Dear Dr. K,
Any ideas on how I can relieve my mother’s anxiety about her thinking an animal got in the house? I can’t find anything and have moved the couches but she is convinced and scared.
She’s always been a worrier, plus her thinking has been deteriorating and her vision is impaired a bit. I take care of her and my Dad both 94. She gets upset if I tell her I think she just thought she was seeing something and says I think she is crazy. Last night she woke me up shaking and practically in tears because she thought she saw it again -I offered for her to come sleep with me but she wouldn’t. Any suggestions? — C.S.
Thanks so much for sending in this question. This is a very common complaint I hear from family caregivers, so I am happy to share some thoughts about what might be going on and what you can do.
Now, I can’t say for sure what is going on with your mother. That’s because she’s not my patient, and I’m not in a position to interview her and examine her.
What I can say, however, is that it’s very common for older adults to develop persisting fears, worries, and complaints that often strike their family members as irrational, paranoid, absurd, or ridiculous.
Why is this?
Among my own patients, I’ve found this is often related to underlying cognitive impairment. Meaning, a problem with memory or thinking that hasn’t yet been fully diagnosed by doctors. In some cases, this kind of complaint ends up being one of the very earliest signs of clinical dementia.
Lewy-Body dementia, in particular, is associated with visual hallucinations. But any process causing brain deterioration (Alzheimer’s, vascular dementia, etc.) can result in anxieties spiraling out of control, or persisting strange beliefs.
That said, it’s quite possible for an aging person to express such fears and not have it be dementia. Maybe there really is an animal in the house, or a person stealing your parent’s things. It’s also possible for people to develop confusion or false beliefs due a problem other than dementia, such as mental illness or delirium.
(For more in-depth information on the most common causes of paranoia and strange beliefs in older adults, see this article:
6 Causes of Paranoia in Aging & What to Do.)
Still, given your mom’s age and the fact you’ve noticed other signs of “thinking deterioration,” there’s a good chance that her persisting fear could be related to some chronic underlying cognitive impairment.
4 Things to try to help your mother
I can’t tell you what you should do, but here are some ideas that are generally helpful for this type of situation:
1. Evaluate her underlying cognitive condition. In other words, get her evaluated for possible underlying dementia. Alzheimer’s and other dementias are not curable, but if that’s what’s going on, getting a diagnosis sooner rather than later can help you. For instance, if she gets this diagnosis then you’ll know to look for relevant caregiver resources, including resources on communication in dementia.
For more on what can cause cognitive problems in older adults, see “Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.”
There are also a number of things you can do to help her thinking be the best it can be, such as avoiding certain medications, minimizing stress, and promptly recognizing delirium.
Last but not least, if she is diagnosed with dementia, your family should address advance care planning, and prepare for further cognitive decline. (This is sad to think about, but important!)
2. Reason why, rather than reasoning with. Instead of trying to convince her that nothing is there, see if you can figure out what might be triggering her perception that an animal is in the house. Is there a flapping curtain or other object that she’s misinterpreting, given her vision problems? Would better lighting in the house at night help?
3. Prioritize reassurance, validation, and emotional connection over rational explanations. No matter what their age or mental condition, people respond to feeling heard and loved.
And once the brain starts changing, it’s even less likely that a logical explanation will relieve a person’s anxiety. So, try focusing on acknowledging her concern and helping her feel better. It does sound like you’re already trying to do this, but since it’s such an important point, I’m saying it anyway!
Interestingly, research indicates that even people with poor memories maintain a lasting impression of an emotional experience. So keep fostering those positive emotions however you can. You might find that a hug and song work better than moving all the couches, and having your mother worry that you think she’s crazy.
4. Consider getting ideas from others caring for elderly relatives. Other family caregivers are often an excellent source of advice for trouble-shooting common problems such as anxiety, or even delusions.
You can start getting ideas — and support — from other caregivers right away through an online forum, such as the one at AgingCare.com. I would recommend doing this while her cognitive evaluation is pending, as you and she need practical behavior solutions sooner rather than later.
(Need more guidance on how to implement the suggestions above? I do offer a course to help families with all of this: Helping Older Parents with Early Memory Loss.)
Whom to ask for help
Of course, I always recommend families bring up their concerns with their relative’s doctors. Most concerns families have about an aging parent do track back to underlying medical problems that should be identified and addressed.
That said, many primary care doctors don’t have the time or experience to provide the optimal evaluation and support. If her doctor doesn’t seem very helpful, consider a specialty consultation with a neurologist, memory center, or geriatrician. (See this post for ideas on how to find a geriatrics consultation.) This should enable you to get a better understanding of what brain and body problems might be affecting your mother’s behavior.
For managing day-to-day challenges, you can get excellent practical advice from geriatric care managers, but this usually requires paying out of pocket.
I hope some of this advice helps. This is a tough situation to deal with, but if you’re persistent about investigating and looking into other ways to respond, you’ll hopefully hit upon an approach that brings your family some relief.
If nothing else, finding out that other people are dealing with similar problems is often a big relief to people.
You might also find my free online training for families helpful (see below), in which I teach families how to better communicate with an aging parent who may have memory loss.
[This article was last updated in June 2023.]
Dawn says
My 78 year old mother has Parkinson’s. About a year and a half ago she had to be admitted to the hospital due to falling and suffering from psychosis. My brother and I transferred her to a short term care facility where they got her medications straightened out and she received physical therapy. She returned home able to move about her home with out falling and also hired Day cna assistance.
Over the course of the year and a half she has stopped her physical therapy and in the last two weeks has fallen again 3 times. The last fall was serious. She went outside to look for something that she thought she threw away (with out her walker), fell and split the back of her head open. Hospitalized again, my brother and I along with mom in agreement decided to have her go back to short term care for physical therapy. Yesterday she was fine, and when my brother came to visit she was pleasant to him. When I came to unpack her things she cried and lashed out at me saying that I was a horrible daughter and “if I loved her I would take her home”. She said many more cruel things and instead of losing my temper told her I loved her and had to go.
It’s interesting to see her turn it around when the cna or nurses come in but treats me horribly.
My question is, is that the best way to handle it? I want to see her and let her know I am there but it’s very difficult to take the abuse.
I also provide care for her when she is home (afternoons and weekends). She can be cruel then as well and I have had to make sure she is secure and then leave as soon as possible
Leslie Kernisan, MD MPH says
Oh, I’m sorry to hear that she’s being so unpleasant to you. That must be painful, especially when you are making all these efforts to support her.
One book that might be helpful is “Coping With Your Difficult Older Parent: A Guide for Stressed-Out Children,” by Grace Lebow & Barbara Kane. I just read it and thought it was very good. They have a lot of important advice on how to set healthy limits and how to support a parent who is behaving in the way you describe.
Basically the approach is to validate her emotions when you can (you can usually do this without explicitly agreeing with whatever terrible thing she is saying), try to give her some of what she needs (probably it’s to know you care, even though she may not show appreciation), avoid arguing/reasoning with her, and then take care of yourself by setting limits, learning to think about her behavior differently, and making sure you get enough support.
All easier said than done, but the book will help you get started. Otherwise, if this situation remains stressful for you, consider looking for a therapist or geriatric care manager who can counsel you. Your health and well-being are important. Good luck and take care!
Sheila Garcia says
My Mother is 65. My Stepfather passed away two years ago and she lives alone now. She is the caretaker for my three daughters while my husband and I work. My youngest daughter started attending school all day, and my oldest daughter started attending college. My kids still go to her house but not as much since they are in school most of the time. My Mother has a lot of time to her self and does not have any hobbies or any real friends.
Lately she has started obessing saying that everyone and everything smells. She says my house and her house smell bad. She says that my family and I have a bad smell to ourselves, yet we are oblivious to this fact. I think she feels that we are making here house smell bad when we go stay there. She has started obsessing over the smell and covering her house in essential oils and baking soda. As soon as She opens her door you are assaulted with Peppermint, and the smell is so strong that you can hardly breathe. She is constantly sniffing my kids, telling them they smell, and then spraying them with some concoction. She will take their clothes and then bring them back wrapped up in bags. She will wrap up all the bedding in her hose and air out her mattreses for weeks. She will take her furniture and put it outside to air out.
Today we found charcoal air freshners and baking soda hidden all over my house. When I called and asked her about it she just screamed at me and said that she was not crazy and it was not because she lived alone (I did not even accuse her of this) but did tell her that no one but her was ever aware of a smell in our house or hers. And no one else has ever told us that we smell bad or have a smell. She refused to listen to me, like always, and hung up.
Now my Mother has obessed over things in the past, but this is making me really worry. This obession is not only affecting her life but my family as well. It is giving my children a complex about themselves and it is affecting their relationship with their grandmother. I am worried that this may be something more than depression affecting my Mother, but I do not know how to help her. She won’t even accept that she has a problem, so how do I get her help. Where do I start and who do I take her to, to make sure that she is okay?
Leslie Kernisan, MD MPH says
Oh wow, this definitely sounds like a tough situation. It also sounds a little unusual, with this focus on smells. I believe it’s possible but uncommon for people to develop “olfactory hallucinations” due to something physically affecting the part of the brain that processes smell. Otherwise, this could be considered an unusual variant of late life paranoia, and I explain the most common causes of that here: 6 Causes of Paranoia in Aging & What to Do.
The second half of the article on paranoia is about options for getting help, even when a parent is reluctant, so please do take a look at that article if you haven’t already done so.
Otherwise, I’m not sure just where you should start, but here are some things to consider:
– have you noticed any other signs of changes in her thinking or memory? The article has links to other pages that can help you know what to look for.
– Is it currently possible to reason with her regarding some things not related to the smell issue? If so, you might be able to negotiate that she at least try to distress your kids less. If she’s not able to engage in a constructive conversation (and if so, is that new or has she always been this way?), then don’t persist in trying to reason with her, as this will aggravate her and make it harder for you to otherwise coax her into getting help.
I also think you need to seriously consider how you can protect your children while you sort this out with your mom. It might be a good idea to limit your mother’s time taking care of them for the time being, mainly to protect your kids’ relationship with their grandma and also their sense of themselves. If she is constantly criticizing them, that can be damaging to them.
Obviously if your mom is used to taking care of them, she may well be hurt or distressed if you try to scale back her time with them. See if you can find a way to be diplomatic.
Honestly there are no easy answers for this type of situation. You absolutely do need to try to get her medically evaluated, the question is how to manage it if she’s resisting, and how to protect your family from the impact of her behaviors.
I describe a way of considering the pros and cons of your available options in a recent podcast episode (we call this “balancing the benefits versus the burdens” in geriatrics), you might find it helpful:
054 – How to Make Difficult Decisions Easier: Using Goals of Care & Weighing Benefits vs Burdens
Good luck!
G.vamsikrishna says
Namaste ,my name is vamsi krishna my problem is my mother,she is always think wrong and in reverse if when any two persons outside my house talking biggerly and at that time if my mom hear that sounds she go out side and use abuse language without any break( biggerly) that makes me very gilty and shame to face others and i lost my confidence i think she has psychological problem i hope u will give me a correct solution for me thank you
Leslie Kernisan, MD MPH says
Sorry to hear of your mother’s problems, that does sound very difficult.
As I explain in the article and in the comments above, she really needs a medical evaluation to see what might be causing or worsening her thinking.
In the meantime, it’s unfortunately not going to work to try to reason her out of these behaviors, so you have to just try to reassure and redirect her. You might be able to discreetly apologize to anyone she offends by letting them know she is not well. Good luck!
Sumit Singh says
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Gayla Snowdon says
My mother is 91, lives alone in the house that she and my father built together. My sister and I, her only living relatives, live near each other, but 400 miles away from my mother. The only medical problem she has is hypothyroidism, which is well controlled and she sees her PCP once a year. My sister and I make the trip back to take her shopping every other month. I cook up soups, and dinners and fill up her freezer so she can just warm things up. I call her everyday to check in. She’s still pays all her bills and does quite well except for times when she gets very upset with the TV. It’s always on, her constant companion. But she is convinced that the people on the news can see and are talking directly to her. (she thinks the present administration is spying on her and hates it) Part of the problem is her hearing, which she will not admit is a problem, and the fact that she basically does not have any contact with people on a daily basis. She refuses to move, either in with me, or to her own place near us. These outburst of anxiety happen about once every two weeks. Then the next day she is fine. I think she is very lonely, but fear of change has always been a problem. How can I best deal with her anxieties over the phone, so that my BP doesn’t go through the roof when talking with her? She doesn’t trust the medical community, and would not talk to her doctor about it. I think in the back of her mind she knows this is whacked thinking and would never admit it to anyone else but me. Other than that she seems to be fine. Cleaning the house, sticking to her routines, eating 3 meals a day etc. She has always been a bit on the paranoid side, and can get quite mean. What would be the best way to handle this episodes? Thank you.
Leslie Kernisan, MD MPH says
So, she’s always been a bit paranoid but sounds like you think she is getting slowly worse, right?
This is a tough situation. It’s not uncommon, but that doesn’t make it easier.
To narrowly answer your question: to deal with her on the phone without getting too stressed out, things that help include:
– Don’t argue or try to reason her out of her beliefs. It will frustrate you both. Instead, you need to accept that she is going to inhabit a somewhat different reality. Help her feel heard and validated without encouraging any problematic delusions.
– Work on building up your own resilience to these types of stressful situations. Get enough sleep. Consider meditation or a mindfulness practice. Get enough exercise. Learn and practice techniques that help you let go of difficult situations that you can’t control.
– Consider joining an in-person or online support group for people with aging parents. This is a good way to get support and ideas.
It sounds like she doesn’t have a diagnosis of any form of cognitive impairment. Still, you might find it helpful to read some books on how to constructively communicate with people who do have mild dementia and are paranoid, because the practical communication tips should be helpful.
The ideal would be for your mom to get medically evaluated to make sure there isn’t anything treatable going on, which is worsening her thinking.
In terms of the bigger picture on your mother’s situation, there are really no easy solutions. Families are sometimes able to coax an older person into getting more help or supervision or evaluation, but it’s usually hard to do so if the person has a suspicious mindset. So instead, change often comes about when a crisis hits.
I have some additional suggestions on helping a resistant older parent with paranoia here: 6 Causes of Paranoia in Aging & What to Do. Good luck!
Gayla Snowdon says
Thank you so much for your reply. It is greatly appreciated.
ANDREW BENKE says
My dad has always been racist, homophobic and just an angry man. This is now spilling over into my family’s family and is putting great strain on us as my wife and I are in the middle of this. Rationalising with him does not work as he keeps fanning the flames with derogatory comments aimed at her family members on Facebook. His view is that it is a “free country” and his views are “his views” even if it hurts other people. It’s getting worse. Any help would be so appreciated.
Leslie Kernisan, MD MPH says
Yikes, that sounds like a tough situation.
Well, if he has always been like this and you haven’t noticed any signs concerning for memory or thinking problems, then it’s really about how to cope with a difficult family member. You would basically need to figure out how to set healthy boundaries, so that his toxicity doesn’t spill over into your own life too much. It also helps to build up your own capacity for resilience and constructive communication. This is much easier said than done, but there are books on dealing with difficult family members and then relationship therapists are usually quite experienced with this as well.
If this is getting worse as he gets older, or you otherwise suspect that brain changes might be a factor, then it’s a little trickier. You should still set boundaries, but you might also want to consider whether you can help him get evaluated, and you might want to monitor for further deterioration and possible safety concerns.
Good luck, it is definitely difficult to have someone like this in your life.
Marty says
Cognitively Impaired.
So here is a story, I work at a grocery store and an elderly man comes in every day and steals several times a day. He has been spoken to about it. When approached he says he won’t do it again but keeps on doing it. There are no present caregivers with him. Not sure if he has dementia or Alzheimer’s. But if he knows what he’s doing is wrong when approached, does he have a mental illness?
Leslie Kernisan, MD MPH says
Interesting situation.
“If he knows what he is doing is wrong” is not really a good test to apply, in terms of determining whether or not he is cognitively impaired, or has another form of “mental illness.” I would expect that many people with early dementia would know stealing is wrong yet could still have difficulty controlling the behavior. And then of course some people steal and are not cognitively impaired, they do it for economic reasons or occasionally due to a stealing compulsion.
It does sound like he needs evaluation of his cognitive state. Your best bet might be to report his behavior to the police. (In some places, police are getting trained to better understand older adults who might be confused.) They might be able to contact family or otherwise facilitate some kind of process to learn more about his social situation and health situation.
Good luck, and if you can, let us know what happens.
Joanne says
My 88 yr old mother in law called me to ask if my husband (their son) had been in their city that day. (We live over an hour away) my 90yr old father in law claimed (and argued) that he had seen and spoken to him, and that their son had said he was going to get a chicken (cooked!!) and would meet up at the food area…where my in laws waited for over 1/2 an hour, when he obviously didn’t show up, they went home and waited for our arrival. When we didn’t show up, they called to ask where we were. My fil literally argued with me that he saw and spoke to him.
Other issues…he will call to ask how to put gas in the car; how to open the trunk; couldn’t get the key out of the ignition (lights are one and bell dinging) he hadn’t put it in park, and wouldn’t listen to instructions to check if it was in oark.
He will decide that he has to put the garbage out, when it’s not even garbage day, or insisting that he has to go get his blood taken, and when told that it’s not open or not garbage day, half hour later, he’ll say it again. Is this a start of dementia? Thank you!
Leslie Kernisan, MD MPH says
This certainly sounds concerning. If it’s been going on for a while and is slowing getting worse, it would indeed be quite concerning for possible dementia. However there are other problems that can scramble an older person’s thinking a bit (e.g. medication side-effects, electrolyte imbalances), and even if you suspect early dementia, it’s important to check for those.
If you haven’t already seen these articles, I would suggest you read:
6 Causes of Paranoia in Aging & What to Do (even though you aren’t describing much paranoia, the problems that cause paranoia can also cause scrambled thinking)
How We Diagnose Dementia: The Practical Basics to Know
Good luck!
Karan Jodhani says
My grandmother has been recently gone through 2 minor operation. She is behaving in awkward way .i am really worried about her mental stability.she can not differentiate between morning and night. Sometimes she starts saying something than simultaneously turn the talk and say something else .Barely could be understood .
Leslie Kernisan, MD MPH says
If she has mentally changed after having an operation, then this may well be delirium. You can find more here:
Hospital Delirium: What to Know & Do
10 Things to Know About Delirium
John Clarkson says
My dad has had a hip op after a fracture aged 91. He has pernicious anaemia. He has severe anaemia but it slowly got better. Then a UTI was discovered. He has only had one uti in the central white matter 8 years ago. Has had PA for about 10 years.
After the op he was his usual lovely self and has declined as the UTI got worse. Medical people say it is only 1 month. Gen Anasthetic, Post Op Cognitive Dysfunction; and UTI are giving him irrational thought. He called me by his brothers names one night when he woke. He keeps talking about joining up his gums or face???? He has problems with taps at home. And he keeps saying ‘now what’ when doing very basic things so loss of exec function. But he passes all the Alzheimers tests including short term memory, counting backwards, months of year backwards, day, date, year but has problems guessing the time. Sometimes forgets what time it is. He can walk with his zimmer really well.
Has restless leg syndrome. Has Atrial Fib and SVT now and again but also irregular heart beat permanently though you cannot tell from feeling pulse on neck.
Because he can talk two languages (English and basic servant hindhi) and he was quite well qualified (Intermediate Science in Chemistry) and was a very switched on guy, using a laptop excel sheet regularly up until his fall on 13 May 2017 it is very depressing to see him like this.
Leslie Kernisan, MD MPH says
I am a little perplexed by your reference to “uti in the central white matter,” because UTI usually means “urinary tract infection,” which should have nothing to do with “white matter,” which usually refers to brain health. (I do have an article on white matter lesions here: Cerebral Small Vessel Disease: What to Know and What to Do
I am not at all surprised by the general contours of your story, because it sounds like your father developed some delirium while in the hospital. It is very common for older adults to develop confusion related to illnesses or hospitalizations. Increasing age makes this more common, so it’s quite common for people in their 90s like your father.
I explain more about delirium in these articles:
Hospital Delirium: What to know & do
10 Things to Know About Delirium
I hope he recovers. There is more information on recovery in the articles above. Good luck!