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.
M. Simpson says
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 ?
Leslie Kernisan, MD MPH says
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.
Karen Smith says
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.
Leslie Kernisan, MD MPH says
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!
Diane says
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).
Leslie Kernisan, MD MPH says
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!
Susan says
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?
Leslie Kernisan, MD MPH says
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!
Todd in Texas says
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
Leslie Kernisan, MD MPH says
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!
savanah gonzales says
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.
Leslie Kernisan, MD MPH says
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!
savanah gonzales says
Thank you!
Denise says
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!!
Leslie Kernisan, MD MPH says
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!
Aman says
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
Leslie Kernisan, MD MPH says
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!
Matilda says
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.
Leslie Kernisan, MD MPH says
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!
Gina says
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.
Leslie Kernisan, MD MPH says
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!