Paranoia in the Elderly: Causes and Treatments

Paranoia becomes more common with age, and it can be very difficult for adult children and caregivers to deal with. It has many causes and varying degrees of severity; sometimes it’s suggestive of a serious mental health issue or disorder, other times it can be explained away as a medication side effect.

Causes of Paranoia in the Elderly

It’s normal for an elderly person to be a little paranoid from time to time. 

Put yourself in their shoes for a moment. If they live alone, don’t have a spouse to turn to or friends to see, and everyone around them is constantly fretting about their health, preventing them from eating what they want to eat and going where they want to go, they may get frustrated.

Loneliness can exacerbate the feelings of paranoia, and if they were already predisposed, they may lose their sense of reason and allow their irrationalities to take over. Visual and auditory disturbances have a similar effect. If they regularly see someone who isn’t there or hear voices that don’t exist, they may start to think that someone is messing with them or trying to steal from them.

If you speak with a senior who lives alone and has done for many years, it’s not unusual to hear stories about neighbors secretly involved in drug rings/illicit affairs, and governments that are out to make their life miserable. 

Paranoia becomes a problem, however, when they truly believe that someone is out to hurt them, and when these feelings are combined with hallucinations, erratic behavior, illogical thought patterns, and bizarre speech.

It’s something that has a massively negative impact on their lives and the lives of their caregivers and may be the result of one of the following:


Delirium is a very common disorder often triggered by illness or trauma. It’s said that as many as a third of hospitalized seniors will experience delirium at some point, and it often occurs as a result of stress, medication, or anesthesia.

It’s one of the most common symptoms associated with UTIs in patients who have dementia, and it can result from the following:

  • Infections
  • Sensory impairment
  • Withdrawal from drugs or alcohol
  • Severe dehydration
  • Sleep deprivation

Disease and Brain Damage

Everything from iron and B-12 deficiency to kidney problems and brain disorders can cause paranoia and psychosis. Absorption problems, electrolyte imbalances, and neurological disorders can trigger these symptoms and a host of others, including fatigue, seizures, and heart palpitations.

Drugs, Alcohol, and Substance Abuse

Opioid withdrawal often mimics the effects of a really bad flu, and can include hallucinations, extreme sensitivity to external stimuli, and paranoia. Abuse of these drugs may trigger a similar effect, and if they are consumed for longer periods and then stopped, withdrawal symptoms can be just as problematic.

Many seniors are addicted to opioids without realizing it. They take the drugs for chronic pain and use them over the course of many months or years. Only when they stop and the withdrawals take over do they realize they have an issue.

Antidepressants, sleeping tablets, and a host of other medications can trigger similar side effects.

Mental Health

The average age of onset for schizophrenia is around 25 to 30, and it is rare for this disorder to occur in individuals over the age of 40. However, a small number of new cases are reported in seniors, and individuals diagnosed with it earlier in life may struggle with symptoms as they age.

Major depression and personality disorders can cause paranoia, as well. The risk increases if they have suffered with trauma, such as the loss of a loved one or military conflict. They may experience overwhelming feelings of guilt or believe that the things they witnessed happening to others will happen to them.


Many cases of paranoia in the elderly are the result of dementia. 

Dementia is a term that covers a wide spectrum of disorders and diseases, including Alzheimer’s. It plays havoc with the mind and causes rapid deterioration, triggering visual and auditory hallucinations, confusion, and agitation.

A person with dementia may believe that someone has stolen from them or is intending to harm them. If their spouse is present, they may believe that they are cheating on them or preparing to abandon them. 

Feelings of invasion and distrust are particularly common in skilled nursing facilities, where the daily jobs performed by the staff members and the constant presence of other patients intensifies their suspicions.

How to Deal with Paranoia in an Elderly Care Recipient

As a caregiver, it’s difficult to know when to reassure and when to dismiss. Generally, you should opt for the former. As easy as it is to dismiss them right away, it may only worsen the condition. 

Think about how frustrated you would feel if you had a genuine concern about someone stealing from you or trying to hurt you, but every time you told a loved one, they laughed and called you silly.

Rationalizing the situation may work if they still have their wits about them, but this isn’t true for many sufferers of dementia.

To get help for someone struggling with paranoia, take a look at the following options:

  • Speak to their Doctor: Make sure their doctor knows about the symptoms, as there could be a serious underlying cause that needs to be addressed. If they have already diagnosed a disorder and it seems to be getting worse, they may advise you on additional steps to take and/or prescribe medication.
  • Get Help from Support Organizations: There are organizations tied to specific disorders, including Alzheimer’s, dementia, and depression, as well as ones targeted toward caregivers. They will provide helpful resources and assistance.
  • Join Support Groups: Online support groups won’t provide direct assistance but will offer advice. Available on social media and forums, these communities are occupied by people in the same boat as you and provide psychological support.

If the situation worsens to the point where your mental health is affected and their physical health is at risk, it could be time to consider an assisted living facility or nursing home. Available for short-term and long-term stays, these facilities are expensive, but some of the costs are covered by Medicare.