thing to do,” Schnepp said. “It’s something I wouldn’t want to hear or want to tell anybody, but if it’s necessary, it’s necessary.”

“This is a big part of my life,” he continued. His hands shook slightly, but his aim was true. “I’m not a big football fan and I’m not a golfer — but I love breaking clay birds.”