One does not normally associate Homicides or Suicides with Alzheimer's disease. Alzheimer's is however, a very close and frequent connection to one or the other of these sad and sometimes violent events.

Every day somewhere in the United States, there are two or more suicides  or combination suicide-homicides committed in a family unit and as a result of the disease of Alzheimer's.

Four (4) basic types or patterns

a.  The Alzheimer's victim takes his or her own life as a Suicide.

b.  The spouse of an Alzheimer's victim is overcome by grief takes his or her own life in Suicide.

c.  The spouse of an Alzheimer's victim murders the victim in a so called "Mercy Killing".

d.. .The spouse of an Alzheimer's victim murders the victim and then commits suicide.

Suicides and Alzheimer's

Suicides - An Overview/Synopsis: Elderly people are at the greatest risk for suicide. Every half hour another elderly person in the U.S. commits Suicide. One third are married, One half are living with other household members. The majority are white males. Two thirds are in relatively good physical condition, have an active social life and have recently seen a doctor. Many are in severe depression. Firearms are the means of choice for 59-60%. Causes range from psychiatric illness (depression), Neurological illnesses (Alzheimer's), terminal malignant illnesses (Cancer) and Social Isolation. Early stage Alzheimer's always presents an increased risk of suicide.

The Alzheimer's suicide alone, normally would not make the news. It is when there is a homicide associated with the suicide that it becomes a news story. This is in spite of the fact that Suicides are far more prevalent than homicides (double the rate) in our society. When suicides and homicides are compared to disease and accidental deaths, (2007 data) suicides are the 11th leading cause of death in the United States (33,185) while Homicides are the 15th leading cause of death. (17,520)

Suicides of the elderly regardless of cause get very little public notice. That is in spite of the fact that people over 60 are said to be six (6) times more likely than the rest of the population to kill themselves. The reasons for the public apathy is said to be a part of the way that the elderly are viewed. The elderly are looked at as an "expendable" part of the population. Minnesota state epidemiologist Jon Roesler is quoted as saying: "There's an old maxim, "A young man may die. An old man must die."

When there is a murder associated with the elderly suicide, then it becomes a news story.

To their credit, The Minneapolis Star Tribune did a front page story on Suicides of the elderly in their March 28th edition. The story by Jim Spencer was headlined as: "A Dark Trend That's Difficult to Combat"  and "Relatives are Left Confused, Isolated and Full of Grief." This story had particular interest to me not only because it related to the elderly, but because it gave the case histories of two elderly Minnesota Alzheimer's victims among the five cases discussed. While this number may not be statistically relevant of significant, it was a 40% ratio and does suggest a high prevalence of suicide among the Alzheimer's victims.

A brief review of one of the cases that has sufficient details, will perhaps serve to provide some insight into the cause of such sad events.

Don Langland, Age 79, retired Master Craftsman of Pequot Lakes, MN. "When Langland bade his wife of 56 years goodbye as she headed off to Bible study one night last spring, no one had a clue what he intended to do. Langland, took his glass off eyes that no longer saw well enough to make perfect cuts. He took his wedding ring off a hand that was losing the coordination required to frame buildings. He retrieved a shotgun from a locked safety vault he had built, shuffled into his back yard on the crutch he needed to support an increasingly unsteady body, duct taped his weapon to his crutch so his aim would be true and shot himself."

Langland was described as having seen how Alzheimer's/dementia had devastated his mother before him. His wife Shirley described him: "he continued to have embarrassing bouts of confusion that made life unbearable for a high school dropout who once carried the equivalent of blueprints in his head. Not being able to work or plan in his mind, Don was finding it more convenient to sit in a chair with the TV going full blast...for a real active man I felt sorry for him, because that was not his life."

Editorial Notes/comments: There is reference to Doctors at the Department of Veterans Affairs trying three separate antidepressants on Langland. This is in spite of there being NO anti-depressants approved by the FDA for use on Alzheimer's or dementia patients. Don, apparently without hope, decided he would not allow his family to go through what he had gone through with his mother. It appears that he was still in the early to the early-middle stages of his disease in order that he was able to plan his suicide. The early stages appear to present the highest risk.

The Netherlands has legal assisted suicide. It is reported that 22% of those diagnosed with Alzheimer's elect assisted suicide.

There is an online blog entitled: "Had a Dad" Alzheimer's Blog".  (Tuesday September 5, 2006.)  I reviewed the (8) eight comments to the blog. Most (7) of the comments suggest that the reader would commit suicide if they were to be diagnosed with Alzheimer's or if already diagnosed, will do so.    (1.) "My husband just told me that he intends to commit suicide before he becomes incompetent from dementia"...(2.) "my father in law has late stage AD...I will commit suicide before I let myself be taken care of like he has to be"....(3.) "If I find out I have AD, I will commit suicide because I have been thru the pain and heartbreak of seeing my father  in law decline"..(4.) ."I have been thinking that I would die before I would be in a position where someone could abuse me or control my daily life"...(5.) "I am reasonably certain I also have early onset Alzheimer's at age 53. My mother has Alzheimer, as did all four of her older sisters. My father committed suicide four years ago, shortly after my mother's diagnosis I too, will take my own life."   (6.) "I too, would leave this life before I become a burden to loved ones."   (7.) "How long do you let yourself go before you take your life? I am worried that one day I will wake up and forget I have it and there it is, a burden for my family. But I don't want to go too soon either..."

Editorial Notes and Comments: The spouse of an Alzheimer's victim will sometimes be so overcome with grief that they will elect to commit suicide rather then watch the long painful process of seeing their spouse gradually fade away and die. I recall that at the nursing home (Wellstead) where June was first a resident, one of the lady residents was said to have no living spouse as her husband had elected suicide after hearing of his wife's Alzheimer's diagnosis. They were said to have had a very active life together. I have always viewed such a decision as a very selfish act. If there was ever a time that the spouse who is an Alzheimer's victim, needs the care and comfort of their marriage partner, it is at such a time. It should make no difference that the Alzheimer's spouse will eventually not recognize their marriage partner. While I deplore such a decision, I also recognize that in many of such cases, the spouse electing the suicide as a way out is probably very sick with clinical depression.

"Older People With Dementia at High Suicide Risk." - .."High Risk of Suicide in Elderly with Alzheimer's Disease. Article by Kristie Leong in General Medicine, Suite101.com. (25 January 2010) "receiving the diagnosis of dementia - especially Alzheimer's dementia - can be devastating to both patient and family. So poorly do older people with dementia respond to the news that they have a chronic brain disease that some attempt suicide. According to a new study published in the journal Alzheimer's and Dementia, older people with dementia are at a significantly higher risk of suicide - particularly after firs receiving the diagnosis."

A study in Israel by Yoram Barak and Dov Aizenberg, 2002, "Suicide Amongst Alzheimer's Disease Patients": A 10 Year Survey." Between 1991 and 2000 there were 1,551 admissions to our center who were 65 years or older. Of these, 341 were diagnosed as suffering from dementia and 215 as suffering from Alzheimer's disease (AD). Sixteen AD patients (7.4% of all AD patients) were admitted immediately following a suicide attempt. ...Physicians should be aware that suicide attempts are not rare in elderly AD patients. Higher daily functioning and previous suicide attempts are associated with increased suicidal risk."

Homicides-Suicides and Alzheimer's

It was just one year earlier on March 26th, 2009 that the Minneapolis Star-Tribune reported on a combination Suicide-Homicide case in Hudson, WI under the headline "I'M Weary, Dad Said Before Murder-Suicide" with a sub headline of "I'm Weary, Father Said Before He, Wife Died." Story by Anthony Lonetree. On March 27th a follow up article appeared with headlines: "When Weary Caregivers Give Up Hope" with a sub headline of: "Watch For Signs, Counselors Say." That article and story was by Warren Wolfe.

A brief review of this case indicates:

Claire Erickson 83 and Betty Lou Erickson 81of Hudson, WI. They had been married from 60 years. Claire was the co-founder of the Erickson Gas Station chain, later to become the Freedom Valu Centers. They wintered every year in their Naples Florida home. They had just celebrated their 60th anniversary at their Florida home with family and friends only a week before returning to Hudson. On  a Sunday their son David drove them by car back to their home in Hudson, arriving on Monday evening. The son reported everything "was fine, absolutely fine" when he dropped his parents off Monday night at their Crest View Drive home. His father had hoped to be home in time to watch the 9 o'clock news. The next morning Tuesday, a daughter dropped by at 10:30  AM to check on them as they did not answer the phone. They were found in bed and appeared at first to be sleeping. A second look determined something was amiss. It was later determined by the Hudson Police  that they were shot to death in an apparent homicide-suicide. They were members of the Bethel Lutheran Church in Hudson where Betty Lou had been a very active member. "In recent years Betty Lou, battled Alzheimer's disease and had to settle for being a churchgoer." The son David described his parents as a "most loving couple". The father had recently  said "I'm tired, I'm weary." A local pastor described Clair as: "very care-giving, very protective of her." The son expressed the opinion that his father did it "out of love" for his three children , worried that someday they would be left to care for their mother.

Editorial Notes-comments: it is apparent that Betty' Lou's Alzheimer's was still in the early stages as her long term memory was still intact..."Betty Lou Erickson recalled who was there beside them when they married and she remembered the honeymoon, too, a trip down Route 66 "all the way past the Grand Canyon," David Erickson said" David also referred to the father caring for the mother the past three years. The average time from diagnosis to termination is said to be eight (8) years. President Reagan lived for 10 years while my wife June survived just a few days short of 11 years. I have a very close friend, whose wife is 15 years and still going.

I would assume that this is another case of depression sickness causing this result. One would not expect this to happen in early stages of the partner's disease. I recall in my own case, for the first 5 years that June had Alzheimer's, most of her symptoms related to short term memory loss and resulting confusion. This was relatively easy for me to accommodate and compensate. We used these early years (5 years) to the best advantage and did much traveling and lived our lives to the fullest. We traveled to visit our English friends south of London for the last time and made at least 30 trips around the United States. Oh to be sure, there were many moments of sadness. For me I would have short spells of grief as I saw the effects of Alzheimer's on June's life. There were times that June would detect my sadness and grief and minister to me by telling me "don't worry about me Stan, I will be alright". I am sure that we both knew otherwise. It was in years 6 and 7 as she entered the middle stages and beyond, that her care became more difficult. Alzheimer's started taking over more and more of June's life with full blown dementia symptoms taking over. It reached the point early in year eight (8), where I needed the help and assistance of a facility dedicated to such care. I know that the experience of at least 6 other husbands with whom I became friends and associated with in the common bonds of an Alzheimer's wife, that had similar experiences. None of them would ever have used suicide as an escape nor homicide of a loved one. All of these husbands continued spending most of their week days with their wives and assisted with their care as I did, even though she/they were in a facility that would provide full time care. Of course, there are exceptions...I recall a husband of a wife in a nursing home who would spend his winters in a warmer climate leaving his wife to be cared for by the nursing home and other family members. Even his summers were times when he would rarely visit his wife. This was obviously a husband who had no real love for his wife and was not about to let her spoil his life! He was the rare exception in my experience.

The later Minneapolis Star - Tribune March 26, 2009 article interviewed  a Donna Cohen PhD, who was said to be a researcher and expert on Murder-Suicide among older couples. (She is professor with the Department of Aging and Mental Health Disparities at the University of South Florida, Tampa, FL.- Violence and Personal Injury Program.)

Cohen outlines the typical pattern or profile: "The man kills the woman in their bedroom with a gun* an act he has thought about for weeks or months. Cohen states: "those ideas are normal. They are!" .The woman has Alzheimer's disease or another illness and the man is depressed, often exhausted, perhaps sick himself and under strain as the primary caregiver. The woman is rarely a willing or knowing participant. She usually is killed in her sleep. The man almost always mistakenly believes he is acting with mercy, putting the woman out of her misery. Instead, he is ending his own misery."

     * In Carol Bradley Bursack's article on :"Elder Suicide: How We Can Try to Prevent It"  (12 December 2007) she references a case..."The man in his eighties, sent his family an e-mail saying there would be "no more pain and suffering". He stabbed his Alzheimer's afflicted wife once in the heart, then stabbed himself multiple times. This was a loving couple that didn't want to be separated. They didn't want to go to a nursing home. They'd rather die." 

Cohen outlines several points or factors to be considered in the area of homicide-suicide and Alzheimer's.

1. Within weeks before a murder-suicide, the man often has seen a physician - sometimes escorting his wife...

2. Sometimes families can prevent a murder-suicide if they recognize signs such as a health change in a long-married couple, more social isolation, exhaustion or talk of a move to a nursing home - especially in cases where the husband has a dominant personality..."Get Dad talking"...address it directly...acknowledge the good work he has done...ask him if he sometimes wishes his spouse or he were dead... tell him those ideas are normal. They are."

3. The lesson is to be aware, take the signs seriously, start talking and try to get help, you may fail, but you will never regret trying."

4. "In fact, murder-suicide almost always is not an act of love. It's an act of desperation."

5. "Sometimes the problems - often real or perceived health problems - seem insurmountable. that can be especially true for older men who are caregivers, ..women are more likely to ask for help. Men try to focus on the tasks, press on, to do all they can on their own - and that can take a huge toll."

6. The couple are becoming isolated, and the man is talking of moving to a nursing home or experiencing difficulty with eating, anxiety, exhaustion or depression. He may talk of giving away important possessions."

7. Offer support, remove guns from the house, don't be sworn to secrecy and get the man to a physician and find other  help. (Suicide Crisis Center, Family Doctor, Community Mental Health Center.)

Editorial Notes and Comments: I am sure that Donna Cohen is a well qualified person in her field and that most of her suggestions are well thought out and valid.

However when she takes the position that a husband having feelings of wishing his Alzheimer's spouse to be dead are normal feelings than I must object and take strong issue with her. Such feeling may be normal for the husband who is clinically depressed and or who is acting out of a sense of duty or obligation to his wife. However, such feelings are not the feelings of the majority of the husbands that I have encountered in my 11 years and my after years experience with June's Alzheimer's journey.

I would assume that the husbands Cohen sees in her studies are only or mostly those who have committed such horrible acts and would thereby distort her views of husbands in general. I would regard such a profile as insulting, outrageous and degrading to the majority of husbands who are daily acting out of a sense of love to protect, love, and care for their Alzheimer's afflicted wives.

I have never had such death thoughts about June and I am sure that the half dozen plus husbands that I have come to know through the Alzheimer's connections have never had such death thoughts either. 

There have been a couple of exceptions. One is a husband who might have fit Cohen's profile. I recall seeing him leaving an Alzheimer's nursing home one evening in a state of anger. I asked him what was wrong. He told me that his wife made him so angry he could "strangle her" I tried to assure him that this was not his wife that caused his anger but rather it was the disease that was causing her to act in the manner that made  him angry. He did not seem to want to  listen and just continued on his way. I remember thinking - "There goes a husband who is not caring for his wife out of love but rather  out of a sense of duty or obligation". It was only a day or two later that I observed the same husband trying to feed his wife in the dining room of the nursing home. He became so frustrated that he ended up twice slapping her hands. The nearby staff members immediately intervened and his future role with his wife's care became restricted. Again, this case is in the small minority of my experiences with husbands and wives and Alzheimer's.

Currently, my very close friend, Dr. Don Fox,  who is a retired medical doctor, a surgeon, and a  former missionary to Africa, is also a care giver to his Alzheimer's wife. He has been a faithful, dedicated, loving and caring husband who is deeply involved in his wife's Alzheimer's care. This friend and his wife have been long time members of the same church that June and I are members. His wife's first Alzheimer's symptoms appeared in 1996. It was eight years later that her dementia symptoms required that she be placed in a nursing home for care. Now we are in the year 2010 and his wife is still struggling with this disease - in the late stages - some 14+ years after her first symptoms. I see both of them on a regular basis and have never detected the slightest sign of impatience on his part. He has always been and continues to be the example of a dedicated, patient, caring and loving husband. It is my privilege to be their friend.

I remember telling him that at the time when June was in the darkest shadows of her journey into Alzheimer's, was the time that my feelings of love for her and the desire to protect and care for her was the strongest - that such feelings only continued to intensify with time. He agreed that his feelings were much the same. Perhaps this is God bringing some goodness out of this terrible disease. Of course there were almost daily periods of grief and sadness and they continue to this day.

Note: History suggests that it makes little difference - other then perhaps convenience - whether or not the Homicide of an Alzheimer's wife is in a private home or a nursing home. I recall a well publicized Minnesota case of a few years back in which the husband took a gun to a nursing home and killed his wife in a so called "Mercy" killing. He served a period of time in the state prison system. A quick online check reveled a recent similar nursing home husband committed homicide of his Alzheimer's wife  by shooting. This case was  in Wilmington on March 10th, 2010. His own attempted suicide then followed the shooting of his wife. The staff referred to "the devotion between husband and wife."

Note: June Berg passed away on 23 October 2008 after almost 11 weary years of battling Alzheimer's. June's funeral notice as printed in the Minneapolis Star Tribune following her death in October 2008 can be found on the top blue navigation strip under the label "In Memoriam" and on the drop down menu as item: "June K. (Rolstad) Berg - In Memoriam".