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Paranoia in the Elderly: Will it Warrant Additional Care?

Anxiety. Fear. Distrust, and always feeling threatened. These are the common symptoms associated with paranoia, and if your loved one is exhibiting them, it could be signs of something more serious. That’s not always the case, but changes in behavior should always be taken seriously, especially paranoia. After understanding paranoia, and your loved one’s behavior, you can better equip yourself to handle care for someone who may be losing trust in the ones providing it.

The Causes of Paranoia

There are two types of paranoia: Acute paranoia and chronic paranoia. Acute paranoia can last hours or days and is likely due to an individual’s underlying medical condition, says Clover Health’s psychiatrist and medical director, Viwek Bisen. “On the other hand, chronic paranoia can last longer (weeks to months) and is likely due to dementia or another degenerating psychiatric illness,” he says.

Paranoia in older adults can be attributed to medical conditions such as infections, metabolic abnormalities, brain tumors or even side effects of medications accompanying them, according to Bisen. “It can also be a result of worsening psychiatric illness such as depression or dementia, including Alzheimer's and Lewy Body dementia,” he explains.

Cathy Jones Parks has experienced two types of medically-related paranoia while caring for her mother, who lives with dementia. Over the years as her mother’s primary caregiver, she’s seen how UTIs can lead to increased confusion and the onset of paranoia. “We have established better systems to troubleshoot for UTIs and work closely with her primary care provider to proactively address a UTI right away,” Jones Parks says.

Jones Parks has also witnessed medication-related paranoia firsthand. During a stage of significant decline for her mother, medications were prescribed to address symptoms thought to be related to depression due to the passing of Jones Parks’ father. “The new medications, combined with existing medications — and the then undiagnosed Alzheimer's — resulted in serious hallucinations and paranoia. Hospitalization for a geriatric medical/behavioral evaluation, including a comprehensive evaluation of medications, was required,” Jones Parks recalls. As a result, the medication treatment plan was revised and is managed routinely throughout the year with medical professionals who specialize in geriatric care.

How to Cope With Paranoia

Coping with paranoia is difficult as the feelings and thoughts can feel very real and scary, says Bisen. But there are ways to reduce these effects. For example, if an older adult is paranoid that someone is trying to break into his home, making a concerted effort to lock his doors — and ensuring he’s aware of this fact —can have a significant impact. If seniors feel as though people are talking behind their back, they could visit a doctor to discuss potential auditory issues causing this sensation, Bisen recommends. If paranoia is causing insomnia, it could be beneficial for older adults to ask their doctors for medications to help with anxiety or sleep, he adds.

Jones Parks also experiences paranoia as part of her mother’s “sundowners syndrome,” which is associated with dementia. She and her husband, who care for her mother together, have found some ways to cope. “Awareness of this behavior has been the greatest action we have taken to support my mother during this time of the day,” she says. “We have established a very consistent routine and adhere closely to it: in the evenings, we ensure the house is adequately lit and that we are near Mom, we have a salt lamp lit in her room at night, pull her shades, and diffuse the room with lavender.”

Another approach that has alleviated paranoia at sundown time for her mother is avoiding TV shows and online content that can over-stimulate your loved one. Concerning cognitive activities, Jones Parks reserves the morning hours for those, and they're careful to keep her mom moving throughout the day — both of which minimize her paranoia.

“In the evening, we have mom engaged with her embroidery and talk with her to keep her focused and not let her drift into a state of anxiety or paranoia,” she says. “We watch for signs of anxiety like darting eyes or rubbing hands. If there is a strange sound outside, we talk about it so she knows it is okay.”

A consistent bedtime routine has been tremendously helpful for Jones Parks’ mother as well. “We give her medications, rub her feet with lavender, and have a cup of calming decaf tea to signal bedtime. Routine, awareness and being proactive to triggers for Mom (i.e., how she displays anxiety) have helped us to manage her paranoia and sundowning behavior,” she says.

Managing Paranoia Isn’t Easy

As her mother’s caregiver, Jones Parks is the common thread between their team of medical providers, so she consistently addresses medications and side effects of them with the team, in addition to documenting medicines that are not viable for her mother. She also notes any changes in behavior and communicates those directly with the appropriate provider. “Being aware of my mother's diagnosis, routinely documenting her behavior/health, and communicating proactively with her medical team have all helped tremendously to manage the paranoia,” says Jones Parks.

But managing all these moving parts is stressful, overwhelming and exhausting. And for some family caregivers, the task can quickly seem insurmountable. That's where an experienced professional inside a paranoid senior’s home can be extremely helpful.

The first thing to do is have the older adult experiencing these symptoms visit a doctor as soon as possible if the paranoia is acute, recommends Bisen. “Many medical and psychiatric causes of paranoia can be easily treated by addressing the underlying medical condition or psychiatric illness. For example, paranoia caused by dementia can often be treated with medications,” he explains.

It's also important to reassure and validate an older adult’s feelings of paranoia rather than dismissing his or her concerns, Bisen adds. Providing structure by building routines and limiting excess stimulation, like Cathy Jones Parks and her husband have done, can also be helpful in warding off the unwelcome symptoms of paranoia. But for a family member who is already juggling a lot, the thought of implementing a new routine seems impossible. Partnering with a professional caregiver can ease the burden on you and deliver a higher quality of care, like the kind Jones Parks provided for her mother.

If you notice increased levels of paranoia from your loved one, it is essential to be proactive. Click to learn more about a full-diagnostic process.

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