By Veronica Chapin and Marcia Mattso - Jacksonville.com

Saturday, January 13, 2001

Police can't explain what triggered a 75-year-old Jacksonville man to gun down his family and then himself, but they discourage coming to the conclusion that it was Alzheimer's disease.

Billy Hurley shot and killed his wife, daughter and son-in-law, then turned the gun on himself early Thursday evening on the Westside.

Neighbors said Hurley's family had told them he was suffering from Alzheimer's and had become increasingly violent. But the family didn't want to go to police.

Assistant Chief David Sembach of the Jacksonville Sheriff's Office said it was premature to pinpoint the violence to Alzheimer's and that police are waiting to confirm any medical condition with his doctor.

The family had no prior domestic complaints, said John Turner, a spokesman for the Sheriff's Office.

Sembach said police had no other information about the case yesterday but plan to go back to the scene Tuesday to tie up the investigation.

Greg Hurley said he was aware his uncle had medical problems but didn't know to what extent.

The 49-year-old Pikeville, Ky., resident said he visited his uncle recently and didn't see any problems with his behavior.

"He was fine in October," Hurley said. "He evidently had developed something over the past couple months."

He described the family as normal, saying he couldn't have asked for a better uncle.

Police identified the victims as Hurley's wife, 73-year-old Billie T. Hurley; their daughter, 53-year-old Veda Crockett; and son-in-law, 51-year-old Clayton Crockett.

The daughter and her husband lived next door to her parents at 6826 Arques Road across from Normandy Elementary School where the shootings spilled onto the campus.

Alzheimer's experts said it is rare for a person with the disease to kill someone. They don't want the families of the estimated 15,000 Alzheimer's patients in Baker, Clay, Duval, Nassau and St. Johns counties to become alarmed and said violence can be avoided with training and precautions.

There have occasionally been incidences of a murder-suicide after a patient's initial diagnosis because the patient or spouse was distraught over the diagnosis, said Jamie Glavich, a board member of the Alzheimer's Association North Eastern Florida chapter.

When an Alzheimer's patient does become aggressive, it's usually because he or she doesn't recognize a caregiver or has become agitated by something and lashes out from fear or frustration, Glavich said.

Alzheimer's initially causes the death of memory cells in the brain and eventually of cells that direct personality. That explains why a sweet grandmother can suddenly pepper her language with swear words. The most common form of aggression is verbal, but it can be physical or even sexual.

"The disease changes their personality," said Glavich, who owns Almost Home, a Mandarin center for Alzheimer's patients where her mother is a patient. "They're not the same person anymore. That's what's hard for families to understand."

Alzheimer's causes 60 percent of all dementias and is only one of many medical reasons a person could become demented or exhibit aggression, said Hiten Kisnad, one of two Jacksonville psychiatrists who specialize in treating the elderly.

Sometimes elderly people behave as though they have dementia when they actually have depression. They may stop eating or bathing, seem to lose their memory or become aggressive. Their condition may be corrected with medications, Kisnad said.

Among people who actually have dementia, about two-thirds exhibit psychiatric problems such as depression or psychosis that can lead to aggression, Kisnad said. They may be delusional, sometimes thinking their spouse is cheating on them, a family member is stealing from them or their caretakers are trying to harm them.

Besides Alzheimer's, dementia also can be caused by strokes, a vascular problem that limits blood flow to the brain, brain tumors, a deficiency of vitamin B12, or a hormone imbalance.

Ten Broeck Hospital of Jacksonville opened the city's only inpatient psychiatric unit for geriatric patients in May, said Amanda St. Johns, a registered nurse and program manager for geriatrics.

Ten Broeck also has a mobile crisis unit. Health workers go to the houses, nursing homes or assisted-living centers of elderly people to provide a free mental health evaluation.

But the vast majority of people with dementia can be safely cared for at home, with support, Kisnad said.

The Alzheimer's Association offers training to help caregivers learn to avoid or defuse an aggressive incident.

For example, Glavich said a woman may be changing her demented husband's diaper when he forgets who she is and hits her or throws something at her because he thinks a stranger is touching him intimately.

Arguing or yelling doesn't work and could make things worse, Glavich said.

Instead, the caregiver should back away to a safe distance and redirect the patient's attention. For example, the caregiver could note there is pie in the kitchen and suggest they go have a piece.

Families also should review the events that lead up to aggression to pinpoint its trigger.

For example, a war veteran may hear or see a shooting or bombing on television and get aggressive because he thinks he is in a war zone. The family can keep the TV turned off around him in the future and avoid a repeat.

In addition, the homes of people with dementia should be safety-proofed -- including taking away firearms and other weapons.