Q: My mother is 80. She is very active (despite breaking her hip 2 years ago), she still attends water therapy 3 times a week at the YMCA, she drives to the base (which is 20 miles away) and pays her bills on time. She is a retired Psych nurse and has shown signs in the past of paranoia.
Lately, she has “heard” voices of her grandchildren in her home and called my sister. She also has difficulty with getting the right words to say out and has her sleep pattern out of whack and will call people at odd times of the night. With her independence comes the fact she won’t share any medical information because she thinks we are out to get her committed.
How can I test her/question her to find out the level of decline she may be in to make sure she is safe? — K
A: Great question. As you may know, it’s fairly common for aging parents to develop problems like the ones you are describing. Understandably, these problems are frustrating and worrying for adult children.
You are absolutely right to be concerned about your mom’s safety. I do have some ideas for how you can get started assessing her, which I share below.
But first I want to explain the most common causes of this type of behavior in older adults. That’s because one of the things you must do is help your mother and the doctors figure out why she’s developed these behavior changes and other symptoms.
A fair number of people don’t get around to the medical evaluation because they assume that these crazy behaviors are either normal aging (definitely false) or dementia such as Alzheimer’s (true about 40% of the time).
Furthermore, it’s often hard to get a resistant older parent medically evaluated.
Still, it’s worth persisting in this, because many causes of paranoia or other odd behavior in older people can be treated.
6 common causes of paranoid symptoms in aging adults
Paranoid symptoms (e.g. believing that someone is out to get you, or is taking your stuff, or is in the house at night) falls into a category of mental symptoms that is technically called “psychosis.”
Symptoms of psychosis can include:
- Delusions, which means believing things that aren’t true or real.
- Hallucinations, which means seeing or hearing things that aren’t there.
- Disorganized thoughts or speech, meaning saying or thinking things that seem illogical or bizarre to others.
Psychosis is uncommon in younger people but becomes much more common as people get older. That’s because any of these symptoms can emerge when people’s brains aren’t working properly for some reason.
A 2015 review article on “late-life psychosis” estimates that 23% of people will develop symptoms of psychosis in late life.
I like this review article because the authors organize the causes of late-life psychosis into six “Ds”:
- Delirium (10 %).
- This is a very common condition of “worse-than-usual” mental function, often brought on by the stress of severe illness, surgery, or hospitalization. See 10 Things to Know About Delirium for more.
- Drugs, alcohol, and other toxins (11%)
- Medication side-effects can cause delusions, hallucinations, or other forms of psychosis. Pay special attention to medications known to affect memory and thinking. Abuse of — or withdrawal from — alcohol or other substances can also cause psychosis symptoms.
- Disease (10%)
- Many physical health problems can interfere with brain function. These include electrolyte problems such as abnormal levels of sodium, potassium, calcium, or magnesium in the blood, low levels of vitamin B12 or folate, thyroid problems, severe liver or kidney dysfunction, infections, and neurological diseases. Brain damage from minor strokes can also cause psychosis symptoms.
- Urinary tract infections can cause psychosis, but in my experience, they are almost never the cause of paranoia or other symptoms that have been going on for weeks, months, or longer. (A positive urine culture in an older person who has been having psychosis symptoms for a while probably reflects a colonized bladder.)
- Depression (33%) and other “mood disorders,” including bipolar disease (5%)
- About 15% of people with major depression may experience psychotic symptoms. Delusions of guilt or deserved punishment are especially common.
- Dementia (40%), including Alzheimer’s disease, Lewy-Body dementia, and others
- Delusions are extremely common in dementia, especially delusions of theft, spousal infidelity, abandonment, and persecution. Hallucinations (especially visual hallucinations) are also common, especially in Lewy-Body dementia. For more on how dementia is diagnosed, see How We Diagnose Dementia: The Practical Basics to Know.
- Delusional disorder (2%) and schizophrenia-spectrum disorders (1%)
- These two conditions have many symptoms that overlap with those of dementia, delirium, or other conditions affecting thinking. Doctors must exclude these more common conditions before diagnosing a person with schizophrenia or delusional disorder. Schizophrenia affects an estimated 0.1-0.5% of people over age 65. Many were diagnosed earlier in life but some people can develop the condition later in life. Delusional disorder affects an estimated 0.03% of older adults.
The authors of this review article also note that it’s common for older adults to have vision and hearing problems, both of which can trigger or worsen delusions and hallucinations.
So as you can see, when older adults experience delusions, hallucinations, and paranoid thoughts, there is almost always something more going on with their health. Figuring out what is beneath the “crazy” or “irrational” or “paranoid” behavior is key.
Hence I recommend you keep these six causes of paranoid symptoms in mind, as you try to find out more about how your mom has been doing.
How to check on “levels of decline” and safety
It’s great for you to be proactive and want to help check on your mother safety and situation. Ultimately you’ll need to work with professionals, but you can speed the process along by checking for common red flags, and bringing them to the attention of your mother’s doctor.
As a geriatrician, I generally try to assess an older person in the following five domains:
- Ability to manage key life tasks
- These include the ability to manage Activities of Daily Living (key tasks we usually learn as young children, such as walking, dressing, feeding ourselves, and toileting) and also Instrumental Activities of Daily Living (key tasks we learn as teenagers, such as managing finances, transportation, meal preparation, home maintenance, etc).
- Safety red flags
- This includes signs of financial vulnerability or exploitation, risky driving, leaving the stove on, wandering, or signs of elder abuse.
- Physical health red flags
- These include weight loss, declines in strength or physical abilities, falls, frequent ER visits, and complaints of pain.
- Mood and brain health red flags
- These include common signs of depression (especially sadness and/or loss of interest in activities), signs of loneliness or isolation, new or excessive worrying, as well as other signs of memory and thinking problems
- Medication management red flags
- These include signs of difficulty taking prescriptions as directed, checking on possible medication side-effects, and identifying medications that are on the Beer’s list of medications that older people should avoid or use with caution.
Because concerned family members often ask me about checking on an older parent, I created a guide with five checklists based on the five sections above.
You can print the guide and use the checklists to spot these red flags that often represent serious safety or health problems.
Now, no guide is going to enable you to diagnose your parent. And no guide can guarantee that you’ve identified and addresses the most important safety issues. You’ll need to work in person with professionals to do that.
But by being methodical in observing your mom and in documenting your observations, you will make it much easier for professionals to figure out why your mother has developed these behaviors you are concerned about.
Also, by identifying specific red flags or problem areas, you’ll be better equipped to work with your mom and other family members on addressing safety concerns. That’s because it’s much more effective to focus on issues that are specific and concrete (“I noticed that you seem to be having trouble with your grocery shopping”), rather than simply telling an aging parent that you are worried about their safety.
Tips on following up on safety issues and memory problems
Once you’ve identified safety issues and signs of underlying health problems, you’ll want to follow up. You’ll need health professionals to help evaluate and manage any underlying health problems, and you may find you need help from other types of experts as well.
If your older parent is paranoid and resisting your involvement, this often becomes a stuck spot for families.
How to get unstuck depends on the situation. Here are some ideas that often help:
- Relay your concerns to your parent’s doctor. The doctor needs to know about the symptoms and problems. The doctor may also be able to persuade your older parent to accept some help, or even the presence of another family member during medical visits.
- Patient privacy laws (e.g. HIPAA) do not prevent families from providing information to a person’s doctor over that person’s objections.
- The doctor will probably not disclose health information to you but may do so under certain circumstances. That’s because when a patient is “incapacitated”, doctors are allowed to disclose relevant health information to family members, if they feel it’s in the best interest of the patient. For more on when health providers may disclose information to family members, see 10 Things to Know About HIPAA & Access to a Relative’s Health Information.
- If you send your concerns in writing, they will probably be scanned into the medical record.
- Also ask if any social work services are available through your parent’s health provider.
- Contact organizations that support older adults and families, for assistance and for referrals. Some good ones to try include:
- Your local Area Agency on Aging; find it using the locator here.
- Family Caregiver Alliance. The navigator showing state-by-state services is especially nice.
- Local non-profits serving seniors and families. Try using Google to find these.
- Get help from a geriatric care manager (now known as aging life care professionals) or other “senior problems” expert. This usually requires paying out-of-pocket, but can enable more hands-on assistance than is usually available through social workers and non-profits.
- The ideal person will be good at difficult conversations with older adults, will be able to help you communicate with doctors if necessary, and will know what local resources are available to address any safety or living issues you detect.
- Get advice from other adult children who have faced similar situations. You can find caregiving forums and message boards online, where people share ideas on getting through these challenges.
- There’s an active forum of people caring for older relatives at AgingCare.com. You can find a lot of ideas and support there. However, most such forums have minimal moderation from professionals, so you should double-check on any medical, legal, or financial advice you get.
- Daughterhood.org is a website and community for people helping older parents. Look to see if they have a local “Circle” near you.
- Consider contacting Adult Protective Services if you think this might qualify as self-neglect. Self-neglect means an older person is living in a way that puts his or her health, safety, or well-being at risk. It’s not uncommon for older adults with memory or thinking problems to self-neglect.
- This is considered a form of elder abuse and can be reported to Adult Protective Services (APS).
- For a good overview of self-neglect and how APS can get involved, see here.
- In most states, health providers and certain other professionals are “mandated reporters” for elder abuse and self-neglect, which means they are supposed to report any such suspected cases to APS.
When it comes to contacting the doctor and hiring an expert to help, it’s best if you can get your mom’s agreement before proceeding. (Or at least, not have her explicitly forbid you from doing these things). Here are some tips to help with your conversations:
Use “I” statements as much as possible. “I’ve noticed you’ve been calling people during the night. I’ve noticed you sometimes have difficulty with your words. I’m concerned and I’ve heard it’s important to have such symptoms evaluated by a doctor, because they can be due to treatable medical problems.”
- Frame any suggestions you make as a way to help your mother achieve her goals. For most older adults, these include living at home for as long as possible, maintaining good brain function and physical function, and otherwise remaining as independent as possible.
- Avoid relying on logic. Logic never works well when it comes to emotionally-charged subjects. And it especially doesn’t work if people are experiencing any difficulties with memory or thinking. So don’t expect your mom to be logical and don’t rely on logical arguments to convince her.
For more suggestions on approaching a parent who is resistant to help, see this article: “4 Things to Do When Your Parents Are Resisting Help.”
Now, if you find it causes your mother intense anxiety or agitation to discuss your concerns and your suggestions for helping her, it may be reasonable to just proceed. After all, you do have reasons to believe that some kind of health issue is affecting her thinking.
So especially if you’ve identified any safety problems, it’s reasonable to move ahead despite her preference that you not intervene.
In closing, I’ll reiterate that this is a very tough situation to navigate, and it usually takes time and persistence for families to make headway. Do try to take care of yourself as you work through this. Connecting with others facing similar challenges is a great way to get support and practical ideas on what to do next.
Good luck!
This article was first published in 2016; it was reviewed & minor updates were made in August 2021.
Thank you for this information.
I agree; thank you very much Doctor Kernan for your excellent suggestions to deal with challenging situations.
My elderly mother (in her 90s) heard voices, saw people who weren’t there, etc. Finally, was diagnosed with a UTI. I had no idea that UTIs in the elderly can cause hallucinations. I think this information needs to be shared more widely and that in such cases the first check should be for a UTI. Once the UTI was cleared up, the hallucinations ceased.
UTIs in older adults can cause delirium, which is the state of impaired mental function due to illness or other state of stress on the body and mind. Delirium becomes more and more common as people get older. I have more information on this issue here:
10 Things to Know About Delirium
I agree with you, more people need to know that new symptoms of “acting crazy” might be due to an infection, a medication side-effect, or any of the other many possible causes for delirium.
My friends mother was having hallucinations and when she switched her care to a gerentologist, this doctor checked for UTI and once that was treated, she was back to normal and no more confusions or hallucinations. This was 20 years ago.
Yes, new or worse-than-usual confusion is called delirium, and it can indeed be caused by UTIs. That said, hallucinations or confusion that has been going on for weeks or months is unlikely to be due to a UTI.
I have more on UTIs here: UTIs and Urine Bacteria in Aging: How to get the right diagnosis & avoid unneeded antibiotics
MY MOTHER IS 83 YEARS OLD. SHE HAS BEEN LIVING BETWEEN MY BROTHER AND ME FOR THE LAST 17 YEARS. SHE USED TO STAY 6 MONTHS WITH MY BROTHER AND 6 MONTHS WITH ME. NOW SHE ACCUSES MY SISTER-IN-LAW OF TRYING TO POISON HER AND ACCUSES HER OF STEALING HER THINGS. WHEN EVER WE TRAVEL WE TOOK HER ALONG. I HAVE ALWAYS PAID FOR ALL HER TRAVELS AND I DO NOT TAKE A DIME FROM HER OR MY BROTHER FOR HER EXPENSE. SHE HAS BEEN ON SEVERAL CRUISES. SHE USED TO LOCK HER PURSE EVEN THOUGH SHE HAS NO MONEY IN HER PURSE. A FEW YEARS I TOLD HER NOT TO LOCK HER PURSE BECAUSE IT LOOKS BAD AND SOMEBODY MAY STEAL HER HANDBAG. A YEAR LATER WHEN i WENT TO PICK HER UP FROM MY BROTHER’S HOUSE SHE ACCUSED ME OF BREAKING HER LOCK. SHE SAYS I BROKE HER LOCK BECAUSE I AM AFRAID OF HER STEALING FROM ME. SHE USED TO ACCUSE MY DAUGHTER OF STEALING HER TWIZZERS. SHE IS USED TO HAVING LOT OF SERVANTS IN INDIA AND AFTER MY FATHER PASSED AWAY SHE HAS BEEN LIVING WITH US. SHE IS USED TO ACCUSING THE SERVANTS OF STEALING AND KEEPING EVERYTHING UNDER LOCK AND KEY.
HER MEMORY IS EXCELLENT. SHE IS HAPPY MOST OF THE TIME. THE ONLY THING SHE DOES IS WATCH TV ALL DAY. SHE CONSTANTLY ACCUSES ME OF SOMETHING. LIKE I AM TELLING OTHER FAMILY MEMBERS THAT SHE IS STEALING. I CANNOT TALK TO ANYONE ON THE PHONE UNLESS I PUT IT ON SPEAKER.
WHAT COULD BE THE CAUSE OF THIS PROBLEM? HER MOTHER HAD ALZHEIMERS. NOW ITS ONLY MY HUSBAND, MY MOTHER AND ME ME LIVE IN THE HOUSE.
Sorry to hear that your mother has developed all these concerns. This does sound like paranoid thinking and probably delusions as well. I have listed the possible causes in the article.
If this has been going on for a while and is slowly getting worse, then in someone her age, the most common cause is developing Alzheimer’s or another dementia.
I would recommend that you get her medically evaluated. It’s important that the doctors assess for the many medical problems (including medication side-effect) that can either cause these problems or can make them worse.
Families often do better once they’ve learned more constructive ways to deal with accusations, paranoia, and delusions. There are some tips on paranoia here:
Caregiver’s Guide to Understanding Dementia Behaviors
Good luck!
I observed disturbing mood swings with my Mom which included her threats against my Dad. Although I reported it to her PCP, he did nothing. He said he did not see any of the behaviors I described when she was in his office. Your thoughts?
It can be frustrating to have concerns about an aging parent and not get buy in from a primary care provider or other medical professional.
If someone is having mood swings related to a mental illness like depression or dementia, there will eventually be symptoms that will be noticeable by the physician and others. In the meantime, keeping track of the behaviour changes, making note of their triggers and how they resolve will be very valuable. It might also be helpful to talk to your dad about whether he’s comfortable talking to the doctor about his point of view.
You can read more about depression in this article: https://betterhealthwhileaging.net/depression-in-aging-diagnosis-and-treatment/
I would also recommend checking out Dr. K’s new book: “When Your Aging Parent Needs Help: a geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more”. It can walk you though the steps to take stock of your mom’s challenges, take aim at where you can help and then take action to move forward. You can find out more about the book here.
My Parents, inspite of me doing that little bit of research on Schizophrenia, cannot accept the fact that my Granny is a victim. They have this BIG ego, where they constantly keep getting back at her, as she was unkind towards them in the past. Instead of trying to handle the situation they keep trying to argue with her as to what is rational and what is not. It is a very big disappointment to me as I always tried to see my parents as role models or atleast people who lead by an example… But their lack of Compassion and Empathy makes things even worse. I just don’t know how to lend support to her. Oh! Also my grandpa, who is no more was suffering from Alzheimer’s.. The thing is they are ready to accept my Grandpa’s situation but not my Granny’s. All this Negativity in my House is so draining. Sometimes I feel my parents represent a synonymous example as to how stupid and ignorant human beings can be. I just dont know how to handle this situation. I feel sad that my Granny is stuck in that loop of mental nightmare.
Yes, I sometimes hear from people who are concerned about how their parents are treating their grandparents. It can indeed be frustrating, if it seems they are doing something that is counterproductive (e.g. trying to reason away an older person’s paranoia).
For a variety of reasons, parents sometimes have difficulty accepting advice from their children. (This is especially true when an emotionally loaded topic is at hand, and them dealing with their own aging parents is often emotionally loaded.) So one thing to try is to see if someone else can help your parents try a different approach with your grandmother. This person might be a family doctor, a clergy person, a family friend…you will have to see what your options are, within your network.
A few other ideas for you:
– you can get support and ideas from an online caregivers forum, such as the one at AgingCare.com. You will find others there who have been through something similar, and this can help you feel better.
– It’s also important to learn and practice strategies that can help you remain calmer despite the negativity and conflicts. Mindfulness-based stress reduction is one approach. Therapy can help as well. Also make sure you get your exercise and rest, and so forth.
good luck!
Two co-dependent parents, in their mid 80s, still living at home together. Mom has a diagnosis of dementia with paranoid ideations from a highly-respected neurologist, but (a) refuses to accept the diagnosis or get on meds, to the point of (unsuccessfully) trying to get a lawyer to somehow reverse the diagnosis, while refusing to get a second opinion; and (b) has episodes of paranoia about her children (who have POA) trying to liquidate all her assets and stick her in a home (we aren’t) and trying to declare we’re committing elder abuse, gaslighting, etc. Every morning it’s a new fiction creating drama, and getting in the way of work life. Dad is mostly deaf and increasingly forgetful and confused himself, utterly exhausted dealing with Mom. He takes minimal responsibility for his own health care, putting Mom in the business of creating or refusing appointments, and she’s starting to get in the way of him seeing doctors due to his own distrust. She refuses in-home help or the idea of assisted living, refuses to get the urgent geriatric psychiatric exam her neuro called for half a year ago, calls everybody in and outside the family daily to rant about her delusions, and is creating confusion in her finances and estate planning, health care, and even little things like housekeeping, cell phone plans, and information technology. What can we do to ensure Mom gets the care she needs, starting with accepting this diagnosis and getting medicated? We don’t want to call social services but we’re almost at that point.
That situation is not uncommon, but it’s certainly a doozie and a challenge to navigate.
First off: it’s quite possible (quite likely, really), that your mother will never accept her diagnosis. A little denial early on is very common and then many people accept that things are changing. But when someone has already been rejecting or refusing a diagnosis for a while, it becomes much less likely that this will change. Her mind is slowly getting worse, plus she’s feeling anxious and embattled.
So, it might help for you and your siblings to accept that she may never accept this diagnosis, and that you will have to find a way to help her and your dad despite her refusing to accept a diagnosis.
Probably there is no easy way to get her the care she needs and take care of your dad. You will need to equip yourself with information and resources, and you will probably need to call for help, and she’s likely to get very upset at your actions at times.
Even if you do manage to medicate her somehow, it might help a bit with the paranoia but she will still probably be very challenging to deal with.
I do think it might help you to learn more about decision making capacity. I have an article here:
Incompetence & Losing Capacity: Answers to 7 FAQs
I would also recommend reading books on communicating with people who have dementia (don’t spend time reasoning with them, instead try to validate and reassure as best you can).
Another thing to consider is joining an online support group for people caring for aging parents. You’ll get lots of practical advice and moral support.
Otherwise, some specific things that can help you intervene:
– Talk to an elderlaw attorney, about your options for intervening. Laws regarding older adults vary from state to state. A qualified attorney can help your family understand your options regarding requiring her to make changes, or taking over your father’s care.
– Talk to adult protective services. Your father may be at risk, and your mother may be risking herself.
– Talk to a senior advisor or geriatric care manager. Such professionals have experience helping families navigate these kinds of thorny situations. They will also know about local resources.
You probably will have to intervene, to keep your father safe. In fact, your mother will object but really you are intervening to help her with her goals too, which are likely to maintain her health and wellbeing and independence and financial stability for as long as possible.
I wish there was an easy way forward, but almost certainly not. Don’t forget to get support for yourself as you go through this, and if any tensions or disagreements arise between your siblings, consider investing in some mediation and guidance from a professional…it does usually cost money, but in the long run, it can save you a lot of stress and heartache.
Good luck!
my father in law is 47 years old and has been thinking and hearing things yhat arent true or real. he also belives that a posted of a man was lookin and yalking to his wife that he even took the poster down because it made him so upset. and he always thinks that were ib a pack to to something terrible to him like poisioning his food or other things. they recently took him to the doctor because he had become physical with my mother in law and the told her nothing was wrong that his blood presure was high and so was his sugar diagnosing him with diabetes. can any of this relate?
Sorry to hear of this, it sounds scary for your family.
Hm. Is your father-in-law only 47 years old, or is he older? Regardless of his age, it would be extremely unusual for these types of symptoms to be caused by high blood pressure or high blood sugar (unless his blood sugar was so high that he required hospitalization).
In older people (e.g. older than 70), delusions and paranoid behavior are often a sign of Alzheimer’s or another medical illness. It is possible that a doctor might say “nothing is wrong,” meaning they don’t see any sign of abnormality on bloodwork or other signs of physical illness, but it’s not really correct, because if he is paranoid and having delusions then something certainly IS wrong, it’s just that doctors often wave off dementia symptoms in aging adults. I have more here:
How We Diagnose Dementia: The Practical Basics to Know
Now if your father-in-law is actually 47: it is possible for a non-psychiatric condition to cause delusions and other psychiatric symptoms. However, it’s far more common, for that age, for delusions and paranoia to be caused either by substance abuse, substance abuse withdrawal, or by significant mental illness such as bipolar disease, schizophrenia, or perhaps depression with psychotic features.
I’m sorry the doctor wasn’t helpful the first time. I would recommend asking more questions, or having your father-in-law seen by another clinician.
In general, it’s often necessary to do a little homework and ask a lot of questions, in order to get the right medical care. Good luck!
My mother of 92 lives in a group home. She listens to a lot of news and has also been an extremely religious person for many years. She has had good claity of mind until the past year or less but cannot get around on her owm. She owons a cd that someone purchased for her some time ago that suppisedly shines a negative light on Obama. She plays it often and wants others in the home to listen…and they have but it agitates them. The tspe was hidden from here instead of management coming out and telling her that it cannot be played but in her room. She nagged until they gave it to her. She believes that she is one of few who has this cd and believes that if Trump had it then he could ruin aobama’s polutical career…which for some reason would make her satisfied. The employees of the home asked her to allow my sister to take it to her home and place it in her safe. My mother refused saying no…that even though it’s her daughter…she wouldn’t listen to the cd. (My sister doesn’t want to listen). I am very concerned because she also calls people in the early morning hours for trivial reasons…she has been demanding for so in her own way, acts entitled, and over time has worn out my sister, sister,nlaw and my brother. I live out of state and can’t asssist them. Should she first gey physical testing?
So, it sounds like your mother has gotten more fixated on this CD, is more suspicious or distrustful of others at times, and is otherwise a little less well connected to reality and reason.
If she is 92 and you have noticed other changes in her memory or thinking, she probably has developed some chronic changes and damage to her brain, which will never get entirely better. (Hard to say just what it is in her, but it’s quite common for people her age to have developed mild vascular dementia combined with some mild Alzheimer’s-type neurodegeneration.) Those types of underlying changes can’t really be cured or treated per se. But it’s still a good idea to have an older person evaluated when their thinking changes or worsens, because there may be other treatable factor or illness that are making the thinking worse. For instance, she could have a mild metabolic imbalance that’s making mild dementia or pre-dementia worse.
I list the problems we usually check for in my article on evaluating dementia symptoms, it’s here: How We Diagnose Dementia: The Practical Basics to Know
Otherwise, the mainstay of managing difficult behaviors is to identify and remove triggers, and to learn more constructive techniques for communicating, relating, and redirecting. Trying to reason with her probably won’t work and will likely aggravate her. You need to validate her concerns and feelings without overly encouraging any paranoia or delusion, and then try to redirect the person’s attention. These techniques are described in a variety of books, you can also find some good suggestions in caregiver support groups, which are available in-person and online.
You and your family may also have to see if there’s a way you can set some healthy limits, to not burn yourself out, while still providing her with the attention and connection that she needs from you.
Medications are sometimes used to manage difficult behaviors but they are almost all problematic and risky, and so should be used as a last resort, after everything else has been tried. I explain the medication options here: 5 Types of Medication Used to Treat Difficult Dementia Behaviors
To return to your original question: it is generally a good idea to have an older person with thinking changes evaluated, mainly to see if there are any treatable conditions (including medication side-effects) that might be worsening their thinking. You may still end up with some difficult behaviors to manage, and to handle that, you’ll need patience, education on constructive approaches, and persistence. Good luck!
How come no one has mentioned Parkinson and the paranoia and delirium that comes with that
When Parkinson’s disease progresses far enough along, people do develop dementia, and that can certainly be associated with psychosis symptoms.
Psychosis also occurs earlier in Parkinson’s disease, and in such cases, it’s usually due to the anti-parkinson’s medication, or to underlying Lewy body dementia. Many Parkinson’s medications increase dopamine levels, and although this is necessary to control the motor symptoms, it can cause or worsen hallucinations and other psychosis symptoms.
Hello,
My mother is soon to be 96 years old. For the past year or so she has been telling us about a “man” peeking in her windows or knocking on her doors in the middle of the night. It is getting much worse and she says she is nervous and can’t sleep much any more (she still lives by herself). Her husband died 53 years ago and she has spent most of her life living by herself once all her children (6) left the house. This paranoia or dementia seems to be getting worse, especially since another child passed away last year (one passed away four years ago as well). When we have people spend the night with her or when I set up a game camera to take pictures of whoever is at her door, nothing ever happens. She claimed that she saw an image of a man in her back bedroom window. I went around the next morning and saw no footprints or evidence of any kind. Also, the bottom of the window is like 6 feet off the ground, so unless the guy was like 10 feet tall, it just didn’t happen. When I told her that, she got mad at me and was very dismayed that I didn’t “believe” her. We are at our wits end and not sure what to do at this point. Thanks.
This does indeed sound frustrating for everyone involved.
Unfortunately, it’s not uncommon for these kinds of issues to come up in people your mother’s age. As I explain in the article, the recommended next step is to get a medical evaluation, both for more evaluation of her memory and thinking abilities, and to check for other medical conditions that might cause or contribute to delusions or hallucinations.
In the meantime, it’s usually best to avoid arguing with her and instead be reassuring and focus on what might help her feel better. This is also a good time to do everything you can to reinforce a positive relationship and connection with her. Depending on how things evolve, you may need to talk about getting her more support in the home, or possibly having her move, or otherwise making some types of changes to support her if her mind or health are changing. Especially if her mind really is changing, it will become problematic for her to keep living alone. good luck!
Lewy Body Dementia.
most misdiagnosed disease among elderly people.
Ask the doctor about it being Lewy Body Dementia.
If this goes undiagnosed and medication for something else is given thinking that its something else, that medication can actually make Lewy Body Dementia symptoms even worse.
The quality of a persons life is in question here, it’s important to know.
Dementia with Lewy bodies (aka Lewy Body Dementia) is often associated with paranoia and hallucinations in particular. And it can be tricky to get the diagnosis right, since it can look a lot like Parkinson’s disease, delirium, or Alzheimer’s disease. It can take a specialist to sort the diagnosis out at times.
Your point about medications is a good one. People with Dementia with Lewy bodies can have a very adverse reaction to antipsychotic medications (like haloperidol or risperidone) so those should be avoided at all costs.
My mom is 78. She lives with her partner of 40 years. She has had a personality shift. She’s always been one to think the way she does things is the best way and has never been good at talking about feelings, but lately she’s become mean. She’s very mean to her partner–slamming him and promoting herself. Recently my sister went through a divorce and my mom could sometimes be mean to her. She also was not answering my calls or texts, which is unusual for her.
My sister and I know she couldn’t have been like this her whole life, or we wouldn’t have always gone to her for advice, which we did.
Being with her now is stressful, as we’re worried about saying something that will set her off. Any thoughts?
Well, if you’ve noticed a change in personality, then I would encourage you to confer with your sister and ask yourself what else might be changing. Personality shifts in people her age can be caused by something affecting brain function, especially the front part of the brain. Especially if she seems to be experiencing any changes related to memory, thinking, or learning, it would be a good idea to consider an evaluation for cognitive impairment. I explain what should be covered here: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check
If her personality changes aren’t being caused by a change to her brain or some other aspect of her health, then you might want to consider whether it might be something like being sleep-deprived, or stressed out about something in her life. Could she have some stressors going on that you aren’t entirely aware of?
Good luck!
What to do with a 76 year old aunt who has been estranged from her family for 40 + years but suddenly shows up on a doorstep after leaving an assisted care facility because they were “out to get her” and has no other friends or family and has been traveling from airport to train station to hotel for more than a month but refuses to believe anything is wrong? If anyone suggests that she see a doctor or that her delusions aren’t real she immediately cuts off all contact. She wants to live with a family member so that she can feel “safe” but none of us are in a position to add her to our household.
Wow, that’s a tough situation. There is really no right answer regarding what you should do. She does need help but you can also set some reasonable limits, which means you help her but not necessarily in the way she wants.
She probably does need more of a medical evaluation. I’m guessing no one has power of attorney for healthcare for her, so that might be tricky…some families end up having to petition for guardianship, especially if the older person seems to be gravely disabled and unable to manage their essential needs on their own.
I would not recommend telling her that her delusions aren’t real, that just tends to aggravate things. I would instead encourage you to coax her into seeing a doctor and letting someone from the family come along.
You can also contact the assisted living facility and see if they are willing to disclose at least some essential information to you, given she’s impaired. (More on accessing a relative’s health information is here: 10 Things to Know About HIPAA & Access to a Relative’s Health Information)
Also if you are worried that she can’t care for herself, you might consider calling Adult Protective Services. Good luck!
My mother is 64 years old and over the past few years her behavior has become increasingly alarming and unpredictable. When I told her that I was moving out of state, she seemingly out of the blue announced that she was leaving her husband of nearly 25 years and no one was able to change her mind. Around the same time, she announced that “the universe” had told her that my grandmother had dropped her and kicked her with she was an infant and that is why she has back problems (many of us have hereditary back issues). She also began using a crystal pendulum to help guide her in everything from what to buy at the grocery store to when someone was going to die. Anytime someone has questioned her choices, they become an enemy and she lashes out at them, usually by labelling them as “extreme narcissists” (myself included). Most recently, she has started warning family members that some of their siblings are witches and placing curses on us. This seems to be a recurring theme that has presented itself on several occasions, beginning sometime in the last year. I no longer feel safe allowing my children to spend time with her and I don’t know whether this is a personality disorder that has become worse or something new. This has been very stressful for the family and I’m not sure what to do.
Yes, this does indeed sound worrisome and also very stressful. Lashing out at people can be a personality issue aggravated by some kind of irritant, but if she has started believing that some people are witches, that sounds like a delusion and is worrisome for psychosis.
I would recommend you help her get medically evaluated, as explained in the article. Hopefully, she will be willing to go see a health professional. If not, you can still relay your concerns to her doctors. If you are really worried about her ability to care for herself, you would have to consider calling Adult Protective Services. good luck!
Hello,
I am looking for some advice and guidance, for about 2 months I have been very worried about my 64 year old mother.
My mother has always been a strong brave pillar of the family, mentally focused and emotionally driven, however I am not sure how to go about this.
My mother has been talking about someone at work saying things about her, to the point that she has said this person is coming to her home, and the neighbours know him. She also said everyone knows what is going on, as they said it over the speaker at work. She said that she heard people talking over the speaker about her at Tesco/Sainsburys and the staff talking about her. As well as school children and this issue at work was on the news too.
I initially thought she was getting bullied, so I asked if i could have her group leaders phone number and she refused. I asked if any of her friends heard the conversations over the speakers and she said yes. However she didnt tell me which friends.
Is it time to visit the GP? What does this sound like? I have been trying to research on this.
Generally she does all house hold chores, and drives to work, and is fine in her every day life however whenever it comes to work, the story sounds very strange. I am not sure how i can reach out to someone at her workplace to confirm what she is saying is true? She says that the union is fighting for her and that there is money owed to her?
Thank you for you time
regards
Sorry to hear about your mother. Yes, I think you should have her evaluated by a GP. As I explain in the article, there are many health conditions that can cause older adults to start saying things or doing things that others find unusual.
It would also be a good idea to try to get more information from others, to find out if what she says is true. It sounds a bit paranoid but sometimes we find that a person’s “crazy story” is actually true. Good luck!
My 83 year old mother is extremely intelligent and is healthy except for acid reflux. In Dec my father had to have a tube to live and was put into ICU due to complications from out patient surgery. He also has COPD. He is 88. She cares for him and he has recovered although COPD is progressing. He was offered Hospice but my mom felt they were there to kill him. Now she thinks they are going to say she isn’t taking good care of him. she takes great care of him. She stopped Hospice but thinks they are bugging the house. This is not the person I’ve known. Any ideas!!
Hm. That does sound a bit paranoid or possibly delusional. You may want to observe her and talk to others, to find out if she’s showing any other signs of memory or thinking problems.
It does sound like your mom must be under a lot of strain, with her caregiving role and your father’s health problems. That does sometimes make people’s thinking worse…although when that happens and we do a careful evaluation, we do often find that there are additional underlying medical issues affecting their thinking.
If she continues to act differently, it would probably be a good idea for her to get a good evaluation. I describe what should be included here: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.
You may also want to see if it’s possible to get her some caregiving respite; maybe that will help her symptoms.
Good luck!
For years now my mom believes that people break in her house and steal things. She also believes that people come into her house while she’s sleeping and steal things. She believes they steal things like utensils, jeans, cleaning supplies, toilet paper, etc.. She has changed her locks many times, has added cameras and alarm systems. In high school, we lived in a different house and it was the same case. She has accused my sisters and I of stealing her things as well. So no matter where she lives, people are stealing from her. She has called the cops a handful of times to report items stolen. I don’t know if she’s misplacing things or just hallucinating that it even happened. My mom is only 62 years old. She can take care of herself and still gets around. I don’t live near her but we talk everyday. She’s normal for the most part, it’s just that this has been concerning me over the years because along with this she also has really outrageous mood swings. It’s pushed family away and she’s isolated by herself. She blows things totally out of proportion and just twists things to make her the victim and plays mind games. I love my mom but she’s a day by day thing, you don’t know if you’re going to get happy Tina or sad Tina or crazy Tina. I know somethings wrong. Is there any idea? I just want to have something to go off of.
Hm. This does sound difficult and stressful.
She’s not very old, so especially if this has been going on since you were in high school, it’s possible that she has some type of mental condition that isn’t particularly related to older age. Of course, people with mental illness also get older and develop cognitive issues that can make their pre-existing mental health issues worse, so it can be hard to tease out.
I would recommend a careful evaluation by a health professional. Generalists can complete the initial evaluation but for a long history of what you describe, psychiatry might be especially helpful. Good luck!
Thank you!
Dr. Kernisan,
I stumbled across this discussion thread and article while searching Google for the issues my 84 year old widowed mother is experiencing. Your article is excellent and I have a much better idea of what we’re dealing with.
Her case is slightly unique in that she is the most healthy person on the planet that I know. She will be 85 later this year and has never been on any medications, has had no surgeries, has no medical conditions and is perfectly capable of driving, eating, shopping, volunteering and going to church.
About 8 years ago, just after my father passes, she started hearing someone in her backyard. Fast forward to 2019 and we’ve installed over 20 security cameras and have had the police, neighborhood watch groups and church members do “night sentry” duty, only to come up empty. She is convinced that her prowler knows exactly where the cameras are, knows exactly what her schedule is and knows exactly when people are waiting to “catch him”.
We’ve dealt with this issue for some time in the ways you mention. Distractions, sympathizing while not correcting, etc.
However, now she is starting to think that the garbage truck drivers all meet in the neighborhood on trash day to conspire to lose her garbage cans. She has even suggested that my brother drive her down to the local grocery store parking lot so she can “catch them in the act”.
We are concerned that if this progresses much further, we are not going to be able to reason with her at all.
We would love to take your advice and alert her physician, but the last time she was at the doctor was an emergency room visit when she had a knee injury about 4 years ago. It was 10 years before that for her second most recent doctor’s visit. For someone who doesn’t GO to a physician, how methods would you suggest to help us persuade her to go? We are at a loss and the ways we’ve been dealing with this for the past decade won’t be effective much longer, I suspect.
Hope you can offer a suggestion or two!
Todd
Well, kudos to you for all the work you and your family have done so far, in supporting her. It’s too bad but not entirely surprising that she’s continued to decline.
It is indeed really difficult to get someone like her to the doctor. A few thoughts:
– Is there anything that she’s concerned about, regarding her health? Can you think of anything that would motivate her to go? Or could you frame it as a way to get some type of health check with the goal of helping her remain independent for longer?
– It is sometimes possible to find a clinician who will come to the house and do an assessment, especially if you are willing to pay out of pocket. You could see if such a service is available in your area.
– Sometimes another issue forces the person to see a physician. For instance, when an older person is reported to the DMV for driving concerns, they sometimes require a medical evaluation and the older person goes, in an attempt to preserve their license.
I do think it’s reasonable to anticipate that this may continue to slowly get worse. There is often no easy solution, even when the person does see a health provider. Medications can sometimes help with paranoia but almost never help an older person become as they were years ago, or even become “reasonable.”
Sometimes when you’ve tried lots of way to get them to a health provider — and some families do resort to white lies — but it’s still not possible, you end up having to wait until there is a crisis or emergency.
Otherwise, if you aren’t able to find a health provider to come to the home, you could look into consulting with a geriatric care manager. They have experience with these kinds of situations and can help you continue to problem-solve. Good luck!
Hello Dr. Kernisan,
I stumbled upon your article when trying to find if people who have paranoid schizophrenia can harm others. Meaning, my husband and I will be married for 32 years this June. He developed this mental illness when he was a teenager. I am his only caretaker and of course extremely stressed out. We are ten years apart in age (he’s older), and will be 68 this April. He’s under excellent care and on meds that work for the most part in keeping his thoughts under control. My question is…..our psy. just told me that he’s putting me on high alert that my husband’s getting worse. Is there a chance he may harm me?
So sorry to hear of your husband’s condition. In general, the answer to your question would be yes, there is always a chance that a person who is very paranoid or psychotic might hurt another person. That is because the psychosis can cause them to incorrectly conclude that someone else is trying to harm them, or even is not who they say they are, and some people, understandably, will try to defend themselves by striking out.
I would recommend talking to your husband’s doctors further about this issue. It is very important to get help — or at least get yourself safe — right away if a situation ever seems very worrisome to you. Your husbands doctors should be able to help you come up with a plan to address your own safety. It is wonderful that you are helping to care for your husband, but don’t put yourself at significant risk of harm. If you’re not sure what to worry about or when to get really worries, talk to your husband’s medical professionals. Whoever said your husband is getting worse should be able to help you.
Lastly, I believe there are some online support groups specifically for family members of people with serious mental illness; you can get encouragement and advice and support from such a group. Good luck!
Hi Dr. Kernisan, my husband and I have been helping our neighbor for about 20 years. She’s 88 now and moved into assisted living 4 years ago. She never married, has no children, no family , so we are her family. She had a devastating fall on March 11 trying to go to the bathroom in the middle of the night. Miraculously she didn’t break anything, but she fell directly on her face. within hours her eyes had swollen shut and a lump the size of a baseball on her forehead. Nearly all bruising is gone, the lump now ping pong ball sized, but she seems to be declining rapidly. She was in the hospital, then spent 3 weeks in rehab. She was always difficult to please and a complainer, but it is off the charts now. I understand her frustrations,( walking, eyesight, memory,toileting, everything is difficult) but I feel the 24/7 complaining and negativity is going to make her quality of life for the time she has left miserable. She did have a UTI when she was in rehab (she did have some hallucinations and odd behavior). Do you think her urine should be tested on a regular basis? I realize,physically, things will not get better, but is there anything we can do to help her mentally without drugs (I wouldn’t want her to fall again from meds).
Sorry to hear about your neighbor’s issues. It’s so good of you to be helping your older neighbor and looking out for her.
I would actually not recommend regular testing of her urine, I explain why here: UTIs and Urine Bacteria in Aging: How to get the right diagnosis & avoid unneeded antibiotics.
Re her complaining and negativity…it’s wonderful for you to help but I’m afraid you can only do what you can do. Remember that you aren’t responsible for her state of mind or her quality of life and focus on what you can do. If she enjoys your visits or something else you can do, do that. Even if she complains when you visit, she’s probably still appreciating it at some level.
Even though she is not your mother, I would recommend this recent podcast episode, about helping “difficult” older parents: 087- Interview: Coping with Difficult Older Parents. As my guest explains, often the family caregiver’s job is to tolerate the older person’s unhappiness.
Otherwise, her situation is concerning in that she sounds frail and although you are helping, you are presumably not legally authorized to make medical or financial decisions if she becomes ill or is incapacitated. Rather than trying to improve her quality of life, you may want to see if there is any way to help her with advance planning. In some states, it is possible to hire a professional trustee to step in for an older person who has no family. Or, you could contact your local Area Agency on Aging (the directory is at eldercare.gov) and see if they have suggestions for you. I would also bring this up to the hospital social worker if she is hospitalized again.
Good luck!
I have a friend of 43 years, who came to visit with her husband to celebrate her 65th birthday with my husband and I . when they left , They both said thank you and that they had a great time. Less than a week later my husband and I were to stay with them for a few day. we live in different states. When our pane landed I texted her to let her know we had arrived . I then received a text telling us to stay in a hotel and that she didn’t like the way I treated them. She also blocked us on facebook. I was confused because when they arrive home from there trip from our home she wrote thank you so much we had fun, see you Thursday. I did note she was having issues with memory. She did have a TIA about 1 year ago. I love her like a sister, concerned it may be a sign of Dementia or the start of Alzheimers.
Yes, I can see why you’d be concerned about her. Before thinking it’s dementia, I generally start considering the possibility of “cognitive impairment”; that’s a broader term and it can be reversible, depending on what’s causing it. I cover common causes and what evaluation should include here: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.
If she is having memory issues, she may not welcome you asking her about them. You could consider talking to her husband, to see what he’s noticed and gently inquire as to their plans.
It is for every friend to decide how far they want to go in bringing up these issues. Good luck!
My mother will be 64 yrs old this year … for the past several yrs she has been showing signs of severe paranoia … that has gotten increasingly worse. She’s suspicious of everyone & constantly thinking everyone is out to get her. Currently she lives with me & my family. If she loses something – she accuses someone in the house of stealing it. & now her accusations are getting worse to the point it’s a threat to our safety & I’ve had to seek legal guidance for myself & family. She’s due to move into a senior community next month & I plan to talk to her doctors located there … but her recent behaviors are very concerning & I’m unsure if I should wait until she moves or order emergency evaluation? At her age do you think she is experiencing dementia or another underlying mental illness ?
Sorry to hear of your mother’s symptoms; it’s very stressful to live with someone who is paranoid and constantly making accusations like this. I would say it’s better to seek evaluation sooner rather than later, and it might even be harder to arrange if you aren’t living with her. Also, I would be concerned that she’s not likely to do well living on her own in a senior community if she is so paranoid, plus a change in surroundings might make her worse.
She is not very old. Both dementia and mental illness sound plausible, plus there are some less common brain conditions that can cause paranoia.
Good luck, I hope you are able to get some evaluation and answers soon. I also highly recommend finding a group to support you as you help her navigate this time. There are some good free ones online, and then we will be soon re-opening the doors to our Helping Older Parents Membership Community.
My dad is 61 yrs and acting weird after getting circumcision done. We took him to doctor and after urine culture and sonography he concluded nothing was wrong except mild enlargement in prostate. For weird behaviour he prescribed esciltlopram. Prostate medicine caused weakness and low bp so we discontinued. Esciltlopram caused excessive sleepiness and we discontinued it too. We cannot figure out which specialist should we see next?
Weird behaviour: He is abusing sometimes, complain of not getting poop completely, weight loss sometime earlier but now stable, laziness,not handelling financial task, complain of not feeling anything in stomach and brain.
Hm, hard to say what would be the right specialist. If he is acting strangely and now having difficulty handling financial tasks, you may want to consult with neurology. He might also benefit from a thorough check up with an internist or someone else who will consider the whole picture of his health. Good luck!
hello,
thank you for the article. it was very informative. there is situation in my house and i was wondering if you could shine some light on what is going on. my grandmother, who is 78 years of age has become increasingly paranoid about people taking her stuff. this has been happening from the past 5 or so years. she believes that her own children are out to get her. she locks her room every time she steps out of the room and believes that people are stealing things like makeup, creams, lotions, etc from her room just to spite her. we have tried to sit her down and explain things to her calmly but it has failed every time. she refuses to listen and instead resorts to “i am older than you so shut up”.
our family has come to the conclusion that due to her recent hospital visits, especially the last one where she had refused medication and was sent to the ICU has made her feel like she no longer is the matriarch in the house.
it takes a toll on all of us however, when claims such as “you purposefully put — in the curry so i can get sick”, “the insulin injections are the ones that are making me sick”, “the T.V is too loud, it hurts my ears, you’re increasing the volume to spite me” (when she actually has a slight hearing problem and there is no way she heard the T.V).
Until now our approach has been going along with the things she says and simply nod along. but seeing as all her children work and every time she talks she accuses them of something, there have been fights at home. what would you suggest we do instead? how do we take care of her when she refuses treatment by accusing the medication itself?
your advice would help a lot.
thank you
Sorry for delayed reply, we had a glitch in our system that we have just resolved.
As I explain in the article, someone with these kinds of paranoid symptoms needs further evaluation. I would not keep trying to explain things to her; her mind sounds unwell and so the explanations won’t work.
If she is also becoming forgetful or is showing signs of thinking problems, it’s possible that she is starting to develop dementia. Even if you don’t have a diagnosis, you may want to try reading a book about living with people with dementia, as they provide guidance on how to take care of someone who is often resistant to care. The book Surviving Alzheimer’s is a good one, but there are others. Good luck!
Hello, thank you for this post. I have a question if you are able to answer it. My mother moved across the world to Hawaii after a major psychosis episode. She was hearing voices, seeing things, driving erratically, and believed that certain entities like the Freemasons were out to get her. She eventuallyturned on me thinking first that I was a sex worker for drugs from the freemasons and later that I was a doppelganger and the real me was dead and visited her as an angel.
She was picked up by the police and committed a few times in a short period but let go. She read found sitting in the road near the airport once. She then disappeared for two years thinking all of us were trying to harm her because she wrote a book (hundreds of pages that made no sense.) She finally got in touch with me from Hawaii and while she seemed still to be a little weird (which is fine) she seem to be functioning okay.
Recently she has developed all the same symptoms and possibly worse levels including a new book that is even more nonsensical than the first. She refuses any help any time I’ve asked her and has said no hospital multiple times claiming she was sexually assaulted in one the last time (which may or may not be true it’s really hard to tell what’s real.) But I am disabled and she is across the world and I don’t know what to do. I actually worry that me telling her I was having surgery triggered her. I wish I hadn’t told her.
She has stopped responding to my texts and calls for about 3 weeks. She also doesn’t remember anything from the last time which I didn’t know until I tried to explain to her why I agreed to 302 her before.
She is only 62 years old. She’s never had psychotic episodes before this happened a couple of years ago. She had isolated herself for years and was very into woowoo stuff, was paranoid about certain things, but remained functional so I didn’t think to label anything. I keep sending her texts telling her I love her and that I’m thinking of her and want to hear from her when she’s ready. My therapist says that she may be okay but the last I spoke to her she had lost her job and believed she was being gang stalked which is a whole other conversation about that online community.
Anyways thank you for reading this lonnnng comment and I understand if you’re unable to get to it and answer personally. I’m just wondering what I can do for her aside from the exercises you listed in this post. I am physically incapable of traveling there by plane but I’m very worried that she will be picked up by police or hospitalized and that I won’t be on her contact list. I tried getting her to set up an advance directive but she always refused. She also said she might abandon her phone because “they” were tracking her.
Wow, this is a tough situation. Kudos to you for caring so much and trying to find a solution.
Honestly, I’m not sure there’s more you can do without going there physically or coordinating with someone who is in touch with her. She is “young” for geriatric care and for having something like dementia, and so you might get better advice by finding an online community specifically for families of people with serious mental illness and psychosis.
Good luck!
my dad is 56 yrs old and he is thinking that our neighbor is spying on us and he thinks that people are out to get him like at his work. He also thinks that when he is driving that people do things on purpose to him like they want to hit him, they want to race him, cut him off on purpose. And he gets annoyed with everything. And then it also goes in to really big fights with my mom because he thinks that she is doing things on purpose to hurt him and not only does he think that. He also hates it when i wear tank tops with a bandeau because he thinks that i am showing everything when in reality my tank tops are less revealing then most of the clothes the girls my age wear. Now i know that his abuelita had dementia so i don’t know if it’s the same thing that his abuelita had?
Sorry to hear of your situation. Your dad is quite young for dementia, but it does sometimes happen at an early age. Another possibility would be mental illness. You don’t say but I assume these are changes compared to the way he was a few years ago?
He really would need to get carefully medically evaluated. I hope your family will be able to get him to a health provider soon. Good luck!
My dad is 58 and he has epilepsy and has had it since he was 30.. no one has ever figured out why he started having seizures and theres so many triggers and they change or evolve in a way to the point where they stop one type and he starts having another type so they cant get them under control. A few years ago he started just saying whatever was on him mind like he lost the filter.. it has grown to the point where hes just down right mean. In this past year it has gotten WAY worse. A few months ago he was convinced my mom was cheating on him when she was going to work.. he thinks that me and my mother treat him like a child because we take precautions when hes cooking or working with tools because he has hurt himself before when cooking because he had a seizure in the middle of cooking. He thinks we are against him. Now mind you my father and i were always super close i am his little girl and he loves my mom and never wanted anything but happiness for her no matter what! Now he calls me a horrible mother and tells me that im not doing what i should for my kids hes constantly putting me down and as for my mom he puts her down and makes her feel like everything is her fault.. he told her the other day “i thought i wore the pants and had all the balls but i guess not” he would have NEVER said that a few years ago because thats not the type of relationship they have they make all decisions together and if one doesnt want to do something they dont do it. He also has times where hes perfectly fine and happy and other times hes just rude. And if he starts a fight 5 minutes after he will act like nothing happened and everything is fine. I just dont know what is going on. The drs keep saying its just him getting older but they never run any tests or do an evaluation because he says hes fine and that we are the problem. Im wondering if because he has epilepsy everyonr is playing it off as damage from 28 years of seizures but i think theres something else.. any advice would be greatly appreciated
I think it does sound concerning and worthy of more investigation, and I would not recommend writing it off as due to seizures. This sounds like a significant personality change, plus some paranoia. Your father is “young” compared to the people I have experience caring for. I would recommend having him see either a neurologist or a psychiatrist…or possibly both. Be sure to bring them information about any other memory or thinking changes you’re observing. Good luck!
My mom moved to the US eighteen years ago when she was 56. We live in a rural area and she does not drive so she naturally became somewhat isolated particularly due to her poor English and reserved personality. She lives in our house in a next door apartment but we are busy working full time and taking care of 3 young children. We take her out to all appointments and grocery shopping but she does not have any friends. She began complaining of deep sadness couple years ago but does not want to mention to her doctor and when I try to mention it (I have to be in the room to translate for her), she denies it and refuses help. She also developed B-12 deficiency but is getting shots for it. Anyway, now she is afraid to be in the house alone, hears suspicious noises and accuses us of hiding her things. This started a year ago and is getting worse. She is now 74 and I am not sure where to turn as we have very limited access to specialists in this remote area. Dementia does not run in our family and I am not sure how to proceed because she refuses to speak with doctors about these issues. Any advise is appreciated – thank you for taking your time to read. This appears even more difficult for elderly immigrants like herself with language barrier. Thank you.
Sorry to hear of these issues affecting your mother, I can certainly see why you are concerned. And yes, the language barrier often makes a difficult situation even harder.
Re your translating: it’s common for family members to step in, but patients often have a right to a professional interpreter, and one should be available by phone if not in person. Of course, if your mom is feeling paranoid and suspicious, she may not cooperate with an interpreter, but it’s still something to consider, esp if you think she’s reluctant to express herself in front of you. She may be trying to protect you, or she may be worried that you’ll treat her differently or even take over her life.
Re the deep sadness and then emergence of these symptoms: ideally she would be evaluated for depression and for medical problems that can cause depressive symptoms. It is possible for depression to cause psychosis in some cases. But it’s also possible that there is something else changing in her brain.
Generally, for someone like her, I would recommend medical evaluation to make sure that a medication side-effect or physical health condition isn’t causing these changes. I would also recommend at least a brief cognitive assessment in the office. If there are signs of depression, ideally she would attempt treatment and you’d see if things get better. However many older adults associate depression with a stigma and so they can be reluctant to try treatment.
I hope you are able to get her the next steps in evaluation and in understanding what is going on with her. Good luck!
My father in law 60 something up and left my mother in law of 40 yrs of being together out of the blue! Left a note saying I can’t do this and that was that!
It’s all coming out now that he was having thoughts of mother in law hurting him and taking his money! Also when he come to see us he was talking to hubby and hubby would stop talking but father in law would just keep saying yeah I know Yerp yeah so on! He is going to talk to someone but I was also thinking mayb he should get a health check as well do u think that is what’s needed or wait and see what the shrink says! Been a hard month and just wanting to help out as much as I can there’s a lot more to the story his mum dying of old age two yrs ago them just selling their house on his demand then moving into a rental and up and leaving seems like it’s been planned for awhile we thought he was just being a arse but now thinking might b a lot more to it
Hmm. Hard to say just what is going on, but if his rationale for leaving his wife did involve delusions and paranoia, then yes, ideally he would get evaluated. A good shrink should consider the possibility of medical illness and also of less common causes of thinking problems, such as fronto-temporal degeneration, which often starts with personality changes rather than obvious memory problems. I hope your father in law is cooperative with the health providers and that he allows you to help him. Good luck!
None of this will make a difference as long as we have attorneys who look the other way when they witness their client as the one with cognitive decline.
It can be frustrating when medical issues intersect with legal ones. Most lawyers have fairly limited knowledge of dementia and its symptoms, so it may be hard for them to recognize cognitive decline in a client. This underscores the need for more public awareness and education about Alzheimer’s and other causes of dementia.
Agree with Dr. Didyk that many attorneys — and other people, for that matter — are often inadequately educated about cognitive impairment.
Since issues with attorneys have come up quite a lot in our Helping Older Parents Membership, I interviewed an elderlaw attorney about these issues for the podcast. He talks about what could be tried, to connect with the attorney of a relative who is impaired, so you may want to listen: 097 – Interview: Common Elder Law Issues When Helping Aging Parents. Good luck!
Hi, we have a resident who has paranoid ideation where they think their housekeeper or someone else is stealing from them (this has happened over the years on and off with various residents and the housekeeper is not stealing). You cannot reason with the resident no matter how illogical their reasoning is. If other things have been ruled out, then what else can you recommend to do to assist them? It is obviously distressing to them and also it is unfortunate that the housekeeper is always the one to get accused of stealing. It seems harsh to recommend a higher level of care, when this is the only issue, and it will continue at their new residence. Thank you for any insight.
Hi Marilyn. Sorry to hear that your resident is suffering. I’m not surprised that using logic is not working. Responsive behaviours like the ones you describe occur in about 75% of individuals with dementia, at some stage and to some degree of severity.
I work in Ontario, Canada where we have a Behavioural Supports Team – clinicians who can work with individuals with dementia, families, and staff to discover the unmet need behind the behaviour and address it. There may be similar resources where you are.
This document might also be of help, as it describes the basics of how to approach responsive behaviours in long-term care. Most of the principles are the same no matter what the setting of the person with dementia. Dr. K has also addressed this in the blog.
The basic steps include identifying the triggers for the behaviours and finding ways to minimize the frequency and severity of the person’s response. Often the behaviour doesn’t go away completely, but can become less bothersome. Good luck!
My in-laws have always been difficult to deal with. Their son, my husband, has bipolar II and we beleive his parents have some form of mental health issues themselves but they refuse to take medicine or see doctors for anything.
His mother, 78yrs old, has always been an extremely jealous, controlling, manipulative woman. She has a tendency to exaggerate, lie and fabricate stories to suit her purposes. Her husband, 82 years old, is a beaten down man who will do whatever it takes to prevent his wife from having an adult tantrum. She won’t let him go to the doctor and discourages him from taking any pills…she has total control of him. He can’t leave the house without her for fear he might end up in bed with another woman. Even I, their daughter in-law, am a threat to their marriage.
Due to their very toxic nature, we have kept a healthy distance from them but still call frequently to see if they are well. In the last year we have been concerned on a whole other level. His mother, has breathing issues, mobility issues, passes out often, has chronic swollen and painful legs, scoliosis, possible heart issues, teeth issues (affecting diet), loss of voice, increased delusion, paranoia, memory decline and the list goes on. (We have witnessed most of these symprom but some are claimed by her.) His father has had a mini stroke and has lost some vision and also suffers from osteoarthritis and possibly from SAD or Bipolar. Their last doctor visit was many many years ago and we actually don’t know what is truly wrong with them because as far as we know their diagnoses comes from Dr. Google and diagnoses from 30 years ago!!
We do not have POA. They will not get evaluated or allow anyone to come to their home and refuse any help offered (cleaning ect..). They refuse to move closer to us even in a place of their own. We cannot move there due to work.
We are concerned because the father is so dependent on the wife for everything that his health /quality of life could suffer as result of her increased delusions and fear of doctors since he will never contradict her. They both still drive (very little, and never far) but we feel this should be evaluated since his vision is poor and she claims to pass out often.
Our hands are tied. Do we have to wait for a tragedy or a serious fall (broken hips) before they get the right help? Reasoning with them is futile. None of the tricks in your articles would work with them. There is only the lawyer route or wait for tragedy.
Anything we are not thinking of? We have a strained relationship but we do care and wish them no harm.
Hi Natalie. It sounds like an extremely stressful and difficult situation, and not an uncommon one unfortunately. I am not in practice in the US, so I am not sure what legal measures you could take.
In any Geriatric practice, there are many couples who have had longstanding patterns of what some might call co-dependency or emotional abuse, and the fallout from that can be more pronounced when age and disability become advanced. In my experience, you are correct that reasoning is futile. Again, you probably need legal advice that is specific to your state.
Thank you for your reply Nicole. Yes it truly is a difficult situation. We live in Canada if that is any help. I really enjoyed reading articles on this topic on your website and have recommended your site to others.
Well, if you are in Canada, then in most jurisdictions, there isn’t really a mechanism to apply for “guardianship”, as far as I know. If there is an imminent risk to safety due to a mental or neurological illness, then a doctor could place the person on a “Form 1” and apply for a psychiatric assessment within 48 hours. I do work with many families in similar situations to yours, and yes, sometimes we are waiting for a crisis to happen before the older adults are ready to take some action.
Thank you for the info. Maybe someday….when crisis happens our paths may cross as they live not that far from your office. This is a sad situation, we should be able to help loved ones before some crisis arises.
You are absolutely correct. Sometimes it seems like our system is set up so that people need to “fail” before they get access to the resources that are needed. Sometimes, as Dr Kernisan suggests in the Helping Older Parents Membership, it’s helpful to remember the Serenity Prayer, and that often we can only accompany an older parent on the journey, and not solve all of their problems. Best of luck to you!
Hi! My mom is 66 and it seems she changed overnight about 5 years ago. She was married and got divorced, claimed he was cheating and not long after the allegations he moved out. Then she started saying he was breaking in (somehow bypassing the alarm) and sleeping on her couch at night, he was now drugging her to rape her, physically abusing her, stealing her money out the bank, tapping her cellphone and stealing her medication. She was calling the police frequently and wherever she left the house she carried all these bags with personal documents in them with her everywhere she went and she would fall all the time. Fast forward I moved her out of state to live with my family of four and everything seemed to be working out at first and then not to long after she started telling people we were starving her and mistreating her and anytime you tried to have a conversation with her she would get upset and saying I’m going to make her have a stroke. We started therapy together and during the first session the therapist asked me to come back without her because she wouldn’t answer the questions properly and would say nothings wrong with her. She started calling first responders when we weren’t home to help her up and eventually started accusing me of stealing her medication and money out of her account, threatened to call child protective services, and pretended to call the police on me. We asked her to move back home and she wouldn’t because she said she liked here and we shouldn’t have moved her out her house to begin with. We had to almost evict her. She eventually moved into an elderly apartment and now she is saying the people who work there are breaking into her apartment stealing her food and medication, poisoning her food, drugging her and has raped her on multiple occasions. She is here now for a visit going on the second day and is complaining of how much pain she is in, falling again, and making all these moaning and screaming in pain sounds. Please, what do you suggest?
Hi Nita, and I’m sorry to heat about all of the difficulty with your mom. I can’t make any specific suggestions, but I can tell you that when an older adult has a dramatic, “overnight” change in personality and behaviour, I usually think about looking for a medical or medication-related cause for the change. As Dr. K points out in the article, there are numerous brain and body conditions that can cause such disruptions in thinking. If all of those are ruled out, it’s been my experience that it’s often an exacerbation of a longstanding personality or mental health issue, sometimes triggered by a social stress (like a loss, a financial crisis or similar).
This article about falls might be helpful to you as well. Best of luck.
Hello! For the past 2 weeks my mother has been acting paranoid. She tells me that “this man” is trying to hack all the phones, computers, and TVs. That he changes the settings on all of her electronics. That he can see her through the camera of her phone. She changed her phone number, bought new phones, locked out of all entertainment accounts. Like Netflix, etc. She takes all the money out of her account and wants me to order her a new card. I try to help her and talk to her but she won’t listen to anyone. She’s only 48. She also has depression, her husband passed away 3 years ago and lives with my two younger brothers and sister. I’m not sure where to start on helping her. What do you suggest I do?
My certification is in Geriatrics, so I don’t have much experience with people in your mom’s age group, but the symptoms you describe would be worrying in a person of any age.
If someone asked me this question in my clinic, I would encourage them to share information about the behaviour changes with the parent’s primary care provider. The PCP would know the parent’s health history and current medications and could decide on a course of action. As always, if a family member is showing sudden, serious signs of a mental health issue, they should be taken to the Emergency Department right away.
i’m so glad i found this article. shed some pretty amazing light on things for me in regards to my mom. shes 86, has heart disease, which has her on a lot of medication. she has many of the disease symptoms mentioned above which she takes medication for ie: potassium, calcium, or magnesium in the blood, low levels of vitamin B12 or folate, thyroid problems, severe liver or kidney dysfunction. now i have a guideline and can understand her paranoia, mostly stealing. something to mention and talk to the dr about.
I’m so glad that you found the article helpful! I hope that you get some advice when you visit the doctor.
Dr. Kernisan also runs a special online Helping Older Parents Membership, a unique and affordable program she founded to answer questions and support people helping aging parents.
The membership provides ongoing guidance from her and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her. This might be a great resource if you need help with your mom. Best of luck!
Hi,
My mom is 62 and she is stuck in paranoia thinking she is tapped and stalked. A few months ago, there was a suspicious man in her back alley and Both myself and my mom reported the suspicious activity. The cops have confirmed the man is harmless and lives in the neighbourhood. Since then, my mom has been paranoid and has been admitted to the psychiatric ward.
She initially seemed ok like she was getting rest the first day, but the second day she started calling and talking about being stalked in the hospital.
I want to follow up or make sure I pass this information to the doctors but I’m not sure which doctor do I work with? Her family physician who asked her to see a specialist or the doctors in the hospital?
I’m sad to see her like this. And what type of environment or care is best for her or people who’ve experienced similar situations?
I don’t question what she says and just listen. If she asks me to use my house line, I just do it. She gets into more arguments with my brother (who tries to show her or prove to her some of these things aren’t real), but we are learning not to trigger her and hope that if we comply, she would feel better. Which I’m not sure if she is or not.
Thank you for this website, any insight will be helpful.
It sounds like a very stressful situation for your family. I’m glad she’s in a hospital where she can get some help.
It’ll probably take more than a few days to see improvement in your mom, as the team there gets to know her and develops a care plan. While she’s in hospital, I would try to share information with the team that’s looking after her. They may not be able to give you details about your mom’s health (unless your mom has given permission), but you can definitely share your impressions with them.
It’s hard to say what’s going on and what type of environment will be best when she’s out of hospital, but the hospital discharge planning team should be able to help your family figure out the next steps.
And most of the time it is a better approach to not try to reorient someone to reality, but every family member is going to have their own approach.
I hope things get better soon.
HI! My 80 year old mother (who lives in Germany) just recently started with some weird behavior: for ex. she thinks that the people on TV talk specifically to her and that they can see her; she thinks that there are people on the second floor of her house; she talks to the people in the magazine she reads; and she says that she doesn’t know what to cook for “them” (meaning me and my two sons). Other than that, she seems like always, she remembers things from past days and weeks ago and you can have a normal conversations with her. She talks about moving in with us because she misses us and is lonely (she has lived by herself for 40 years and never said this before, so I’m thinking it might be due to Covid isolation rules). The problem is that I live 8000km away (in Canada), so it is extremely stressful for me that I cannot be there for her in person to help her. Luckily I created an amazing support network for her (friends and family) who look after her, but I want to hop on the airplane as soon as it makes sense with all these Covid restrictions/rules. I was talking to her doctor on the phone, and he wants to send her for evaluation to a psychiatric clinic which I declined. I am thinking that it would make more sense for her to see a geriatrician doctor. I have to add that her mom had alzheimer’s.
It’s so difficult when your parent is far away. I agree, a Geriatrician would be a good specialist for your mom to see, but if a psychiatrist is more readily available, then that might be a reasonable place to start.
It does sound like your mom is hallucinating, or she could be misinterpreting things that are actually happening in her world. She could be living with dementia, or have some psychiatric or other type of medical issue (like a medication reaction or an abnormality in her bloodwork). This video about conditions that mimic dementia might be of interest: https://youtu.be/Qs8eF8tzmco
Dr. Kernisan’s new book is a great step-by-step guide to how to help your aging parent, and includes some special information for those who are helping from a distance. It sounds like you’ve gotten a great head start with building a team of helpers around your mom and I hope you can see her soon, safely.
Thank you so much for this read. It is very helpful but I will say that I am struggling to figure this out. My mother will be 78 this Saturday and within the last couple of months has been showing signs of paranoia. It breaks my heart to see her feel unsafe. She lives by herself one street over from me so we see her and talk to her daily. She is offended when we address it as something we should ask for help on. She always leads with “you guys think I’m crazy..I’m not crazy!” I am a social worker myself so I know to for one never call her crazy but I struggle with not resorting to explaining and rationalizing with her to get out of her head. She thinks people are trying to steal her money or messing with her phones or trying to get in the house at night. Solicitation calls trigger her and give her confirmation that someone is trying to harm her and steal from her. When she isn’t consumed with those thoughts she is perfectly fine. She still drives, picks up grandchildren from school a couple days per week and goes to grocery store but it’s escalating and to say the least I am worried. I tricked her to go to doctor last month to get all her levels checked and they all came back fine. They said next step would be to go to a senior center where they would do in depth assessment of brain activity. Mom is not feeling that one so I am lost on what to do. I work and have children as well as my brother. I worry of her being by herself and driving her self crazy when we aren’t there bc she thinks someone is trying to get in her home. Any suggestions ?
Hi Kyra and thanks for sharing your experience. It must be so hard to see the changes in your mom, and can be even more difficult as a health professional yourself.
I agree with avoiding correcting your mom, and even sometimes suggest to my patients to try “fiblets” if they work and if you’re comfortable: https://youtu.be/MAzG-HpsAvM. For example, it might be an idea to encourage the senior centre assessment to look at other health issues, rather than just a brain exam. This may get more buy in.
Dr. Kernisan’s new book is for children who are helping aging parents, but many of the issues the book covers could be applied to helping other family members too. The book provides advice on how to communicate with someone who’s living with dementia and resisting help.
This article about how to help when your parent is resisting might also be of interest.
Hi,
My concern is my 98 yr old dad. About 7 yrs ago my mom, dad and I went to see a couple of attorneys to draw up DPOA, etc. When finished, both attorneys at different locations told me that my dad had dementia but they were still willing to go ahead with the paperwork and file things through the courts. My mom passed in 2015 and my dad went on living alone for the past 6 yrs. My hubby and I would take him out to eat 3 times a week and out gambling (his favorite activity). Since covid, we haven’t been anywhere and only to see him twice a week as not to get him sick. He does not want a covid vaccine. I did notice a decline in his mental abilities and also physical abilities. He kept telling me he felt weird in his stomach area and it made him feel shaky. So the falls started. Outside a few times that I didn’t know about because the neighbors picked him up. And he never wanted me to touch anything in the house. Not even clean! I thought he just wanted to be left alone until he passed. He took a tumble at home one night and crawled all over the house and finally into the garage where a neighbor heard him. He was on the floor for over 16 hrs. He had a UTI, sepsis and a bunch of bruises. The hospital gave him antibiotics and his infection was gone. This week in the hospital he acted normal. No issues, joking, forgetful but not worried, and repeating himself as usual. He remembers the very distant past and not much else. He went into assisted living to make sure he was clear of infection and to treat his uncontrollable diabetes. He was fine for a couple of days and all hell broke lose! He accused me of stealing his money, car, and his drivers license and ss cards. It was just crazy. All these years and never an argument. Now just calling me.every name in the book and even accusing me of abusing my dead mom! Next day he apologized and said he didn’t mean it. Now tonight, he is accusing me of cleaning out his home and getting rid of him. I want him dead. I took him there and left him and never been to see him?????? I asked the nurses about this and they said nothing. I asked about getting him evaluated and they said that that was a diabetes and rehab place and they don’t do that. I have to take him to the dr, In the meantime, my brother calls him and he tells him all these things and my brother believes him and says I’m abusing my dad!!! Am I over reacting? I just don’t know if its actually me or him right now. Can you please give me some advice? I’m new to this behavior. I took care of my grandmother for about 8 yrs and she never acted like this. My mom either.
Thank you
This sounds like such a stressful situation!
One thing I would wonder about is delirium which can cause fluctuating symptoms of confusion, sleepiness or restlessness and hallucinations or delusions. Delirium is very common in hospitalized older adults, especially those living with dementia, and can last for weeks or months. It can be very frightening for a family to witness.
I agree that an assessment would be helpful, since it sounds like the diagnosis of dementia was suggested by the lawyers, rather than a physician, who may be more qualified in that domain. It might be good for your brother to hear what a doctor would say as well, so that he can understand the symptoms of dementia and how they can affect thinking.
In the meantime, if there’s an Alzheimer’s Association chapter near you, they could give you some practical advice about how to respond to your dad’s responses. I’ve made some videos about this on my YouTube channel as well.
I hope you get some clarity and your dad makes a quick recovery.
Thank you for writing such a great summary of paranoia in the elderly. As an Internist caring for aging patients, I find this information helpful for all involved in their care.
I’m so glad the article is helpful in your practice! Thanks for reading and for taking the time to leave a comment. Stay well.