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Paranoia in Elderly Parents: Causes and How to Respond

Updated January 2026 · 12 min read

"Someone is stealing from me." "The neighbors are spying on me." "You're trying to poison me." When your once-reasonable parent starts making suspicious accusations, it's alarming and hurtful. Understanding why paranoia happens—and how to respond—can help you both.

This Is Not Personal

When a parent with dementia or other condition accuses you of stealing or plotting against them, they genuinely believe it. Their brain is creating a false reality. The accusations aren't about you—they're symptoms of disease.

Why Elderly People Become Paranoid

Dementia

Paranoid delusions are common in Alzheimer's and other dementias. Memory loss creates gaps that the brain fills with explanations—if they can't find their wallet, someone must have stolen it. The brain creates a narrative to explain what they can't remember.

Key sign: Paranoia that didn't exist before cognitive decline began.

Medication Side Effects

Many medications can cause paranoia, confusion, or hallucinations in elderly people, including:

Urinary Tract Infection (UTI)

UTIs can cause sudden, dramatic mental changes in elderly people, including paranoia, confusion, and hallucinations. This is often the first thing to rule out.

Key sign: Sudden onset of paranoia in someone who was previously clear-headed.

Delirium

Sudden confusion and paranoia can be caused by infection, dehydration, hospitalization, surgery, or medication changes. Delirium is a medical emergency.

Key sign: Rapid onset (hours to days), fluctuating symptoms, worse at night.

Sensory Loss

Poor vision and hearing can contribute to paranoia. If they can't hear conversations clearly, they may assume people are talking about them. If they can't see well, shadows become threatening.

Key sign: Paranoia improves with better glasses or hearing aids.

Social Isolation

Loneliness and isolation can lead to suspicion and paranoia. Without regular reality checks from social interaction, fears can grow unchecked.

Key sign: Paranoia in someone who lives alone with little social contact.

Mental Illness

Late-onset schizophrenia or psychotic depression can cause paranoid delusions. These conditions can appear for the first time in old age.

Key sign: Elaborate, fixed delusions; may include hallucinations.

Always Rule Out Medical Causes First

New-onset paranoia warrants a medical evaluation. UTIs, medication effects, and delirium are treatable. Don't assume it's "just dementia" without checking.

Common Paranoid Beliefs

How to Respond

Do These Things

Don't Do These Things

Sample Responses

"Someone stole my wallet!"

Instead of: "No one stole it. You probably misplaced it like always."

Try: "That's upsetting. Let's look together. I'll help you find it." (Then subtly guide them to where it likely is.)

"You're trying to poison me!"

Instead of: "Don't be ridiculous. Why would I poison you?"

Try: "I would never hurt you. What if I take the first bite to show you it's safe?" Or prepare food together.

"The nurse is stealing my things!"

Instead of: "The nurse would never do that. You're being paranoid."

Try: "I understand you're worried about your things. Let's put your valuables somewhere safe together."

Prevention Strategies

When to Seek Help

Treatment Options

Depending on the cause:

Antipsychotics and Dementia

Antipsychotic medications carry a "black box" warning for increased death risk in elderly dementia patients. They should be used only when non-drug approaches fail and the behavior causes significant distress or danger. Discuss risks and benefits carefully with the doctor.

Caring for Yourself

Being accused by someone you love and care for is emotionally exhausting:

Caregiver Burnout Assessment

Dealing with paranoid behavior is exhausting. Check in on yourself.

Take Assessment

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