September 28, 2011

USA: Murder-suicides among elderly an act of desperation

LEVITTOWN, Pennsylvania / Courier Times / News / September 27, 2011

By Jo Ciavaglia, Staff writer

They lived together and died together, but this was no romantic ending for the Middletown couple. Murder-suicide is what the coroner called it.

Jeanne Hoez, 90, had advanced Alzheimer’s disease, a progressive illness that left her unable to respond to her environment. Her husband, Charles, 92, was at his “wits’ end,” according to Bucks County Coroner Dr. Joseph Campbell.

Police believe that Charles strung a hose from the couple’s minivan through their first-floor bedroom window and pumped deadly carbon monoxide into the home. Their son, who lives in Upper Bucks County, found them dead in their bed Monday morning.

Police officers and the Bucks County coroner’s office remove the bodies of Charles and Jeanne Hoez from their home in Middletown. The couple, both in their 90s, died of apparent carbon monoxide poisoning. Steve Gengler / Staff Photographer

The Hoez murder-suicide is at least the third in Pennsylvania involving an elderly couple reported since June, a scenario that mental health experts say is driven by desperation, not adoration.

Nationally, suicide rates among adults over age 60, in general, are climbing, according to mental health and suicide prevention groups. Suicide rates among 65- to 74-year-olds jumped from 12.6 to 13.9 per 100,000 in that age group between 2007 and 2008, according to the American Foundation for Suicide Prevention. That was the biggest one-year increase among all age groups, according to the foundation.

In Bucks County, where senior citizens represent about 14 percent of the population, they also account for one quarter of the 60 suicides so far this year, according to the county coroner’s office. The numbers include five people between 80 and 97 years old; men account for 15 of the 16 suicides among those age 60 and older.

Last year, people age 60 and older accounted for 13 of the 78 suicides in Bucks County.

Neighboring Montgomery County also has seen a slight bump in suicide numbers among senior citizens, Coroner Dr. Walter Hofman said. Last year, people 65 and older accounted for 11 of the 101 suicides in that county; so far this year 16 of the 75 suicides have been among that age group, he said.

Nationwide, at least six other murder-suicides involving elderly couples have been reported since May, according to news reports.

Since 1988, the homicide-suicide rate among couples 55 and older in Florida has increased about tenfold, according to Donna Cohen, a professor of psychiatry and behavioral sciences at the University of South Florida’s department of aging and mental health.

Cohen, who has studied murder-suicide among the elderly, has found that the typical case involves a depressed and controlling husband who shoots his ill wife. Cohen lists a husband who is the primary caregiver for a wife with Alzheimer’s or a similar disease as a potential risk factor for a murder-suicide scenario.

Generally, older adults are more likely to experience social isolation, loss of independence, declining physical health, loss of a spouse and distress over finances. They are considered significant suicide risk factors, behavior health experts say.

But older men particularly see depression as a sign of weakness or failure. The social stigma of mental illness is so strong that they refuse antidepressants or psychotherapy, even if they are diagnosed.

A fear of losing control of their relationship, frustration over a long illness and a lack of community support are typically what motivates elderly men to kill a spouse, then kill themselves.

Family and friends may also dismiss classic suicide warning signs, such as depression or changes in personal hygiene, as a normal part of the aging process, but they are not, said Sharon Curran, chairwoman of the Bucks County Suicide Prevention Task Force.

“A lot of it, I think, goes back to caregiver stress and feeling there is no out for them,” added Curran, associate director of clinical services at Lenape Valley Foundation, which has a special in-home program for people age 60 and older who are reluctant to use traditional mental health services.

Taking care of a sick wife is particularly stressful for older men who generally lack the temperament for it, said Patrick Arbore, director of the Center for Elderly Suicide Prevention at the Institute on Aging in San Francisco.

“Watching his wife deteriorate, due to whatever illness, can be very, very stressful on a man whose main role in life was not the caregiver role,” he said.

Jo Ciavaglia
Twitter: @jociavaglia

Figures are from the National Center for Health Statistics
Source: American Foundation for Suicide Prevention
Source: Donna Cohen, professor of psychiatry and behavioral sciences at the University of South Florida’s department of aging and mental health

Signs of suicidal behavior among the elderly

Adult children should be aware that the following situations are risk factors for murder-suicide:

■The 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 similar disorder.
■One or both have multiple medical problems, and the health status of one is changing.
■A move to a nursing home or assisted living facility is pending or under discussion.
■The couple is becoming more socially isolated, withdrawing from family, friends and social activities.
■The couple has been arguing or there is talk of divorce.

Source: Donna Cohen, professor of psychiatry and behavioral sciences at the University of South Florida's department of aging and mental health
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