6 Causes of Paranoia in Aging Parents & Checking Safety (2023)

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).

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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.

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 thataren’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.

A2015 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”:

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  • Delirium (10 %).
    • This is avery 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) arealso 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.

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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 muchmore 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 onfollowing 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 .
    • 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 isliving 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:

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  • 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.


What causes paranoia in an elderly person? ›

What Causes Paranoia in the Elderly? Often linked to memory loss, paranoia can occur in the elderly if they misplace things, forget instructions, or no longer recognize people. Brain tumors can cause mood or behavioral changes that manifest into a heightened mental state.

How can I help an elderly person with paranoia? ›

Don't argue with them.

Paranoid delusions are very real to those who experience them, especially individuals with dementia. Arguing will only help convince them that you are not on their side. Reassure and validate your loved one's feelings rather than trying to provide them with rational explanations or answers.

What triggers paranoia? ›

You are more likely to experience paranoid thoughts when you are in vulnerable, isolated or stressful situations that could lead to you feeling negative about yourself. If you are bullied at work, or your home is burgled, this could give you suspicious thoughts which could develop into paranoia.

Is paranoia part of dementia? ›

Delusions (or strongly held false beliefs) are a common symptom for a person with dementia. They can take the form of paranoia, which makes the person feel threatened, even if there is no or little reason to feel this way. Dementia can make a person suspicious of the people around them.

What are the symptoms of paranoia? ›

Symptoms of Paranoia
  • Being defensive, hostile, and aggressive.
  • Being easily offended.
  • Believing you are always right and having trouble relaxing or letting your guard down.
  • Not being able to compromise, forgive, or accept criticism.
  • Not being able to trust or confide in other people.
Sep 9, 2021

Are there different types of paranoia? ›

  • Paranoia is the irrational and persistent feeling that people are 'out to get you'.
  • The three main types of paranoia include paranoid personality disorder, delusional (formerly paranoid) disorder and paranoid schizophrenia.

How do you respond to paranoid accusations? ›

Speak clearly - Simple sentences and unambiguous words reduce the chance of being misinterpreted.Be accepting, yet firm - Delusions are very real to the person having them. Don't confront the person about their beliefs or attempt to help him reality-test.

How do you deal with a delusional parent? ›

Ten Tips for Dealing with a Paranoid Parent
  1. Put yourself in your mother's shoes. ...
  2. Stay calm. ...
  3. Remember that the person is not doing it for attention. ...
  4. Do not argue or use logic to try to convince the person that they are wrong. ...
  5. Validate the person's emotions.

How do you deal with delusional elderly? ›

See the doctor.
  1. Don't take offense. Listen to what is troubling the person, and try to understand that reality. ...
  2. Don't argue or try to convince. Allow the individual to express ideas. ...
  3. Offer a simple answer. ...
  4. Switch the focus to another activity. ...
  5. Duplicate any lost items. ...
  6. Share your experience with others.

What mental illness is paranoia a symptom of? ›

Paranoia can be a symptom or sign of a psychotic disorder, such as schizophrenia or schizoaffective disorder. 16 Paranoia or paranoid delusions are just one type of psychotic symptom. Other symptoms of psychosis include: Disorganized speech.

How do you talk to someone who is paranoid? ›

Here are ways to help the person who is paranoid:
  1. Don't argue. ...
  2. Use simple directions, if needed. ...
  3. Give the person enough personal space so that he or she does not feel trapped or surrounded. ...
  4. Call for help if you think anyone is in danger.

What are the first signs of dementia in a person? ›

Common early symptoms of dementia
  • memory loss.
  • difficulty concentrating.
  • finding it hard to carry out familiar daily tasks, such as getting confused over the correct change when shopping.
  • struggling to follow a conversation or find the right word.
  • being confused about time and place.
  • mood changes.

What type of dementia causes paranoia? ›

In a person with Alzheimer's disease, paranoia often is linked to memory loss. It can become worse as memory loss gets worse. For example, the person may become paranoid if he or she forgets: Where he or she put something.

What stage of dementia is suspicion? ›

Suspicions and delusions — firmly held beliefs in things that are not real — may occur in middle- to late-stage Alzheimer's.

What is an example of paranoia? ›

Verywell Mind provides examples of paranoid thoughts, some of which include the following: You think someone might steal from, hurt, or kill you. You feel like everyone is staring at you and/ or talking about you. You think people are deliberately trying to exclude you or make you feel bad.

How do you beat paranoia? ›

5 Strategies for Dealing with Paranoia
  1. Take your medication every day as prescribed. ...
  2. Use a friend or family member to test your reality when out in public. ...
  3. Develop a strong sense of self. ...
  4. See the good in what's happening. ...
  5. Develop an exit strategy or secret code. ...
  6. A few hopeful things to take away about paranoia:
Aug 19, 2018

What is the difference between paranoid and paranoia? ›

Within the field of mental health, the term paranoia describes an aspect of psychotic disorders or a personality type, characterised by fear, distrust, and suspicion. Someone who is paranoid will more than likely present as anxious, however someone who is anxious may not be paranoid.

What is the most common type of paranoia? ›

Persecutory paranoia is generally considered the most common subtype.

What are the seven 7 types of delusional disorder? ›

How is delusional disorder diagnosed?
  • Obsessive-compulsive disorder.
  • Schizophrenia.
  • Delirium/major neurocognitive disorder.
  • Bipolar disorder.
  • Personality disorders, especially borderline personality disorder and paranoid personality disorder.
May 22, 2022

What are the three types of paranoia? ›

Paranoia is a predominant symptom of three disorders namely paranoid personality disorder, schizophrenia, and delusional disorders. Paranoid individuals suffer from permanent delusions.

How do you identify the 7 traits of paranoid personality disorder? ›

What are the symptoms of paranoid personality disorder?
  • believing that others have hidden motives or are out to harm them (in other words, experiencing persecutory delusions)
  • doubting the loyalty of others.
  • having trouble working with others.
  • being hypersensitive to criticism.
  • quickly becoming angry or hostile.

Does paranoid personality disorder get worse with age? ›

Personality disorders that are susceptible to worsening with age include paranoid, schizoid, schizotypal, obsessive compul- sive, borderline, histrionic, narcissistic, avoidant, and dependent, Dr. Rosowsky said at a conference sponsored by the American Society on Aging.

How do you deal with a mentally unstable elderly parent? ›

The first thing you'll want to do is talk with your parents when you see signs that they're dealing with a mental illness. Having a conversation about mental illness can be a touchy subject, so it's best to try to: Keep a calm tone and voice. Ask them questions about their health instead of telling them what's wrong.

How do you talk to an elderly delusion? ›

10 ways to respond when someone is experiencing dementia hallucinations
  1. Determine if a response is needed. ...
  2. Stay calm and don't argue or try to convince using logic. ...
  3. Validate their feelings and provide reassurance. ...
  4. Check the environment and remove possible triggers. ...
  5. Offer simple answers and reassurances. ...
  6. Look for patterns.

How do you deal with a psychotic elderly parent? ›

Here's how you can care for elderly parents with mental health issues:
  1. Have a Conversation. ...
  2. Schedule a Doctor's Visit. ...
  3. Ensure Effective Communication. ...
  4. Gather As Much Information about the Illness as Possible. ...
  5. Ensure They Take Their Medications as Prescribed. ...
  6. Complete the Necessary Paperwork. ...
  7. Give Them Some Level of Control.
Jun 21, 2019

What can cause sudden psychosis in the elderly? ›

Medical disorders may predispose elderly patients to develop psychotic symptoms. Common disorders including thyroid disease, diabetes, vitamin B12 and folate deficiency, sodium-potassium imbalance, sleep deprivation, and dehydration, as well as chronic illnesses have been associated with psychosis in the elderly.

What are the most common delusions? ›

Persecutory delusion

This is the most common form of delusional disorder. In this form, the affected person fears they are being stalked, spied upon, obstructed, poisoned, conspired against or harassed by other individuals or an organization.

How do you respond to delusional accusations? ›

How to help someone with persecutory delusions
  1. Listen. Though it may be difficult, listening to the person helps them feel respected and understood.
  2. Avoid disputing or supporting their delusions. When a person's delusions are disputed, they will further believe them. ...
  3. Redirect the situation. ...
  4. Be supportive.
Mar 30, 2020

Can a person with paranoid personality disorder become violent? ›

Patients with paranoid personality disorder are likely to engender strong countertransference feelings of defensiveness and even aggression in the clinician. Clinicians should avoid reactive counterattacks, which will probably result in disengagement or even violence.

What type of dementia causes paranoia? ›

In a person with Alzheimer's disease, paranoia often is linked to memory loss. It can become worse as memory loss gets worse. For example, the person may become paranoid if he or she forgets: Where he or she put something.

How do I deal with a paranoid mother? ›

Talk therapy and psychotherapy often form the cornerstones of a PPD treatment program. They can help your parent re-examine paranoid thoughts, reduce their feelings of anxiety and paranoia, and learn to communicate more constructively with others.

What is elderly psychosis? ›

Psychosis in Elderly & Dementia

Signs of psychosis in elderly persons include agitation, hallucination, slurred speech, mood swings, uncooperative behavior, agitation, and a handful of other symptoms that are easily mistaken for dementia.

How do you deal with delusional elderly? ›

See the doctor.
  1. Don't take offense. Listen to what is troubling the person, and try to understand that reality. ...
  2. Don't argue or try to convince. Allow the individual to express ideas. ...
  3. Offer a simple answer. ...
  4. Switch the focus to another activity. ...
  5. Duplicate any lost items. ...
  6. Share your experience with others.


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