Paranoia(11)

Carrie d

My 85 year old dad lives with my husband and I. For the past year, he has had a fairly rapid cognitive decline. He has trouble finding the right words when talking, difficulty writing but the most upsetting to him and us is his paranoia. He feels that people are breaking in every night or during the day to take his things or move them around. I have found most of what he claims was taken but now he is hiding things which only exacerbates the problem. I recently told him I think he has dementia, which he denies and I don’t think he would go to the doctor to discuss. He has also recently developed a strong dislike of any doctors or dentists. Should I make the appointment and try to make him go?  Is there a medication that may help?  Thanks for reading.

M1

Welcome to the forum. Yes there is definitely medication that would help. But he needs evaluation for sure. Do you hold power of attorney for him for healthcare and finances? You will likely need it.

A common strategy is to tell him that medicare requires the visit or he'll lose his insurance. Also write down your concerns for the doc and deliver them ahead of time. Also: don't discuss dementia with him, it will only make him defensive. Read about anosognosia, most have it and can't realize that anything is wrong.

If he's paranoid about taking a pill, there are liquid formulations that you can put in beverages. Hard to get used to doing things like that, but paranoia is difficult to treat.

GGood luck-

harshedbuzz

Carrie d-

Hi and welcome. I am sorry for your reason to be here, but happy you found this place.

In your shoes I would work on these 3 tasks simultaneously.

1. You need to get the legal pieces in order so that you can step in and make sure your dad can be cared for medically and financially. If you do not already have the necessary documents as POA, I would make an appointment with a CELA asap to get these done. Wait too long and he could be deemed incompetent to sign which would require a more lengthy and costly guardianship/conservatorship process. 

Since he's already moved into the paranoia phase, you will have to finesse this. Some folks find success presenting the appointment as routine financial planning/wills for the whole family. You can find a CELA here-

National Elder Law Foundation (nelf.org)

If you do have to go the guardianship route and prevail, costs would be paid by your dad. I have and aunt and friend who were forced to go this route; in both cases the court and attorney fees were paid by the PWD. In both cases, the judge ordered a cognitive examination which was useful in the latter case as his dad had a lot of cognitive reserve and was fighting the process. 

I would caution you to take a deep dive into dad's finances to avoid him being prey to scammers or making bad decisions with money that'll be needed to fund his care later. Dad day-traded away $350K while my mom was refusing to make an evaluation happen. 

2. In your shoes, I would start with his PCP who can start the process if you can. Often a PCP can order a panel of blood tests and imaging to make sure his symptoms aren't from a condition that mimics dementia. My dad had mixed dementia; one was treatable but because my mom fought me on making a work-up happen this didn't happen until fairly late in the game. Had it been identified and treated earlier, they both might have had a better quality of life until his Alzheimer's hit the later stages. I had a friend who brought her mom in expecting a dementia diagnosis but found out her mom had a tumor which allowed her to get hospice set up and family in to visit while mom was still able to enjoy them. 

You'll probably need to create a ruse to get dad in to see his doctor. Talking about suspected dementia with a PWD is a classic rookie mistake. I'm guilty, sadly. In the earlier stages when dad's symptoms were more personality changes and re-writing family history all I managed to do was put dad on alert that I was looking to take away his independence and only made him more paranoid. This made getting to a diagnosis and medication so difficult I had to wait until an emergency to make it happen. I actually got dad diagnosed through a ER visit and hospitalization for a psychotic episode-- a better way to do this is to send his PCP a detailed bulleted list of concerns ahead of time and get him into the office under the guise of a Medicare-required visit to keep his insurance, a necessary check to have a prescription filled or even to accompany you to the doctor for moral support for an imaginary concern about your health. When you go, sit in the doc's sight-line behind dad so you can non-verbally confirm or deny your dad's reporting during the visit.

3. There are medications that can help. Some folks have some improvement in mood and function with the Alz medications like Aricept. Dad's paranoia and aggression ramped up to the point where he was taking a cocktail of 3 psychoactive medications at lower doses to limit side effects which was enough to dial back his anger and suspicions enough that validation and redirection strategies could calm him most of the time. Dad saw a geriatric psychiatrist for meds management-- they're the specialists in the field. His was much more creative in prescribing to avoid sedation than dad's neurologist was and more comfortable and proactive prescribing than they PCP. 

Depending on where in the disease your dad is, he may also have anosognosia which prevents a person from being able to know that they have had a cognitive shift. In their mind they are the same as always and doing all the things they always did. It's best not to try to convince them otherwise. Rule one of dementia fight club is that you never try to reason with someone who can't. 

understanding-the-dementia-experience.pdf (alzconnected.org)

Stages of Dementia Dr. Tam Cummings

HB

CRGeez

Hi, I am a newbie here, and also to my mother being "semi-diagnosed" with vascular dementia.   But, my mother has been exhibiting the same paranoid behavior.  She accused people at the Independent Living place of stealing things, she accused the ER of stealing her coat and her phone (I located both).   She has also become paranoid about all of the doctors and suggests that they are all in on a grand conspiracy against her (and that I am in on it0.  She also called the county Sheriff and told him she was being held against her will and that I was trying to kill her.  So, I know the pain of false accusations, and paranoid thoughts, thinking I would steal what little financial means she has.  I sure hope the situation does not get worse for your dad, but based on these episodes my mother has gone through, it's a possibility that it may not just come and go.  You are not alone.  It is a devastating thing to experience, I can tell you that, but I just try to remind myself that it's the mental illness.  

I hope if nothing else, that me sharing my experience with my mother will tell you that you are not alone in these types of experiences.   I just hope your dad won't start calling the Sheriff like my mother has....and the Independent Living place only told me today, that their have been other instances where she has done this in the last few weeks.  I was shocked they didn't say anything the first time it happened.  It's crazy to me that they did not share this with me, but my mother is in Independent Living and they seemed to suggest that they try to respect that.   I don't really have a solution for this yet, but if things don't improve my biggest fear is that she will be kicked out or forced into Memory Care which is unaffordable.  

Ed1937

Carrie and CR, welcome to the forum. Sorry there is a need for it. You have excellent advice above. 

When people are dealing with paranoia, delusions, illusions, or hallucinations, please don't try to use logic with them. You will never make them understand that what they feel is not real. When they say others are trying to break in, just tell them that they have been caught by the police, and they won't be back, then change the subject. There are different ways to handle these things, but trying to use logic is not one of them. Ask for help here when you need it. You will get good information on how to handle things.

Delusions = a very rigid belief that is untrue. "You have a girlfriend/boyfriend".

Hallucinations = this has to do with the senses. They see, hear, smell, or feel something that is not really there, but it is very real to them.

Illusions = when they see something that actually exists, but they perceive it to be something else. A shadow on a wall could look like a man. Coats hanging on hooks can look like other people. Just two examples.

Paranoia = when they think people are out to get them.

When you change the subject, that is called redirecting, and it is very useful when dealing with dementia. PWD (people with dementia) have a hard time keeping more than one thought in their heads at one time, so changing the subject can really help.

Ci2Ci

CRGeez wrote:

She also called the county Sheriff and told him she was being held against her will and that I was trying to kill her. 

This has happened enough to me now I joke that I need to wear makeup and dress up when going out, in preparation for yet another police body cam! (Those precious 15 mins. that a police officer was talking with her alone has been the only respite that I've had in 15 months.) 

But, on serious note, from personal experience, this can escalate from annoying to dangerous. LO is now in geriatric-psych because of latest incident. I was driving on the interstate when she tried to open car door to flee. Each time thwarted, escalation: open door; open window; grab steering wheel; yank gear shift into low gear; attempt to hit me with her cane. No where to pull over. Luckily, I managed to make my right-hand (giant loop) exit with one hand steering, while holding her wrist & cane. 

Was very scary. She could have caused accident on interstate and killed herself, me, and innocent drivers. That is a mistake that no one can afford to repeat.