Homicides of dependent elderly adults by their caregivers violate trust and have long term consequences for families. Understanding the characteristics of homicide by caregivers may provide insights for informing prevention efforts. Data collected in the National Violent Death Reporting System between 2003 and 2007 were used to characterise victims, perpetrators, care giver roles and circumstances that precipitated the homicides. Sixty-eight incidents were categorised into either homicide by neglect (n=17), intentional injury of the victim only (n=21), or homicide followed by suicide of the perpetrator (n=30). Demographic, mechanism of injury, location of injury and victim-suspect relationship variables are supplemented by narrative accounts of incidents. Overall, homicide victims were widowed (42.6%) non-Hispanic (97.1%) white (88.2%) females (63.2%) killed in their homes (92.6%) with a firearm (35.3%) or intentional neglect (25.0%) by a husband (30.9%) or a son (22.1%). The majority were aged 80 years and older (48.5%), 42.6% were aged 50–79 and 0.9% were aged 20–49. Those below age 50 were primarily persons with disabilities requiring care and those 50 years and older constitute elder abuse and neglect. Many homicide by care giver incidents were precipitated by physical illness of the victim and care giver, opportunity for perpetrator financial gain, mental illness or substance use, or an impending crisis in the life of the care giver not related to illness. The mechanisms of deaths, demographics and precipitating circumstances suggest multiple types of prevention efforts are required.
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