Paranoia in Elderly Adults

As our loved ones age and experience cognitive decline, they may occasionally show signs of paranoia. Paranoia in elderly adults is frightening both for the senior experiencing it and the caregiver trying to comfort them. Paranoia can be caused by a few different things including dementia. Luckily, there are some helpful strategies caregivers can use to calm and assist a senior feeling paranoid.

What Causes Paranoia in Elderly Parents?

There are five main causes of paranoia:

• Dementia: Approximately 40% of seniors who experience paranoia are also suffering from dementia. Elderly paranoia about stealing is generally associated with dementia, along with suspicions about family members being out to get them.
• Depression: Depression can often cause feelings of anxiety or paranoia. Other related mental disorders, such as bipolar disorder, can cause paranoia as well.
• Disease: certain diseases can lead to paranoia. A urinary tract infection (UTI) is a frequent but little known cause of paranoia and hallucinations, which tend to be worse in the elderly.
• Delirium: Delirium-induced paranoia often occurs after a surgery or hospitalization, when an elderly person is in an unfamiliar location and encountering atypical levels of stress.
• Medication: Drug-interactions can lead to paranoia. Medication for memory and brain function should be double-checked by a doctor if a senior experiences paranoia or other mental struggles while taking these medications.

Download Guide to Understanding Dementia

How to Cope with the Elderly and Paranoia

When, for example, you see paranoia in your elderly parents, it can be scary. Your initial reaction to hearing your elderly mother say she is hearing voices and feeling paranoia may be to say, “There are no voices, just sit down and eat dinner.” This approach, however, will likely just be frustrating for both you and your mother. Instead, start by validating their feelings. Say something like, “I understand you are hearing voices.” Patting them on the back can offer reassurance and physical touch can help push the paranoia away. Stay honest, but don’t attempt to use logic to prove them wrong. An emotional elderly person can have difficulty thinking logically, and this will only cause frustration and exacerbate an already tense situation.

When observing paranoid behavior, consider if the behavior is hurting anyone. If the behavior does not become dangerous for the elderly person or anyone around them, it may be best to let it happen uncontested. If your elderly aunt wants to keep her jewelry in the safe instead of on top of her dresser, so what? You can also ask the elderly person open-ended questions, for example, “I know you are feeling uneasy. How can I help you feel safe?” This provides validation and reassurance. It can also help get to the root cause of the paranoia.

Some causes of paranoia can be solved by modifying the environment. Shadows may look frightening to an elderly person experiencing delirium or dementia, so a room may just need some more lights. If a senior is scared by the stranger they see in the mirror, simply cover the mirror. You can also practice the “yes, and…” technique common to improv comedy. This can help keep the conversation going and ultimately lead to solutions to help everyone feel calm and safe.

Being a caregiver for a loved one struggling with paranoia can be challenging and scary. Remember to stay calm, reassure and validate, and start a conversation so you can work through the scary feelings together. And as always, speak to a healthcare professional who can help you determine the cause of the paranoia, and if there may be medication or other treatments that can help.