Paranoia in Elderly: Symptoms, Causes, and Treatments

Are you having problems in handling your elders? To know your next step, we have in this article the symptoms, causes, and treatments of paranoia in elderly.

Are you a primary care companion who got lost in translation while assisting your elder patients?

Maybe your elderly mother has become more suspicious of everyone and everything she meets?

Do you think you need to know more about their psychosis symptoms to plan your course of action?

We know how it feels to be lost trying to find the correct information. So, we have the right article for you.

In this article, we will help you run through the symptoms, causes, and treatments of paranoia in older adults.

Paranoia in Elderly: An Overview

Paranoia in Elderly

One of the most common types that are linked to psychosis is paranoia.

Paranoid behavior makes an individual think like someone is constantly looking over them or calling their names — when in reality, they are alone.

Also, an older person with paranoia distrusts their environment. It is a familiar cognitive impairment among elder dementia patients and those with Alzheimer’s disease.

In fact, 70% of older adult patients with Alzheimer’s experience paranoid delusions.

Is Paranoia Common in the Elderly?

Yes, paranoia affects aging parents and other older adults. It is fairly common among this age group.

According to studies, 23% of the population of older adults develop psychotic symptoms mainly from dementia.

Michael M. Reinhardt and Carl I. Cohen’s study shows the proportion of psychosis among elders:

  • 5–15% are geropsychiatric inpatients
  • 10-62% are nursing home patients
  • 27% are community-dwelling psychiatric outpatients

Symptoms of Paranoid Behavior in the Elderly

Catching symptoms of paranoid behavior for some may be easy. But, there are times that it blends well with normal aging persons’ daily records of suspicions.

If you observe one of these symptoms from your aging loved one, consult your family doctor:

False Beliefs

Elderly paranoia is often linked to feelings of discrimination. Your aging loved one may feel like they are treated poorly by people around them.

They may even have hearing problems like feeling somebody talking behind their backs or hearing noises that aren’t even there in the first place.

Sometimes it can be caused by their hearing aids; that’s why it’s better to go on a check-up.

Delusions will also include the notion that someone might pose harm to them through abusive actions or harassment.

Visual Hallucinations

Older adult patients can have hallucinations, such as seeing people not present in the vicinity.

They may even “see” somebody stealing their money even if, in reality, nobody’s touching anything.

These hallucinations can also be caused by their existing medical conditions with high doses of medications.

It can also be caused by problems in vision which is quite common in elders.

Jumbled Thoughts

This symptom can be linked with false beliefs and visual hallucinations when they consider non-existent things as factual.

When the elders convince themselves that they are seeing or hearing things even if there are none, it can be a reason for jumbled or disorganized thoughts.

What Causes Extreme Paranoia in the Elderly?

Knowing the symptoms is one thing to help your elders from paranoia. Yet, what causes paranoid delusions? And worse, what makes it extreme?

These are the causes of paranoia among older adults; if left untreated, this can be fatal:

1. Diseases

Some diseases can cause paranoia when untreated, like brain tumors and urinary tract infections (UTI).

On the one hand, a brain tumor and its medications can cause neuropsychiatric symptoms that affect an individual’s mood, behavior, and personality. These can then result in paranoia.

On the other hand, an untreated UTI can trigger paranoia and other psychotic symptoms.

As found in studies with actual patients, 88% of the medical records evaluated showed a positive relationship between UTIs and neuropsychiatric disorders.

2. Alcohol and Other Toxins

Alcohol abuse can lead to kidney dysfunction, equating to physical and psychological differences in an individual, like paranoia and dementia.

One of the disorders is alcohol psychosis, predominantly diagnosed in alcoholic men.

If left untreated, some patients are prone to extreme measures just to satisfy the spike of jealousy within since this disorder is most often associated with men being suspicious of their partners’ “other affairs.”

Additionally, there’s another form of this substance abuse-induced paranoia called alcohol hallucinosis which leans more on optical hallucinations of the patient.

3. Cognitive Impairment

Cognitive impairment can be caused by delirium, dementia, and Alzheimer’s. This can then affect how individuals experience paranoia.

Delirium is a sudden change in cognition, which can sometimes fluctuate. It can be one of the prescription medication side effects in elders.

Dementia, on the other hand, is a continuous memory loss that affects how dementia patients think, feel, and perceive situations.

Lewy body dementia also has hallucination symptoms that can be attributed to paranoia. However, this is hard to diagnose, given that its symptoms are similar to other disorders.

Lastly, in Alzheimer’s disease, paranoia can significantly affect the progression of memory problems.

As Alzheimer’s patients often forget things, they become paranoid whenever they try to remember what happened or where they put things.

4. Mood Disorders

Paranoia is linked to these disorders as most symptoms include paranoid behaviors.

A study shows that mood disorders such as psychotic bipolar disorder and severe depression can cause delusional guilt. It can also lead to extreme aggression if not appropriately treated.

In one of the cases in the study, a female nurse diagnosed with chronic paranoid schizophrenia thought that law enforcers and the hospital management would bring her behind bars.

She thinks she is incompetent for the job after her patient, who is terminally ill, died. However, in reality, it was not her fault, and nobody was bringing her to jail.

5. Elderly Paranoia After Surgery

Aside from the mentioned causes of paranoia above, post-operative delirium also causes paranoid thoughts among older adults.

Thomas Robinson, MD, a professor in surgery, explained that this is one of the common post-op complications as surgery can change the cognition of the patient resulting in sudden confusion.

You can see this in medical dramas where medical professionals are extra careful and gentle with patients in the recovery room after surgery.

However, it is manageable. Aside from medications, prevention plans that include the following can be of great help:

  1. Walking as a physical exercise for the patient
  2. Patient awareness of the location and time they’re in
  3. Letting the patient rest and sleep adequately
  4. Older adults need fluids, their glasses, and hearing aids

Sudden Paranoia in the Elderly

A sudden series of paranoia symptoms in elders is a matter of concern.

It may be caused by their pre-existing medical condition like brain tumors, urinary tract infection, or an onset of Alzheimer’s disease, dementia, or delirium.

To ensure a systematic review and a medically evaluated diagnosis, bring them to clinical psychiatry or related healthcare professionals.

Treatments for Paranoia for Elderly Patients

Treatments for Paranoia for Elderly Patients

Upon witnessing one or more symptoms of paranoia in your elders, these are the steps you should follow for treatment:

1. Visit Your Family Doctor

A significant change in mood, attitude, and behavior is already a red flag that you need to address.

Visit your elderly loved one’s doctor and ask for their professional opinion. They may refer you to professionals that specifically focus on this aspect.

After careful evaluation, medical professionals may give your patients non-drug or prescription medication.

2. Non-Drug Interventions and Therapy

According to records from the Alzheimer’s Association, non-drug interventions include physical and mental activities for relaxation. It includes doing art and being involved in music.

Walking, running, and road trips can also be one of these. It helps redirect energy into positive activities.

Also equally important is using affirmations and uplifting words such as you’re doing great, it’s okay, and you’re getting there.

Of course, these patients need a healthy environment that fosters inclusivity and peace alongside adequate rest and sleep to make the body and mind function well.

Therapy can also include conversations with psychiatrists. Yet, paranoid aging patients will have difficulty entrusting their feelings and sentiments to professionals.

This may result in slower progress. Nonetheless, little progress is still progress.

3. Prescription Medication

Sometimes, those mentioned above aren’t enough for certain aging patients. That’s why the Alzheimer’s Association stated that doctors resort to prescriptions.

Antipsychotic medications are prescribed for paranoia patients to help lessen paranoia and make them feel comfortable.

However, it is only given for a specific time because it has serious side effects.

4. Hospitalization

Some individuals may experience extreme paranoia that is beyond regular medications or therapy.

These patients are advised to stay and be admitted to hospitals. Health professionals will do close monitoring and medical evaluation to stabilize the paranoia.

Top Tips to Handle and Care for Elderly Dementia Patients

Having elders as dementia patients under your wing means caring for them with patience and understanding.

To start your hands-on assistance, you need to be reminded of these tips:

#1 Breathe and Don’t Argue

When they confront you with accusations personally grounded on their irrational anxiety and increasingly forgetful state, don’t argue.

For elderly people — whether a dementia patient or have Alzheimer’s — the strange noises and people they see are very true to them

Arguing with them may worsen hallucinations or other psychotic features.

#2 Be Calm and Respect Their Decisions

Support older adults when they decide to think alone in a safe space or rest in the comfort of their rooms.

Give them privacy and security. When it’s time for certain medications or there may be tweaks needed in their rooms, be calm and talk to them nicely.

In all ways, respect them and their decisions. But, of course, be mindful. You can intervene respectfully if you think their choices may affect their current state.

#3 Monitor Triggers and Comfort Points

You must observe their points of triggers and comfort. Knowing these two will help you monitor their progress or regression.

Note new feelings and emotions shown by your older adult patients. By this, you will know the triggers and the comfort points.

This will help you diverge your aging parent with dementia into similar challenges of tantrums and paranoia.

Also, when you know their comfort points, you can quickly address potential problems.

Frequently Asked Questions

As a caregiver, you must know everything. If not, at least most. That is why part of your job is to ask questions.

In this section, we have common questions and their answers for your reference:

How Should Family Members Talk to Someone Who Is Paranoid?

Family members should gently talk to their paranoid patients. They should also avoid arguing.

It is a necessary move to remain calm as much as possible when negotiating with paranoid patients.

Is Paranoia Early Signs of Dementia?

Yes. Paranoia can be an early sign of dementia as it is associated with memory loss. However, to ensure a proper diagnosis, visit a medical professional.

What Causes the Sudden Onset of Paranoia?

Post-operation complications, untreated urinary tract infections, and alcohol abuse can cause sudden paranoia. These can affect an individual’s way of thinking and push them to be suspicious of almost everything.

When Should I See a Doctor for Paranoia?

If you notice an onset of symptoms or significant changes in behavior or personality, visit your doctors immediately.

Do not let your patient reach extreme paranoia before scheduling a doctor’s appointment.

How Do You Calm Down Paranoia?

Treatment can help calm down paranoia. However, as the caregiver, you can also learn these ways to ease your older adult patients:

  • Talk gently and openly with them
  • Consider their feelings and explanations
  • Make them feel valid and secured

Does Paranoia Ever Go Away?

There is no one-time cure for paranoia. However, with proper treatment, patients can still enjoy life as it is.


Late-life psychosis or any delusional disorder has been a normal part of aging adults. This mild cognitive impairment has a lifetime risk of 23%.

The brain function is affected by this mental condition. It takes away the opportunity for elders for rational explanations as they can have optical hallucinations, auditory hallucinations, and other symptoms.

A geriatric care manager, other caregivers, and you should always be mindful of the symptoms, causes, treatment, and how to negotiate with these patients.

It may be difficult, but always be calm and offer kindness to these older adults with paranoia.