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Identifying Signs of Paranoia in Elderly Loved Ones

By Noah BandtMay 23, 2022
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Paranoia in the elderly is a widespread concern. It’s estimated that nearly 70% of seniors with Alzheimer’s will experience paranoid beliefs, and one in four will experience some form of psychosis, according to the National Institutes of Health. Caregivers working with paranoid seniors may find it difficult to ease those seniors’ fears, and many caregivers feel at a loss about how to assist them. Some caregivers may even find that they are the target of a senior’s paranoid thoughts when they are simply trying to help. Read on for several useful tips and treatments that may help ease your loved one’s paranoia.

In this article:

What is paranoia?

Paranoia can be described as an individual’s unfounded belief that others intend to do them harm. For instance, a senior experiencing paranoia may believe that a caregiver is stealing from them or that one of their friends wishes to hurt them.

Paranoia can be extremely harmful to seniors if left untreated. Seniors who believe they are being threatened or feel that they live in an unfriendly social environment are more likely to experience anxiety, heightened stress, and agitation. A paranoid senior’s distressing thoughts may even drive them to lash out physically at caregivers or alienate family members.

What causes paranoia?

Paranoia is a symptom of a broader condition known as psychosis, which occurs when a person’s mental processing becomes disconnected from reality. While there can be many different triggers, psychosis in seniors generally tends to be caused by one of the following symptoms or factors:

Although paranoid behavior is typically a symptom of another medical condition, you should never immediately write off a senior’s concerns as being unfounded. Take the time to do your own thorough investigation, and talk to a doctor if you are worried about your loved one’s well-being.

What are the symptoms of elderly paranoia?

While the experience of paranoia may vary between individuals, the most common symptoms of elderly paranoia fall under three general categories:

  • Persecutory delusions. These delusions occur when a person has false convictions that others are out to harm them. Seniors experiencing persecutory delusions will wrongly believe that they are being spied on, followed, poisoned, harassed, abused, or unfairly treated.
  • Paranoid ideation. This is when feelings of paranoia dominate an individual’s thoughts. Where persecutory delusions are generally fixed or persistent, paranoid ideation may come and go in waves. During periods of paranoid ideation, a senior may, for example, believe that different people are trying to steal their money or that their peers are talking about them behind their back.
  • Increased suspiciousness. While external factors such as stress can cause paranoid ideation, some seniors may experience a general sense of increased suspicion. This feeling of suspicion often manifests as a general distrust for other people, resulting in rude behavior or remarks and changes in demeanor.

Elderly paranoia red flags

Several warning signs can help you identify if your loved one is experiencing paranoia. Symptoms of paranoia may include these behaviors:

  • Saying things that seem illogical or bizarre to others
  • Extreme agitation or caution that isn’t easily explained
  • Unfounded feelings of unfair persecution
  • Hearing strange noises, although this may also be a sign that your loved one needs to have their hearing aids checked
  • Accusing caregivers or family members of stealing from them
  • Avoiding going outside or keeping the blinds closed at all times
  • Accusing a spouse of infidelity

What is the difference between paranoia and hallucinations?

Many people often incorrectly use the terms paranoia, delusions, and hallucinations interchangeably when referring to psychosis. The main difference between paranoia and hallucinations is that hallucinations involve a sensory experience, while paranoia affects a person’s thoughts and beliefs. External events do not necessarily cause hallucinations. On the other hand, paranoia is related to a person’s perception of their environment. Meanwhile, a delusion is simply a belief that is not true. In many cases, a person may experience paranoia, delusions, and hallucinations simultaneously. This is especially true in seniors with Alzheimer’s or other forms of dementia.

Tips for caregivers of seniors with paranoia

There’s no doubt that paranoia in seniors can be difficult for caregivers to manage. Seniors may unintentionally alienate their loved ones and leave their caregivers distressed while they struggle to feel safe in their environment. Here are some tips for caregivers to help care for seniors with paranoia:

  • Don’t argue with them. Paranoid delusions are very real to those who experience them, especially individuals with dementia. Arguing will only help convince them that you are not on their side. Reassure and validate your loved one’s feelings rather than trying to provide them with rational explanations or answers.
  • Respect a senior’s private space. Ensure their room is clean, has good lighting, has stimulating decorations, and is thoroughly secured. If they have roommates or live in a community setting, make sure they have somewhere to store valuables, such as a safe or lockbox. Be sure to ask permission before making changes to a senior’s private space.
  • Don’t overlook small changes in behavior. These can indicate a more significant problem. New feelings of stress or anxiety may signal that the individual is not comfortable in their environment.
  • Journal their day-to-day behaviors to look for signs of improvement or regression. Keep note of any changes you make to your care routine to see if they have a positive or negative effect.
  • Remember that you are not alone.Reach out for help. Ask your family for support and connect with other caregivers for advice. They’ll understand what you’re going through and may have tricks and tips to help your unique situation.

Treatment options for seniors with paranoia

It is important to remember that most cases of paranoia in old age are treatable. “Most families’ concerns about an aging parent track back to underlying medical problems that should be identified and addressed,” according to Dr. Leslie Kernisan, MD, who holds a master’s degree in public health. This means that the first step in managing symptoms of paranoia is to visit your family doctor.

Depending on the frequency and severity of a senior’s paranoid behavior, a doctor may explore several different treatment options. For example, a licensed therapist can help your loved one better understand their underlying emotions, and palliative care techniques can alleviate some of the discomforts of Alzheimer’s or other forms of dementia. Another technique, known as redirection, involves introducing a third party into a situation to distract the individual and help alleviate the tension.

If a senior’s paranoia does not improve, your loved one’s doctor may suggest medication as a further treatment option. A doctor may prescribe antidepressants to help treat symptoms of depression that often accompany dementia. In severe cases, they may prescribe antipsychotics. However, antipsychotics are used sparingly due to their potential for adverse side effects.

When to seek medical attention for elderly paranoia

Contact a doctor if you notice any significant changes in the health or behavior of your loved one. It is crucial to reach out to medical professionals if your loved one’s paranoia is affecting their ability to complete activities of daily living or if they become a danger to themselves or others.

If your loved one is experiencing symptoms of paranoia, it may be time to consider other senior living arrangements. A Place for Mom’s Senior Living Advisors can help you explore local assisted living, independent living, and memory care options to find the services that best suit your family’s needs.


Reinhardt, M. & Cohen, C. (2015, February). Late-life psychosis: diagnosis and treatmentCurrent psychiatry reports.

Brendel, R. & Stern, T. (2005). Psychotic symptoms in the elderlyPrimary care companion to the journal of clinical psychiatry.

Caregiver Assistance News. (2020, July). Alzheimer’s – hallucinations & paranoiaCaregiver Assistance News. 

Chaudhary, M. & Rabheru, K. (2008). Paranoid symptoms among older adultsGeriatrics and aging.

Salters-Pedneault, K. (2020, November 16th). What is paranoid ideation? Verywell Mind.

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal, or financial advice or to create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.

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Noah Bandt

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