The Imperfect Caregiver

The subject of murder-suicide is one I shuddered to even consider writing about. It would be much easier to write another piece, steeped in truth yet clothed in humor, like the one I wrote in November 2013 titled Give a Caregiver a Bath, than to tackle this subject. However if we, the caregivers and our families, don’t become educated about this issue more people will die.

I first wrote about caregiver murder suicide for my local newspaper in September 2007 when it happened to two wonderful people in a town very near where I live. Here is that article:

A Family Tragedy – A Community in Mourning

My deepest sympathies go out to the entire Nichols family in Purcellville, VA. The shocking news of the recent deaths of Edward and Margaret Nichols filled me with deep sadness. Although I never met them, I recently learned enough about these two very special people to realize that the quality of my life was enriched when I became a part of the community they helped to define. I wish that the end of their life together could have come with the same quiet dignity that defined them as they moved through our community.

Shining examples of America’s “Greatest Generation,” they served their country, raised their family, and enriched the lives of those they encountered in the quiet way of truly good people.

The list of their volunteer activities is long, the results sure to be enduring:

Margaret, known to friends as Meg, taught at the Columbia School for the Deaf in Manhattan before marrying Ed and moving to Purcellville. Later she was an active volunteer at the hospital and her church.

Ed spent his life in service to others. He served on active duty in the Navy during World War II. He was a volunteer for the fire department, served on the board of the Robey Foundation, and was a valued and active member in the Purcellville Lion’s Club. He served on the Purcellville Town Council for 20 years, the Planning Commission for 15 years and the Board of Zoning Appeals for five years.

Ed Nichols was a man who lived to help people. How then could he have killed his beloved wife of over 60 years and then taken his own life and how can we take steps to prevent something like this from happening again?

While cases of homicide – suicide among the elderly are rare they seem to be happening more often than ever before.

According to an article written by Donna Cohen, Ph.D., Professor, Department of Aging and Mental Health, Florida Mental Health Institute, University of South Florida:

“Older adults have homicide – suicide rates that are twice as high as younger adults. Each year more than 500 homicide-suicides or 1,000 deaths occur in persons 55 years and older, which means that nearly 20 older Americans die each week in a homicide suicide.”

I find those statistics shocking and I fear that others in our community are in danger.

Men are most often the perpetrators of homicide –suicides in older couples and frequently his motives are more altruistic than malicious. If a couple has been married for a long time and they are very dependent on one another the man can fear losing control when his health or that of his wife is changing. Even if the woman is not sick, a real or perceived change in the man’s health coupled with depression can precipitate the act.

About half of all homicide –suicides are the result of this type of situation and are called Dependent – Protective Homicide –Suicides.

It has been reported that Mrs. Nichols was in the later stages of Alzheimer’s disease and also had Parkinson’s disease and that Mr. Nichols was losing his vision and had hearing problems. It appears that Mr. Nichol’s last act was one of deep devotion coupled with an overwhelming sense of desperation. If only we had known we could have helped him as he helped so many others during his lifetime.

Clues to Look For
There are common clues to a possible homicide-suicide that must be taken seriously. Knowing and acting on these clues may help you save lives.

• The older couple has been married a long time and the husband has a dominant personality.
• The husband is a caregiver and the wife has Alzheimer’s disease or a related disorder.
• One or both have multiple medical problems, and the health status of one or both are changing
• A move to a nursing home or assisted living facility is pending or under discussion.
• The older couple is becoming more socially isolated, withdrawing from family, friends and social activities.
• The older couple has been arguing or there is talk of divorce or a history of estrangement.
• Since the husband is usually the perpetrator, look for the following signs.
o changes in eating or sleeping
o crying for no apparent reason
o inability to feel good about the future
o talk of feeling helpless or hopeless
o talk that the future is bleak
o talk that there is nothing they can do
o threats to harm the wife
o loss of interest in activities that used to give pleasure
o anxiety and agitation
o giving things away that are important to them
o making plans to give someone a key to the home

If your spouse is showing these changes, or if you are an adult child or relative and you see these changes in a parent, talk to them. Do not ignore these signs.

What to Do if You See Signs

• Do not be afraid to ask if the older person has thought about suicide or homicide-suicide. You will not be giving them new ideas.
• Do not act surprised or shocked. This will make them withdraw from you. Continue talking and ask how you can help.
• Offer hope that alternatives are available. Do not offer glib reassurance. It may make the person believe that you do not understand.
• Get involved. Become available. Show interest and support. If you cannot do this, find someone who can, such as a neighbor or a minister, priest, or rabbi.
• Ask whether there are guns in the house. Ask the person what plans they have to die. The more detailed the plan, the higher the risk.
• Remove guns and other methods to kill.
• Do not be sworn to secrecy. Get help from persons or agencies that specialize in crisis intervention.
• Call a crisis hotline in your area or seek the help of a geriatric specialist. Do not try to do things by yourself.

Finding Help:

There is help in the community. If you believe there is a risk for homicide-suicide, contact a professional immediately. Call a suicide crisis center, a crisis hotline, a family physician, a psychiatric or medical emergency room, or a community mental health center listed in the yellow pages of your phone book.

Related stories:

http://www.washingtonpost.com/wp-dyn/content/article/2007/09/24/AR2007092401250.html
http://www.webmd.com/depression/features/murder-suicides-in-elderly-rise
http://www.washingtonpost.com/blogs/she-the-people/wp/2013/01/26/murder-suicide-disturbing-trend-among-the-elderly/