Caretakers’ dreaded thought: Is it mercy to kill someone with dementia?

Pleas from the woman he’d loved since he was a teenager tormented Bruhn. But he let the disease run its course.

Stephen Kruspe made a different choice. On March 27, the Lake Worth man walked with his wife of 42 years to the back of the memory-care facility she recently had moved to and shot her.

Arrested at the scene, Kruspe blurted, “What the (expletive) have I done?”

He faces a first-degree murder charge.

The killing of a spouse with dementia is not common. But the despair of a caretaker is, and with growing numbers of elderly, the challenge is to understand and help the “healthy” spouse cope, not shoot.

Lighthouses and races

Outside the small yellow house in Lake Worth, nothing is out of place.

A white picket fence borders the graveled yard. There is not so much as a stray pebble in the driveway.

It’s the home Stephen and Pamela Kruspe shared since 1994, when they moved from North Carolina, where Kruspe spent part of his 23 years as a Marine.

Together, they saw their children married and grandchildren born.

She participated in the Race for the Cure in 2013, placing a more-than-respectable 183rd in a field of 700.

He won a $100 savings bond and bragging rights after acing a contest to create Lake Worth’s official town motto, “Worth Preserving — Worth Developing,” in 1993.

He volunteered at the Jupiter lighthouse  for 16 years, then was hired as the lighthouse keeper in 2010.

Both he and his wife were history buffs, and he took his history seriously: He fished with nets and traps, not rods and reels. When he went hunting, he used a bow and arrow.

The couple traveled to Key West and St. Augustine, partly because the cities were steeped in history.

And they traveled together: “She goes where I go,” Kruspe said in 2004.

Even though Pamela Kruspe was healthy enough to have participated in a race just four years ago, dementia could have already taken hold, said Mary Barnes, president and chief executive of Alzheimer's Community Care, a longtime West Palm Beach advocacy and support organization.

On average, she said, it is a five- to eight-year stretch from the time a person first suspects they have a problem to the time they go to a doctor to the time they ask for help.

The unprepared caretaker

For Dale Bruhn, Christmas 1985 marked a turning point. He had noticed his wife, Norma, growing increasingly irritable and forgetful — symptoms, he thought, of aging. But their youngest son insisted something was off.

When the couple visited him for the Christmas holiday, the young man begged his mother to see a doctor, pushing her into a silent rage that lasted the entire trip from Texas to Wisconsin, Bruhn recalled.

But Bruhn brought Norma to a doctor. A doctor diagnosed her with Alzheimer’s in July 1986.

Women are more often the caretaker of an ailing relative, such as a parent. But women are diagnosed with dementia more often than men, Barnes said.

So in a marriage, the caretaking role falls frequently to the husband.

Even working women, Barnes pointed out, typically have run the household before they fell ill, planning birthday parties, preparing meals and doing the dozens of other tasks involved in keeping a household running smoothly. Husbands whose wives fall ill must learn those skills and also learn to take care of their wife at the same time.

For years, Bruhn answered his wife’s incessant questions, carried her in and out of the bathtub and helped her dress. Otherwise, she’d go out with three blouses, mismatched socks and only one shoe, Bruhn said.

“I literally would some days walk up to a wall and bang my head against it,” Bruhn recalled. “You get so frustrated and upset.”

‘Most traumatic thing’

It is not just physically exhausting and emotionally wrenching for caretakers. It is potentially deadly.

In the 1990s, Bruhn’s doctor diagnosed his chest pains, shortness of breath and weight loss: stress. If he didn’t move his wife into an assisted-living home, the doctor warned him, he’d be in a nursing home sooner than she.

“It’s the most traumatic thing you ever do,” Bruhn said, of moving his wife.

Norma remained in assisted-living for more than eight years, with some days easier than others, Bruhn said.

That’s typical. There may be “empty days” when the loved one simply seems to sit, unable to do the smallest thing that once brought them happiness. In the late afternoons, there can be “sundowner” syndrome, when a person with Alzheimer’s becomes agitated, even frantic.

Loved ones with dementia alternately may become depressed or enraged. One elderly wife saw her gentle, churchgoing husband of more than 60 years throw punches — and occasionally, furniture.

All 25 caregivers in the support groups Bruhn now leads have considered putting their loved one with dementia “out of their misery,” he said.

All 25 said they couldn’t.

‘Somebody please help’

In fact, caretaker killings are rare. But they do happen.

In 2015, a New Jersey man shot his mother in a murder-suicide. This year, a North Carolina man shot his wife, who had Alzheimer’s.

In 2013, Roy Boldt, 81, killed his wife, Virginia, in a Tequesta assisted living facility before turning the gun on himself. Both had been ill and Virginia reportedly had shown symptoms of dementia.

In California, a trio of such killings began in 2010, when Roy Charles Laird walked into a California nursing home and shot his wife in the head. In 2013, also in California, Lisa Nave’s brother shot and killed her as she lay in a vegetative state. He had first killed his wife, who had dementia. On Valentine’s Day 2015, a 72-year-old man brought a bouquet of roses to his wife’s bed before he shot her.

The most famous case of killing a loved one with dementia, the case that ignited a national debate on mercy killing, came in Fort Lauderdale in 1985.

Retired engineer Roswell Gilbert loaded an antique 9mm Luger pistol, walked to the back of the sofa where his wife was sitting, shot her once, felt her pulse and shot her again. "She said, 'Somebody please help,'" Gilbert told UPI news service. "Who was that somebody but me?"

A state of desperation

Bruhn is among those who wants a legal option to end a suffering loved one’s pain.

In fact, Alzheimer's has been a focal-point of the death-with-dignity debate. The first public assisted-suicide Jack Kevorkian — "Dr. Death" — conducted involved a 54-year-old woman diagnosed with Alzheimer's. Today, there are death with dignity laws for those with terminal illnesses in five states and Washington, D.C.

Still, although Alzheimer’s is inevitably fatal, critics have pointed out that a person’s stated wish to die may be distorted by the degenerative brain disease. And juries may be skeptical that the shooting was altruistic.

Gilbert served five years of a 25-year sentence for manslaughter before being awarded clemency in 1990. Released, he told reporters, “I shouldn’t have killed my wife; now I know that.” But, he said, the combination of her Alzheimer’s and severe osteoporosis “created just a complete state of desperation in my mind.”

He died four years later.

Gilbert and his wife were among the first wave. In Florida alone, an estimated 520,000 people have been diagnosed with Alzheimer’s, a figure projected to grow to 720,000 in the next eight years.

“The epidemic is here,” Barnes said. Better diagnoses and life-care options such as skilled day care are among actions needed to help avoid more cases such as the Kruspe shooting, she suggested — as well as increased support for caregivers: “You cannot do this alone and you don’t deserve to.”

The Caregivers

In 2016, 15.9 million family and friends provided 18.2 billion hours of help to loved ones with Alzheimer’s or other dementias.