This is a sad story of an elderly couple whose quality of life became so bad due to the healthcare options available to them as aged and poor that the healthier spouse decided it wasn't worth it. There's a parallel in chronic pain patients thinking about ending their lives because the intense pain and future functioning looks so hopeless.

Murder-suicides rise among elderly

By SARAH BAHARI
Fort Worth (Texas) Star-Telegram

Every morning, as if it were his sworn duty, Neville Booker drove one mile to a nursing home in Grapevine, Texas.

He would spend hours with his partially paralyzed wife, Jessie -- until he was so exhausted that he needed a nap. In the afternoon, he would go back and spend more time.

"It was his life," Grapevine police Sgt. Bob Murphy said.

When her husband was with her, Jessie Booker, 81, was happy and peaceful. When he was not, she cried.

So when Neville Booker, 84, learned he was dying of leukemia, he made a decision, police say. He would end their suffering.

Last Wednesday afternoon, Neville Booker shot and killed his wife at CLC Woodridge Nursing Home in Grapevine. He then sat beside her wheelchair and turned the gun on himself.

Murder-suicides among elderly people, though still relatively rare, are becoming more common. And as the elderly population continues to grow, experts said, such incidents will likely increase.

There are as many as 300 a year nationwide, said Donna Cohen, a professor at the University of South Florida who researches the incidents.

In Florida -- the only state that collects data about the incidents -- elderly murder-suicides have doubled in the last decade, Cohen said.

Texas ranks second in the country, with up to 18 elderly murder-suicides a year, Cohen said. Florida has the most, with more than 30 a year, according to figures based on 2001 data.

Texas probably ranks high simply because it has one of the nation's largest elderly populations, with 2.1 million residents over 65, Cohen said.

Elderly husbands are twice as likely as young adults to kill their wives and themselves, Cohen said.

In murder-suicides among younger people, domestic violence is almost always the cause, she said. But illness plays a role in more than 70 percent of the cases involving the elderly.

Although Cohen was not familiar with the Grapevine case, she said, "It has probably been a long marriage, a very good marriage and a strong attachment. There's the thinking that, 'I am responsible for my wife and nobody else can take care of her better.' "

'Going out together'

Neville Booker left two suicide notes.

They were similar but not identical. Each talked about the Bookers' health problems, referring to the "dual nightmare" they faced.

The notes said that Booker and his wife were "going to go out together," Murphy said.

Neville Booker folded and tucked one note into his wallet. A medical examiner later found it.

A relative found the other letter on a counter at the Bookers' son's home in Grapevine. The son did not return several calls seeking comment.

Jessie Booker died at a Dallas hospital about an hour after she was shot. Her husband was pronounced dead at the nursing home.

Last week, counselors were on hand for residents.

Depression and heartache are not uncommon at nursing homes, said Lou O'Reilly, who in 1989 founded the Texas Advocates for Nursing Home Residents because she was unhappy with the care a relative received at a home.

She said nursing home employees should pay more attention to whether residents and their families are depressed or having troubles.

O'Reilly's nonprofit organization encourages families to meet in nursing homes to discuss issues or problems. State law permits such "family councils." But, O'Reilly said, many nursing homes do not allow the councils to meet freely.

This week, the Texas Department of Human Services announced that an investigation of the Grapevine shootings yielded no problems with the nursing home.

"We feel very comfortable in saying there were no deficiencies," department spokeswoman Rosemary Patterson said.

Choosing to die

Barbara Coombs Lee, president of Compassion in Dying, called the deaths "a tragedy that was 100 percent preventable." The Oregon-based organization was formed in 1993 in response to suffering AIDS patients. It counsels families in which an elderly or terminally ill person wants to die.

Counselors work mostly with elderly people dying of cancer, Lee said. Texas does not have a chapter, but there are volunteers in the area.

Each year, Compassion in Dying counsels nearly 500 families. Since 1997, it has helped 65 Texas residents.

"People feel as if they're backed into a corner with no choices," she said. "They can't talk openly about their fears and their plans."

When someone contacts Compassion in Dying, a counselor first sits down with the entire family and talks about the situation, Lee said.

The organization recently handled a case similar to that of the Bookers. A husband was dying and worried about what would happen to his wife, who needed care. After talking, relatives assured the elderly husband they would care for her.

"They have got to be able to talk openly and honestly about what they're feeling," Lee said.

If they cannot reach a solution, they discuss humane ways to die, she said. Those can include stopping certain medications, speeding up others or not eating and drinking.

Oregon is now the only state where it is legal for a doctor to help someone die. The organization encourages other state legislatures to adopt assisted-dying laws.

Elderly depression

Experts estimate that 4 percent to 15 percent of elderly people have major depression.

At John Peter Smith Hospital in Fort Worth, 10 percent to 15 percent of those seeking counseling are older than 65, said Alan Podawiltz, a hospital psychiatrist.

While the elderly are likely to experience depression, authorities say, they are the least likely age group to seek treatment.

"They may be afraid of having to take one more medication when they're already on so many," Podawiltz said. "They already spend a lot of time going to see their physician. Seeing one more doctor can be a burden."

But someone with a major depression must seek counseling to get better, he said.

"They think they can pull themselves up by their bootstraps like they always have," Podawiltz said. "But they can't."

Cohen, the Florida researcher, said that family members and physicians must be vigilant for signs of depression and suicidal thoughts.

A family member should not be afraid to bluntly ask, "Are you having suicidal thoughts?" she said. The question will not cause people to kill themselves, she said.

For people who were once active, old age and physical illness can be especially traumatic, experts said.

And by all accounts, Neville and Jessie Booker led active, interesting lives.

Neville Booker served in the British military during World War II and was held as a prisoner of war by the Japanese for four or five years, said Walt Eckelmann, a friend and former neighbor. The Bookers lived and worked in the Far East for several years, where Neville did business.

More than 10 years ago, they retired to Rockport.

In their free time, Neville Booker loved to hunt, said Cecil Henne, another friend. Jessie Booker enjoyed horse and dog racing.

Then, a year ago, Jessie suffered a stroke and became paralyzed on her left side. She could still communicate, but could no longer feed, bathe or dress herself.

They moved to Grapevine to be closer to their son.

After Neville Booker's leukemia was diagnosed, his health began deteriorating rapidly. Doctors told him he had six months to live.

Police said they do not know exactly what happened or how Neville Booker arrived at his decision.

The suicide notes did not say whether Jessie Booker knew of her husband's plans.

"It may just be wishful thinking, but that's what we'd like to think happened," Murphy said. "But we'll never know for sure."

2004 Star Telegram and wire service sources.

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