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 adults to develop problems like the ones you are describing. Some older adults will also start leveling a lot of false accusations. 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.
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 (which can include false accusations)
- 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.
I also recommend you check for other signs of problems with thinking or memory; you can learn about 21 signs I recommend checking for in the video below.
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’ve written a book, “When Your Aging Parent Needs Help,” that walks families through how to do this; it includes checklists based on the five sections above.
You can use the book and checklists to spot these red flags that often represent serious safety or health problems.
Now, no book is going to enable you to diagnose your parent. And no book can guarantee that you’ve identified and addressed 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 on approaching a parent who is resistant to help, I explain how to do this in my free online training for families:
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 September 2023.
K says
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?
Leslie Kernisan, MD MPH says
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!
David says
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.
Leslie Kernisan, MD MPH says
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!
Lee Anne Elwell says
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.
Nicole Didyk, MD says
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.
Janet says
How come no one has mentioned Parkinson and the paranoia and delirium that comes with that
Leslie Kernisan, MD MPH says
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.
Pam says
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?
Leslie Kernisan, MD MPH says
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!
maria says
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?
Leslie Kernisan, MD MPH says
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!
Tammy Layman says
I was reading these comments even though my husband is only 45. Things have progressively gotten very almost seemingly hopeless to me. For the past 2 years my husband thinks I’m cheating. Going to the extream so many times I’ve lost count. He’s locked me out a our home, turned off my phone, badgered me to admit to something I’ve not done, cheating, lieing, moving his things taking his things, sending a vehicle fr volentary repossession so I wouldn’t try to take it “when I left with him” I’ve never fit into a plain box, I’ll be the first to admit that, but I rarely leave home because of the outcome I’ll have to deal with. I love my husband very much and I know he does me as well, however the good has always outweighed any disagreement we’ve had in the years before all this started he wore out a town slot and that’s not eat on either of us but I went with him o this last trip to VA fr the week, we were having a nice trip actually spending time with each other when he got off work n he seemed like he was making a real effort to be affectionate tward me when I’m usually the one who teaches for his hand type thing being married 20 yrs to a Marine has taught me that PDA was even though he’s a veteran now 10 yrs or better is still seen as taboo. He opened doors for me n said he made some kinda plans, but the second night I went down to smoke a cig, n when I got back he wanted to know who’s room I had been in? I was floored, he said he went down n I wasn’t no where to be seen, we have a small dog n I walked her across the street where the area was flat and grassy but never went out of sight of our hotel but he was convinced.
How can I get the help we need, whatever it is I’m sure medication will help n we can live normal lives again but we urgently need help n no will not leave my husband in this condition, if he were thinking strait and the shoe was on my foot I know he’d find a way to help me! It’s jus so overwhelming and heartbreaking, now normal only last a day or so till it’s rite back to something he will not accept or prove me wrong about either, but I do know it is not normal tower people n no one be there or hear things boone else hears but if you jus get good medical help it doesn’t have to be so drastic and damaging to us n everyone who knows n loves us. Although that has dwindled to jus a few select family members that have no idea what to do either.. I’m sorry that all jus came pouring out.. I’m sure any advice in the right direction s to even try n sort through this book I managed to rattle out would at least be more than jus a little helpful, thanks in advance.
Nicole Didyk, MD says
Sorry to hear about the difficulties you’re having.
I don’t typically treat younger or middle-aged adults, and the symptoms you’re describing sound like paranoid delusions. Delusions are false, fixed beliefs (such as that a spouse is cheating, or someone is stealing money) that are not based in reality. Delusions can happen for many reasons including dementia (which is what I see most of the time in my practice), prescription medications or recreation drugs or alcohol, personality issues, depression, mania, or some other mental health condition.
If a person is having delusions that they’ve never had before and they’re getting in the way of the person’s health or the relationship health, an evaluation by a medical professional is essential. Strategies that almost never work and can make the situation worse include: arguing back to the person, trying to prove that their perceptions are false, or changing one’s behaviour to try to avoid the accusations.
It’s good that you’re sharing your concerns with other family members, and it’s vital to have a safety plan in case the exchanges become more heated or serious. I hope that by seeing a professional you can get clarity and help.
CB says
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.
Leslie Kernisan, MD MPH says
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!
Jayanth says
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.
Leslie Kernisan, MD MPH says
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!
Jeffrey Foss says
Leslie, help! My father-in-law lives upstairs. He’s 80, has diabetes and is on Alzheimer meds. He hates me but of course loves his daughter (if grumpiness is love)… I, on the other hand, have CPTSD/complex trauma, chronic pain, a ruined spine, osteoarthritis, depression, anxiety, hyper-vigilance, diabetes and hypertension. I’ve learned to dissociate over the years and calm myself — to a point.
Meanwhile, my father-in-law has treated me poorly in that he never makes a cheerful comment, talks to me, cares about what I do, or even asks how I am once in a while. He nitpicks and always sounds abusive and ugly like my dad was. I read somewhere this is the worst form of abuse — being ignored, reduced and treated poorly. He talks to my wife of course, constantly at supper and later during TV; and on the phone with her constantly.
Finally I confronted him during Braves game 5 (it could no longer wait) and said: “Look, I have CPTSD, can’t you at least be chipper and ask me how I am once in a while, no need to everyday…” And he lost it. He went spastic, belittled my condition, and started slinging it big time. This time, I argued back. This enraged him and he went for a weapon (a wooden pole he would use for a burglar). He marched up to me pointing the end of it at my nose with it without saying anything. So I went into defense mode and snatched it from him after a short struggle. No one was hurt, nothing was broken. I kept him on his feet using short tugs. Then in a heightened emotional response (a loud cry), he screamed: “I was just going to show it to you!!” Then he threw the pole back to where he got it and it knocked over some things. I retreated to the downstairs saying I would not be eating that night just to defuse the event and try to calm myself. I do have dangerous depression, but I’ve kept it under control (again, to a point. I have no help currently, just a new DO who took notes on my first visit. I need trauma informed care and he needs a visiting nurse.
Nicole Didyk, MD says
Your story is alarming and I’m glad it didn’t result in anybody getting physically hurt.
Being a caregiver is hard, and even more so when the caregiver is living with serious illness. So, you’re in a tough spot, and I hope you get the trauma-informed care you need to feel better yourself.
The thing is, if your father-in-law is living with Alzheimer’s he probably has a limited ability to absorb and act on any feedback about his behaviour. Arguing back is unlikely to produce any meaningful improvement and if it escalates, it could be very dangerous for everyone.
I think you’re onto something when you mention that he needs a visiting nurse. In cases like the one you describe, getting more help and some distance from the older adult with dementia (aka respite) is a good idea.
Mickey says
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.
Leslie Kernisan, MD MPH says
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!
HP says
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?
Nicole Didyk, MD says
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: /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.
Tim Haddix says
My father in-law is 88 and has terminal cancer – two years tops. His wife now suspects him of cheating on her and questions his every absence. He is doing nothing wrong – I know it. He is just getting out of the house because he always has been active. He can’t even go walking without being questioned. She is in her 80’s as well and has medical issues. She has incontinence, so she rarely leaves the house. Is her accusing him of things a part of grieving, knowing he is going to die and leave her alone? It is apparent to all that he actually takes care of her, not the opposite. Is this fear that she will be alone when he is gone and knows she can’t go it alone? Why is she being mean to someone she loves, knowing her time with him is limited?
Nicole Didyk, MD says
That sounds like a heartbreaking situation and I’m so sorry to hear that your family is going through this.
Your question is very insightful, and such behaviour changes could be part of an anticipatory grief reaction. We also see delusions and accusatory behaviour in dementia or depression as well. An assessment with a Geriatrician or Geriatric psychiatrist would help to sort that out, but seeing the primary care provider would be a good place to start.
Your dad would probably appreciate knowing that you support him no matter what, even if his choices include putting up with questioning and unreasonable suspicion from his wife. Relationships are complicated, especially when there’s illness and transition.
msww says
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.
Leslie Kernisan, MD MPH says
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.
Karen says
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.
Leslie Kernisan, MD MPH says
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
Roni says
Thank you for this information.
Dee Dee says
I agree; thank you very much Doctor Kernan for your excellent suggestions to deal with challenging situations.