For me, I would start with recoil sensitivity and work from there. It is hard to choose a firearm for someone you have never met. If they are elderly or have medical issues, how often are they going to practice? When I read the title of the thread, my first thought was a Ruger Mark IV .22 pistol. Just the basic model. It is a great pistol with little to no recoil. I have a target Mark II with the slab-sided barrel, so that's the only experience I have with the Ruger Mark pistols. BTW, the stock trigger is so sweet, I don't know why the lawyers allowed to leave the factory! Just by .02 cents.