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.]
Elizabeth says
My mother who is 74 has was just moved to a long-term care facility/nursing home about two weeks ago. She was previously living with my stepfather with daytime professional care but my stepfather could no longer continue to care for her. She is fairly far along in the stages of the disease (diagnosed several years ago), she is unable to do almost anything on her own (preparing food, getting dressed, showering, she can’t read anymore so she just wanders around) but she still recognizes who people are (she knows who I am), or at least recognizes who is familiar to her and who isn’t. As a result, she very much knows she’s in a strange place with people she doesn’t know. Even before the move she had issues of anxiety and paranoia that manifested itself as saying that specific people were “bad people” and doing “strange things” without being able to say why or what they had done, likely a response to not understanding what was going on around her. To “soothe” her anxieties (she had a rough first 48 hours there) the home has put her on 2.5mg of diazepam twice a day. Last week I had a phone call with her where she was noticeably “relaxed” and then in my most recent call with her today she did seem quite anxious saying that strange things were going on around her and that the women around her (the caretakers at the home) were – and I’m translating to English here since my mom and I speak another language together – bitches/tarts/cows. I assume they wanted to help her shower, which is a particularly difficult task, or something else she didn’t agree with, which is what earned them that label. I’ve been trying to push the home to start tapering off her diazepam since I had read that it’s not supposed to be given for more than 2-4 weeks and long-term use can cause confusion, anxiety, memory loss, etc., essentially all the things we’re trying to avoid, but I also don’t want her to be distressed all the time if she sees her new caretakers as strange and mean. I also don’t know what to say to her in phone when she keeps repeating commenting on her caretakers like this. Of course no logic or reasoning to convince her differently helps, if I try it would make her more anxious if she thinks I’m not hearing and understanding what she is saying (she’ll point out – “I know what I see, I’m not an idiot”). I try to tell her she’s safe and introduce other topics of conversation but when she has one idea in mind the conversation always go back to that same topic, in this case, these women are terrible and when are you coming to help? I can’t even go see her in person because of COVID, no in-person visitations yet until she’s vaccinated, she’s in Europe and they have been much slower vaccinating people so it could still be a few months, plus I don’t live nearby (I’m in the US). With all that in mind, I’m not sure what’s best for her, I’m not sure what to do or say to her to make her feel better.
Nicole Didyk, MD says
That sounds so stressful, especially with your mom being far away.
It can take a long time to adjust to a new living arrangement, and if anxiety is severe and the goals are to reduce suffering, sedatives like diazepam might be used. We really try to avoid them in older adults though, as you can read in this article.
Usually, the best way to respond when someone is starting to have false beliefs (also called delusions) is to validate her worries and try to move on to another topic, as it sounds like you’re doing. Arguing is not usually helpful. You can try repeating back to her what she says, to show you have heard her, and let her know you empathize with her feelings.
Dr. Kernisan’s new book is for children who are helping aging parents, but many of the issues the book covers could be applied to helping other family members too. The book provides advice on how to communicate with someone who’s living with dementia and resisting help. The book includes advice for long distance caregivers like you as well.
I hope things settle soon.
Elizabeth says
Thank you so much for your response and for sharing these resources. I have started doing video calls instead of phone calls with her which has seemed to help so she has a visual she can look at along with my voice instead of looking at other people around her while we speak.
I am growing increasingly concerned about the medication use however. The doctor lowered her dosage of valium/diazepam from 2.5m twice a day to a half dose (1.75m) in the morning and regular 2.5m dose in the afternoon. The idea was to continue reducing but I’ve just found out that they will be be keeping her on that same dosage. I’m confused because everything I’m reading online including on your site is that it should not be used long term (it has now been 5 weeks, so over what I’ve read is the max of 2-4 weeks) and with side effects of increased confusion, memory loss, falls, even anxiety. The home’s reasoning is that it is “compassionate” to keep her on the medication to lower her anxiety, but it doesn’t seem appropriate if this medication shouldn’t be used long-term. They of course need to consider staff and other residence if her anxiety leads to outbursts that can cause harm to others, but from what they’ve told me there’s no sign of that so I’m confused at why there’s such a default towards the status quo rather than trying to lower the dosage. I read through some of the recommended questions on your site/linked resources, which I will use when I speak with the doctor tomorrow, but I guess what I’m missing is an understanding of whether and in what circumstances is it ok to continue valium for someone with Alzheimer’s since relaxation recommendations aren’t really open to her (talking to a therapist of how to deal with stress definitely won’t work since she won’t understand or remember what was discussed minutes later, meditation won’t help because she wouldn’t even be able to do it). What other options are there for her to manager her anxiety that might be less risky? In what situation would it be recommended to use longer-term if any? Is it common to continue giving this medication in similar circumstances? I’m trying to push them to reduce the dosage but I don’t seem to have a lot to stand on.
Irena says
Hi, my Mom needs assistance at home. I have found a woman to care for her at day time. She met my Mom and told that she had two sons. It seemed all right and I was kind of calm and happy. But suddenly Mom started making up a story that THE woman will come to her falt with two terrible sons, eat everything and even kill her one day. I am stressed what to do, I probably made a mistake to show my Mom my anger about her wrong imaginations. It seems , no arguments can reach her. I have no other way but hire the woman or another person (any stranger will be wrong for my Mom, I see) to care for her. What I am going to do – to talk to the care person and explain her not to bother my Mom with friendly attemps and communication, just to care she gets food and medication. It is so so so sad.
Nicole Didyk, MD says
That sounds like a difficult situation, Irena!
You don’t mention if your mother is living with dementia, but the behaviour that you describe is one that I see frequently in those with Alzheimer’s or another type of dementia, or with some personality or mental health issues. It sounds like a delusion and no amount of trying to reorient a person with a delusion will work, and usually just leads to an argument.
Sometimes a “fiblet” can work, a little therapeutic lie, such as: “The sons have moved away”, followed by a distraction to a pleasant activity can be effective.
If this behaviour continues with other caregivers, or escalates, I would recommend talking to a doctor for a complete evaluation and consideration of medication or another treatment plan.
Maria says
I have a 95 year old father and 91 year old mother. They live in their own home unassisted. I am their daughter. I work full-time and provide assistance often and as I am able, which includes meal preparation and other household assistance. They refuse any help inside the home as they feel people will steal from them. They are verbally abusive and combative toward me. When I tell them that their behavior is unacceptable, they threaten to call the police to tell me to leave. They are not truthful about any medical issues that may arise. They still have control of their money, which continues to be very challenging to try and manage. My father has several health issues, including but not limited to a very large hernia, prostate issues and blindness. He is almost deaf as well. My mother has atrial fibrillation, which has been fine regarding management, but very recent challenges are arising from this medical state within the last few days.
Any advice regarding moving forward on a positive note in this very challenging situation would be appreciated.
Thank you.
Nicole Didyk, MD says
Wow, you really have your hands full with helping your parents. I’m sorry to hear that you’re having to endure verbal abuse. That is not right, but unfortunately isn’t uncommon.
Dr. Kernisan has some resources, in addition to this website, that would be helpful for you. There’s a new book called “When Your Aging Parent Needs Help”. You can pre-order it here: /education-and-support/when-your-aging-parent-needs-help/ The book gives a step-by-step protocol for figuring out how to use your energy in the best way to help your parents. There’s more to it than I can explain in an answer here, but basically, it involves taking stock of the situation, taking aim at one thing at a time, and then taking reasonable action to see if you can make things better (it usually takes more than one try).
There’s also the Helping Older Parents Membership, and you can sign up for the waitlist here: /bhwa-education-and-support/helping-older-parents-membership-waitlist/. The membership provides ongoing guidance from Dr. Kernisan and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her.
You’re not alone, and there is help available. I hope these resources are of use, and remember that you can’t do it all, and you need to look after yourself as well.
Chick says
My aunt (80) started having hallucinations that my son was not eating well, was being mistreated and it was very worrying. Soon after she started believing that her family were going to leave her at the hospital to die and was begging everyone not to take her there. She insisted on staying in her bed for weeks and would only leave to go to the toilet, and even after convincing her to eat dinner in the dining room downstairs, she stood on the stairs crying about going to the hospital, even though she was reassured no one would take her there. My other family members had to travel to take care of her for weeks and then she latched on to them and would follow specifically my cousin around everywhere, begging for her not to leave. However my cousin has to leave to return to her country and she cries about it every second. Should my cousin extend her already one month stay if that will improve anything , or should she take my aunt with her, where she can take care of her, but we are unsure if it’s a good idea for her to travel, especially because she is still testing different medications the doctor gives her.
Nicole Didyk, MD says
That sounds like a very difficult situation. I can’t give specific advice over the internet, but when I see individuals with a persistent fear or worry, I want to make sure that they aren’t depressed and/or having a delusion (a fixed, false belief, often a symptom of dementia).
When someone is having a delusion or severe anxiety about something, using logic and trying to accommodate the person’s fear by avoiding the trigger (like being abandoned) usually doesn’t work in the long term. An evaluation by a health professional is a good first step to trying to get a treatment plan going that may be more manageable than having a family member at a person’s side at all times.
SM says
My parents just moved in with us. My mother (70 YO) has always had anxiety but it got markedly worse in the last 3 months. My parents isolated themselves completely ever since March to keep themselves safe from Covid-19, and it has lead to their mental and physical decline.
For 5 months they did not meet anyone, got all their groceries delivered, and did not step out of their house. They even put the housekeeper on hold. My mother cleaned the entire house every day, cooked, and stressed daily, while fasting or ignoring her hunger pangs. And finally when someone in their condo complex tested positive for Covid, she started getting panic attacks. She is Type 2 diabetic and has controlled it beautifully ever since she was diagnosed 10 years ago. but now her numbers dip and spike a lot especially after a panic attack. Now that they are with us and I’m seeing the problem is far worse. She is completely consumed by anxiety. So much so, she can’t think straight anymore. She can’t make simple decisions like what to eat for breakfast. Sometimes when I call out to her she doesn’t hear me. First I thought she was loosing her hearing, but now I think she is just lost in her thoughts. She also has difficulty comprehending what I say sometimes. She has lost interest in everything. She doesn’t even watch her favorite shows anymore. She doesn’t have anything to talk about. If I ask her how she is feeling she will say she’s fine or just sit quietly and not say a word (which really frustrates me).
She has difficulty sleeping at night and when she does, she wakes up in the middle of the night due to hunger pangs and heart palpitations. Sometimes she is drenched in sweat. She has undergone numerous tests and everything shows up normal besides her blood sugar and blood pressure for which she is taking medication. It sounds like she is suffering from depression, or early Alzheimer’s, or both. She showed none of these signs a few months ago. How can she change so drastically in such a short time? How can I help her control her anxiety, and help her take control of her life again, take an interest in things again? And how can I keep myself sane while trying to help her, and not stress out?
Nicole Didyk, MD says
It sounds like you’ve noticed a change in your mom, and I can understand being worried about depression or something else. It can be difficult to distinguish between depression or a major neurocognitive disorder, which I discuss in my video, here.
In a case like this, I would want to rule out other conditions, and be sure to check things like hearing, especially if an older parent’s attention has changed.
The stress, loss of routine and social isolation that the COVID pandemic has caused seems to be enhancing symptoms for many older adults with anxiety and depression. This unprecedented stressor could be enough to explain why these changes have come about, but I would encourage someone in your situation to continue to advocate for a thorough assessment and treatment for the anxiety. I often find that individuals with anxiety improve their cognitive performance when their anxiety symptoms are under good control.
In terms of staying sane, Dr. Kernisan also runs a special online Helping Older Parents Membership, a unique and affordable program she founded to answer questions and support people helping aging parents.
The membership provides ongoing guidance from her and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her.
Nancy says
My uncle is 102 years old, is being cared for some days by his daughter at her home and other days by a caregiver at his home. He gets very anxious at times even to getting angry, especially when she takes him to his home. He tries to control and very accusing, especially when it comes to money, like without saying it, he’s accusing her of stealing. What does my cousin do…she’s going crazy trying to deal with him.
Nicole Didyk, MD says
You didn’t mention if your uncle is living with dementia, but I’ve treated many individuals with cognitive impairment who become accusatory and anxious as you describe. My advice, which I outline in this video, would be to avoid logic and arguing back, and to try to see things form the uncle’s point of view and provide distraction and reassurance when he becomes anxious.
Here’s another article that might be helpful.
matt says
My mother (age 66) has had memory issues for about 5 years, and recently has had trouble with focus, judgement, etc.. But this past week, she’s started thinking that the realtor selling her house back east teleported her across the country, and then back to CA, several times. Is this a common thing? It’s more alarming to me than her other hallucinations, which were at least somewhat plausible.
Nicole Didyk, MD says
Hi Matt, and I’m sorry to hear that you have concerns about your mom. That would be alarming to hear. I wonder if it is based on an experience with videoconferencing with the agent?
It is unusual for a person to have delusions like you describe, and it could be a sign of dementia, delirium, depression, or something else like a medication side effect. If I was hearing about this experience in my Geriatrics clinic, I would want to find out more about the person’s cognition and day to day function, as well as do a full medical review.
Having said that, I generally try not to offer antipsychotic medication for hallucinations or delusions unless they are disturbing and upsetting to the person experiencing them. Dr. Kernisan has a good article about how to manage responsive dementia behaviors without drugs – if the dementia diagnosis has been established.
Tom says
The one problem I am having to face with my elderly parents, is their constant resist of the fact that they have grown old, with prevailing old age physical conditions. And they should stay away from doing stuff which tires them or might risk them a fall. If we keep on telling them they should not perform such activities, they behave like a child, either raising a tantrum, complaining that, we are not letting them live as they want, or they keep on repeating the activities. Sometimes as children we loose our cool and raise our voice while preventing them or trying to discipline them. This leads to a very tiring situation at home. Also it triggers negative emotions in parents, that their children do not love them or they seem to become a burden. What process do you suggest that can be followed?
Nicole Didyk, MD says
It sounds like a difficult situation to be sure. It’s interesting that you mention the older parent acts like a child, and this would be a natural response to being treated like a child: scolded, nagged, disciplined and restricted.
There are definitely some approaches that are more likely to be successful than others, and Dr. Kernisan covers these all in detail in her Helping Older Parents course, which I highly recommend!
A good first step is to find out more about your parent’s goals and values. Maybe they are willing to accept the risk of a fall in order to continue doing an activity that is meaningful for them. Trying to respect as many of your parent’s choices as possible can help to find a compromise that you can all live with.
Dave says
There’s nothing you can do, stop making yourself crazy trying to rationalize with them or teach them.
I’ve watched so many people keep deluding themselves into thinking they can fix the situation.
The best solution, is to give them small amounts of cannabis in edibles.
It relaxes, makes them happy, helps with nausea, appetite and helps them sleep.
Keep banging your head against the wall and taking advice from “doctors”. The only thing they can do is sedate them.
Nicole Didyk, MD says
Your comment reflects the frustration that can happen when an older parent is struggling and seems irrational! I think anyone who expects to “fix” a situation is going to be frustrated, but working with a health care professional is probably going to be part of the response, along with peer support and self education, like coming to a site like this one.
Cannabis edibles are hard to recommend because most have an imperfect quality control process, and the amount of active ingredient in them is not reliable.
Fen says
My issue is old father -whom I call arse- in 70s. Since 2002 when his mother passed, never treated us well deprive us of normal life. Extremely dominating and sarcastic to mum and me, but i refuse to be submissive. Social worker diagnosed as a severe form of OCD, like when he forgets where he misplaces junks he would vent on me. I hate him and cannot wait for him to quickly die!! Coz I don’t have financial means to move out. He has threatened me violently and irrationally.
All he cares about is hoarding useless junks, and biased towards brother. My mum and brother don’t support family counseling, just don’t think it’s a problem!! His constant fixing of electronics is madness and obsession, untidy and unsafe too
I used to want to be loved but i realise that will never happen, so what’s the use of such a ‘father’? when i even look at someone’s basically quiet and accomodating dad, it’s so ironic and unfair. So yea i hope karma will hit him, how dare he be Ocd when hes supposed to be a father?!
In short REALLy mad but refuse to allow intervention. this makes me not trust in men and dw to get married, my mother made a serious mistake. it sucks
Nicole Didyk, MD says
Sounds like you’re having a hard time living with your father. You mention a change in behaviour since his mother passed away, and a diagnosis of OCD (I am assuming Obsessive Compulsive Disorder). Unresolved grief and untreated OCD could certainly cause behavioural symptoms like the ones you describe. It may be that the only thing you can do is seek counselling on your own to deal with the anger and resentment that such a situation could cause. Good luck.