Obviously in a heightened risk potential, the law enforcement officer will evaluate for current homicidal and/or suicidal ideation. There are additional red flags to consider including: a history of suicidal and homicidal threats, history of violence with increasing violence towards partner (especially choking or strangulation), increased violence towards the children, comorbid major stressors in social relationships (work, personal, and financial hardships.) Law enforcement personnel are also key in evaluating the plan and feasibility of homicide and/or suicide risks: does the suspect have possession/access to lethal weapons, are there multiple weapons, where are the weapons kept, is having and being willing to use weapons part of their self-image? (This is particularly crucial in relationships that involve people in law enforcement, corrections, the military, and the criminal justice system.)
Additional risk factors include "anniversary date" of a traumatic incident from the perpetrator’s past, history of or current stalking behavior, alcohol or drug abuse as well as a childhood history of abuse.
Dominant Themes: Age 55+
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. 20 older Americans die each week in a homicide-suicide. Murder-suicides in older people were previously considered to be suicide pacts, mercy killings or altruistic homicide- suicides where both partners were old and sick. This has been proven to be untrue. Murder-suicide acts are a result of desperation and depression. Almost all homicide-suicides in older persons involve a husband who kills his wife before killing himself.
There are at least three types of murder-suicide in older couples. The 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 marital conflict and domestic abuse.
Most commonly the male had made a unilateral decision to commit the act. The perpetrator had thought about a homicide-suicide for months if not years. His wife or lover is not a knowing or willing participant. Most victims are shot and killed in their sleep, and then perpetrator then turns the weapon on himself.
Elderly men who commit murder/suicide generally have significant health problems and have had a recent significant decline in health prior to the act. They sense an unacceptable threat related to the integrity of their relationship, most frequently impending institutionalization of themselves or their partners. Statistically, about 50% of spousal homicide-suicides in the elderly are dependent and protective in nature. The man, who has been dominant in the relationship, fears losing his control and ability to care for or protect his wife. Even if his spouse is not sick, a real or perceived change in his health can precipitate the process. At least half of the perpetrators of this subtype are depressed or have other psychiatric problems that have been undetected or untreated.
About 30% of elder murder-suicides are aggressive in nature, with a positive history of domestic violence. This is more common in couples in their 60's, but it does occur in older couples. A pending or real separation, restraining orders against the husband, and familial involvement are the most common features.
A third type is a symbiotic homicide-suicide, occurring in 20% of couples. This is characterized by extreme interdependency in an older couple. One or (usually) both parties are very ill, leading the husband to a mercy killing and suicide. The husband and wife are so enmeshed in each other that their individual characteristics are frequently blurred.
Risk Assessment: Older Adults
The greatest at risk is the older couple (ages 75+) who have been married a long time and the husband has a dominant personality. Most frequently 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 is 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 couple has been arguing or there is talk of divorce or a history of estrangement. The male suffers from undiagnosed mental illness, most often depression. Alcohol or prescription abuse may be present. Since the husband is usually the perpetrator, look for the following additional signs: changes in his eating or sleeping patterns, crying for no apparent reason, an inability to feel good about the future, talk of feeling helpless or hopeless, talk that the future is bleak, threats to harm the wife, loss of interest in activities that used to give him pleasure, anxiety and agitation, giving things away that are important to the couple, and making plans to give someone a key to the home.