Paranoia

Someone suffering from paranoia can be difficult to care for as their delusions and fears can be extreme.  Imagine what it would be like not knowing who you can trust.  The ever-present anxiety must be exhausting, and it can get in the way of their care routine.  Some of the more common fears associated with paranoia include the following:

People are stealing from them.  This can be exhibited by insisting on keeping certain items with them. They may start  hiding personal belongings or other items. If they forget where they’re hidden, it reinforces their belief of being a victim of theft and the cycle continues.   They may make repeated calls to the police.

They’re being poisoned. This could be the reason behind their refusal to eat or drink what’s prepared for them. They may also refuse medications for this reason.

People are plotting against them. This fear becomes magnified if their sense of hearing is failing, because they may misunderstand what is said or believe everyone is whispering so he/she can’t hear their plot.

Family or friends are actually strangers in disguise. This could result in fearful and angry outbursts, uncooperative behavior, hiding, and withdrawal. In a worst case scenario, they could become violent.

Spies are watching them. This could be part of a delusion that they’re extremely important.  You may find them in a darkened room with the blinds or curtains drawn. They may refuse to leave the house.  It’s also likely you’ll discover electronics such as computers, televisions, radios, lamps, phones, etc. dismantled as they search for evidence of spy technology.

Others want to bring harm upon them. They may isolate themselves and/or keep weapons at hand for protection.

Their mind is controlled by the government or alien beings. This could also be the result of delusions regarding their intelligence and imagined high standing in society. Auditory hallucinations (hearing voices) are apt to feed into their belief.

What causes paranoia? It’s not an illness in itself, but rather a symptom of an underlying problem such as:

  • Schizophrenia
  • Psychosis
  • Dementia / Alzheimer’s
  • Enzyme imbalance
  • Toxicity related to failing liver or kidney function
  • Personality disorder
  • Extreme anxiety or prolonged stress
  • Lack of sleep
  • Dehydration
  • Drug addiction
  • Traumatic experience

It’s sad, and sometimes frightening, to watch someone you love living in fear. Here are a few suggestions to help you handle this challenge:

Avoid arguing with them or trying to prove them wrong.  Reasoning rarely works and it could result in their loss of trust in you.. They may act as though they see your point, but do they really, or are they just playing along to throw you off track?

Check your body language and tone of voice. Relax your muscles so your hands are open, your jaw and face are at ease, and your arms are at your side or folded in your lap. Speak in a calm manner. You don’t want to raise any alarms with them by your unintentional actions.

Remind yourself that their fears are real to them. Acknowledge their concern, but don’t dwell on it. Divert their attention to something pleasant such as their favorite activity, book, TV show, etc.

Learn where their favorite hiding places are. It’s not unusual for a paranoid person to hide something and move it repeatedly until they no longer remember where it is.

Be sure they’re getting enough fluids. Keep an unopened bottle of water or their favorite beverage within easy reach. Let them choose what foods they want to eat.

Keep weapons such as knives, guns, bats, and anything that could be used to cause bodily harm away from them. Paranoia may lead them to initiate defensive and/or offensive actions. Think “safety first” and remove yourself if necessary.

Make note of their behavior on their care plan, and include anything that might have triggered it.  Relay this information to their physician, who may prescribe medications to alleviate the symptoms.

Difficult Behavior: Poor Hygiene

As far as difficult behavior is concerned, poor hygiene is one of the more difficult subjects to broach. You don’t want to hurt their feelings or seem insensitive, yet something needs to be done.

The signs of this problem are fairly obvious to everyone it seems, except perhaps to the offending parties:

  • Unpleasant odor
  • Greasy hair
  • Bad breath
  • Dirty and/or food-stained clothes
  • Long finger/toe nails
  • Disheveled appearance
  • Open sores

You might wonder how anyone can stand living like that. Actually there are several possible underlying causes.  Here are some of the more common ones:

Depression  Someone who is severely depressed doesn’t care about their appearance.  They don’t have the energy or motivation to take care of themselves.  Reasoning and trying to ‘talk’ a person out of a clinical depression is not going to work. They will need professional help and possibly medication.

Dementia  This condition often brings other difficult behaviors along with it, such as aggressiveness, paranoia, hallucinations, unwillingness to cooperate, and more.  In this case, you may need assistance from another family member or a professional caregiver to carry out the tasks associated with hygiene.

Sense of Sight and Smell is Failing  The person may have no sense that anything is amiss.  They’re used to the smell or their sense of smell may be failing.  If their vision is also failing, they don’t notice stains on their clothes, or uncombed hair, etc.  In this case, it’s best to politely let them know about the problem and take steps to assist them with their grooming needs.

Memory Problems  It could be they simply don’t remember that bathing, brushing teeth, washing hair, etc. needs to be done routinely.  This is where a care plan, in which they’ve had input, can add structure to their daily routine.  A daily list may be helpful as each item can be checked off as completed.  This could be especially appropriate for someone who is living semi-independently, but is forgetful.

Inability to Keep Track of Time  Most of us live by the clock and calendar to ensure we meet deadlines, remember appointments, and such.  This gives us a clear picture of where we are in our life’s timeline.  However, for young children, those with dementia, and elderly people who have no set schedule, time has less meaning; everything just flows together.  For example, it may have been a week since they brushed their teeth, but to them it seems it was yesterday or perhaps only a few hours ago. 

It may help to have what I call ‘markers’ during the day.  For example, do they watch the news or a cartoon first thing in the morning?  Make it routine that when the program ends, grooming begins.  Or it could be right after breakfast.  Whatever ‘marker’ you choose, be consistent so that it becomes habit.  This structure will also add to their sense of well-being.

Fear of Falling, Vulnerability, Embarrassment, Discomfort  No one likes to feel exposed and vulnerable.  Those with disabilities or the elderly have a definite fear of falling, and may also find they chill easily.  It’s understandable that showering or bathing in these instances is something they dread and want to put off as long as possible.

Regression  This is especially true for someone with Alzheimer’s.  They may need someone to take the initiative for their hygiene as they are not able to handle it themselves.  If you think about how their life was ‘in the olden days’ you’ll realize they probably only bathed once a week.  That was the norm in those days and they don’t understand why it needs to be done so often now.

Control  This is a means of claiming independence.  They don’t want to be told what to do or when to do it, so they go to the extreme just to prove that they are still in control of their life.  This can happen at any age.  It’s a passive temper tantrum without the kicking and screaming.

Medical  Many medical conditions, and sometimes medications, can cause loss off muscle control leading to incontinence, involuntary bowel movements, drooling, and spilling food.  This causes embarrassment for them and they may try to hide it.

This is one serious aspect of poor hygiene that cannot be ignored as it can lead to skin ulcerations and bladder infections, as well as contaminated furniture, clothes and bed linens. In a worst case scenario, this could result in septicemia, a life threatening infection. Refusing a cleanup is not an option in this case.  

What Can Be Done in General:

  • Try to determine the reason for the behavior; speak with their doctor about it.
  • You may need to lower your standards. Bathing 1- 2x per week may be adequate, with spot cleanups as needed.
  • Prepare a bowl of warm water, soap, and wash cloth/towel for a “bird bath” if they’re fearful of the tub or shower.
  • Provide a shower chair, non-slip mat, and hand rail if they have a fear of falling when bathing.
  • Offer to assist them. Move slowly and explain what you’re doing as you proceed, and for your own protection, wear disposable gloves. Be gentle and speak in a soothing tone. Keep their private parts covered with a towel and ensure that no one else is going to walk in. Dry each area before proceeding to the next to prevent chills.  There are also packaged disposable towelettes available for quick cleanups; just carefully warm them in the microwave  before use.
  • Help them brush their teeth, or offer to clean their dentures for them.
  • Keep their hair short. Use a dry shampoo if necessary or run a wet wash cloth with shampoo through their hair, rinse with a wet wash cloth, dry, and comb into place.
  • Help them shave.
  • Use pads or diapers if they have problems with bladder or bowel control. Keep bedding, clothes, and furniture clean and dry to avoid sores, odors, and infections.

Providing hygiene to another is distasteful to some people.  This is nothing to be ashamed of.  Keep in mind, your discomfort will be transferred to them, so it might be better to find someone else to handle it, or hire a home health aide.

Other difficult behaviors a family caregiver may face can be found by clicking here.


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Behavior Problems: Identify the Challenges

IDENTIFYING CHALLENGING BEHAVIOR

There are many common behavior problems caregivers face, and they’re probably the most frustrating and challenging to handle.  They’ll test your patience and challenge your creativity to maintain peace.

Look over this list and see if any sound familiar.  Those that are underlined are linked to a post.

Demanding / Controlling

Crying / Pouting / Temper Tantrums

Paranoia

Hallucinations

Physical, Verbal, or Emotional Abuse

Poor Hygiene

Fits of Rage

Refuses to Cooperate

Offensive or Inappropriate Language

Repetitive Questions, Stories, or Complaints

Wandering

Each one of the behaviors listed will eventually have its own post under this category.  If you’re struggling with a different behavior issue, please send me a message via “Contact Marti” and I will try to address it, or post your concerns in the Comments section below for an open forum discussion.

WHAT CAN I DO NOW?

Do your best to remain calm.  As a rule of thumb, yelling at them or arguing will only serve to escalate the situation.  This can result in a snowball effect.  It certainly doesn’t help them, and it most certainly will increase your own stress level, which is the last thing you need.

While it’s sometimes difficult not to take things personally, try to understand these problems are usually a manifestation of their illness or feelings of helplessness.

Report any changes in behavior to their doctor or hospice team.  Some of the behaviors could be a side effect of one of their medications.  It could also signal a deterioration in their condition.

Track the incidences:  date, time, behavior exhibited.  This might give a clue as to the cause.  For example, does it occur at a specific time of day or night? After taking a particular medicine?  After a certain person visits?  etc…

If necessary, walk away for a few minutes to calm yourself.

If you or the patient are in risk of bodily harm, call 911 for help, then notify the doctor or hospice care team.  Abuse is never acceptable, and you will be of little help to them if you’re injured.


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