What to Know About Paranoia in Older Adults

Medically Reviewed by Carmelita Swiner, MD on April 07, 2023
4 min read

Paranoia in older adults can manifest as symptoms like believing people are following you, stealing from you, or sneaking into your house at night. It falls into a category of mental health conditions called “psychosis.”

Unfortunately, it’s common for older adults to develop persisting fears, worries, and complaints. Experts estimate that as many as 23% of older people have developed psychosis.

But you can help manage paranoia in older adults with care and support.

It’s important to not immediately assume that an older adult is experiencing paranoia. Try to consider the severity and frequency of the paranoid behavior first.

These are some red flags to look out for that may indicate that an older adult might need help:

  • Feelings of caution, stress, or extreme agitation that aren’t easily explained
  • Feeling they are being unfairly mistreated
  • Hearing strange noises they can’t explain (like an animal outside or a tree branch scratching a house window)
  • Seeing animals or people who aren't actually there (which may be a side effect of medication or a vision problem)
  • Thinking that people are talking behind their back (check their hearing aid with an audiologist)

Although paranoia is a medical condition that should be taken seriously, don’t immediately dismiss the worries that an older adult has. If they think that someone is stealing their money when they just misplaced it or that someone is stealing their newspaper when the paper just wasn't delivered that day, take the time to hear them out and try to help.

Many medical conditions can cause irrational anxiety, paranoid behavior, or persistent fear.

Alzheimer’s disease. Alzheimer's disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and, eventually, the ability to carry out the simplest tasks.

Brain tumors. A brain tumor is a mass or growth of abnormal cells in your brain.

Certain medications. Some medications can cause irritability, and sometimes auditory hallucinations and paranoia.

Cognitive impairment. This is a condition where a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life.

Delirium. People with delirium may either be quiet and withdrawn or become extremely agitated and confused. The episodes of confusion can come with mostly paranoid delusions and hallucinations. Often, people with delirium will pick at invisible objects on their clothes or bed.

Dementia. Dementia is a group of conditions characterized by impairment of at least two brain functions, such as memory loss and judgment.

Late-onset symptoms of dementia may happen due to other psychiatric conditions, like schizophrenia, delusional disorder, depression, or bipolar disorder.

Urinary tract infection. If a urinary tract infection isn't treated quickly, the bacteria that enter the urinary tract can move upwards and infect the bladder and kidneys. In older people, this can cause sudden confusion and agitation and may speed up the progression of dementia.

Vascular damage. This refers to damage to a blood vessel, for example as a result of a stroke, blood clot, or vessel narrowing.

If the older adult lives in an unstable environment or is with people they don’t trust, it can intensify their feelings of stress or anxiety.

If you know someone experiencing paranoia, these tips can help both you and them navigate a challenging time:

  • Be understanding and patient
  • Keep their surroundings calm and quiet
  • Avoid arguing about anything that is making them paranoid
  • Empathize with them and let them know that you understand why their thoughts would make them afraid
  • Consider if your body language shows them you are on their side (for example, sitting next to them instead of in front of them)

Paranoia tends to be a symptom of other mental conditions, largely falling under dementia, that an older adult may experience. As a result, it is usually better to see a doctor about it.

However, the general recommendation for any mental condition is to see a doctor if it interferes with your daily life. In the case of someone older, this could include simple tasks like walking, dressing and feeding themselves, or maintaining their home.

If an older person in your care refuses to see a doctor, some tips to get them to the office include:

  • Having the conversation in a space where they are comfortable
  • Beginning with smaller observations, such as asking if they have been stressed or not sleeping well
  • Finding a different reason to see the doctor, such as a physical check-up or blood pressure test

‌If you or someone you know is experiencing paranoia, remember that you’re not alone.

Ask your family for support and connect with other caregivers for advice. Reach out for help. They will know what you're going through better than anyone and may have helpful advice.