Homicide-Suicide in Older Persons:
How You Can Help Prevent a Tragedy

Written by

Donna Cohen, Ph.D.
Professor
Department of Aging and Mental Health
Florida Mental Health Institute
University of South Florida
13301 Bruce B. Downs Blvd.
Tampa, FL 33612

Office: (813) 974-4665
Fax: (813) 974-1968
E-Mail: cohen@fmhi.usf.edu

Background

Homicide-suicides are tragedies that appear to be occurring more frequently in the U.S. than ever before. In these circumstances, a perpetrator, usually a man, kills a victim, usually a wife or intimate, and then commits suicide shortly thereafter. Almost all homicide-suicides in older persons involve a husband who kills his wife before killing himself.

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.

Although these events are relatively rare, they have a traumatic impact on surviving family members as well as neighbors and friends in the communities where they occur. The motivations for homicide-suicide are complex. These lethal actions result from many factors. They are not impulsive actions. The older perpetrator has usually thought about the act for several months and sometimes years. This means that you have a window of opportunity to help prevent a homicide-suicide.

Types of Homicide-Suicide

Homicide-suicides in older persons are not suicide pacts. Homicide-suicides are also not acts of love or altruism. They are acts of desperation and depression. At least half of the perpetrators are depressed or have other psychiatric problems that are undetected and untreated.

There are at least three types of homicide-suicide in older couples. A common feature in all three is a perception by the husband of an unacceptable threat to the relationship. This threat could be a pending move to a nursing home or assisted living facility, a real or perceived change in health, or even marital conflict and domestic abuse. The victim is usually not a willing or knowing participant. Most are shot and killed in their sleep.

About half of all homicide-suicides are called Dependent-Protective Homicide-Suicides. The couple has been married a long time, and they are very dependent on each other. The man fears losing control when the health of one or both is changing or if he believes it 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.

A variation is the Caregiver Dependent Homicide-Suicide, where depression coupled with increasing isolation and multiple stresses produces helplessness in the male caregiver and triggers the act.

About 30% are Aggressive Homicide-Suicides, where there is a history of marital problems or domestic violence. This is more common in couples in their 60's, but it does occur in older couples. However, the perpetrator is usually much older than the victim. A pending or real separation, restraining orders against the husband, and threatening behavior are common features. Domestic violence does occur in older couples!

A third type is a Symbiotic Homicide-Suicide. This occurs in about 20% of cases. The husband and wife are usually very old and highly interdependent on each other. Both are usually sick. The male usually has a dominant personality and the woman is often submissive.

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.
  • changes in eating or sleeping
  • crying for no apparent reason
  • inability to feel good about the future
  • talk of feeling helpless or hopeless
  • talk that the future is bleak
  • talk that there is nothing they can do
  • threats to harm the wife
  • loss of interest in activities that used to give pleasure
  • anxiety and agitation
  • giving things away that are important to them
  • 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.