My 90 year old mother has been becoming more and more paranoid about her surroundings.....Any input?


She is still able to live (somewhat) independently with a lot of assistance from family but has significant memory loss and is fairly frail. My husband and I live the closest, less than 15 minutes from mom, and call and stop by at least once or twice a week. I'm able to take her grocery shopping but she's not up to doing much else and really prefers her environment and card playing with some friends in the building she lives in which is quite nice and she says she loves. However, she is not a fan of the new custodian and the feeling is probably mutual as my mother is very perfectionistic and, frankly, kind of OCD, particularly about her surroundings. So, she now believes he is trying to drive her nuts by coming into the apt. when she's not there and messing with her curtains, leaving notes on the fridge and covering her microwave with plastic so the numbers don't work get the picture. I've spoken with her primary care doctor and he is suggesting that she start taking a low dose of either Seroquel or Trazadone to help alleviate some of her paranoia and anxiety symptoms. Does anyone have any experience with an elderly person taking these drugs and how they react? Given her relative instability I'm concerned that she might become even less sure on her feet (she does use a walker well) but the middle of the night could be problematic. Thanks for any input anyone may be able to provide.

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Thank you, everyone, for your thoughtful and helpful responses. I am considering the nanny cam idea but have concerns about how my mother will feel about this since I don't think she will necessarily retain that the reason it is there is because we put it there and not the antagonizing custodian. To answer some of your other questions, mom is very capable of handling her ADL's so this isn't an issue, at least not yet. The building she lives in is HUD subsidized and while it doesn't have on site nursing there are alarm pulls in the apt. (they are all 1 bedroom) with some other benefits like a hairdresser who comes weekly, a podiatrist who comes monthly and, of course, meals on wheels. We are thinking of the imminent possibility that independent living may have to give way to assisted living but she is a very independent, private person who does well in her own environment and I am certain such a change, unless absolutely necessary, will cause her great distress. Again, thank you all for your insights, particularly on the meds - I will be looking more at this before suggesting she take it which, of course, just comes with a whole other set of issues...."why do I need this, who asked for and/or suggested it, etc." This is a wonderful and supportive forum and I'm very glad my husband found and suggested it to me. God bless you all and my best wishes in dealing with your own stressful and challenging situations......
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I have to second lsmiami post!!

Mom may be past the point of independent living. If she just cannot do her ADL's on her own on a regular basis, then she needs to be in higher level of care facility.She should be fully able to do her grocery shopping, her laundry, open & lock her apartment, get her garbage out correctly, get dressed all on her own or with her walker. If they do meals, then go to the meals on her own at the correct time and dress appropriately. My mom's IL was strict on clothing rules in that they could NOT wear "house dresses" or slippers to meals, they were expected to get dressed and get to lunch on time. I would speak to the office and mom's immediate neighbors about if mom has had other issues that perhaps you are unaware of.
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My first suggestion is for your mom to get an evaluation by a gerontologist not a family doctor or internist but a gerontologist. She needs to be evaluated to see where she is on her level of cognitive ability. At 90 based on what she is saying, she has dementia. But just what type of dementia and what stage, they need to figure out. Not all dementia's are the same. In the US, most stuff is all about Alzheimer's, I'd bet a case of Prosecco that mom does NOT have Alz. She is just too high functioning for Alz. but it is Alz that most doc's know the most about.

Perchance are there other issues with outsiders…like the mailman is stealing stuff or the grocery store clerk puts things in her bag or someone is going through her garbage. Has there been any hallucinations….like her saying that someone's pet had come into her apt and then just left. Things that you assume are accurate because they are kinda plausible but are really "false beliefs" from dementia.

this was /is the situation with my mom. She was still living in her home when she was your mom's age and there would be episodes of paranoia and anxiety. Her
old doc was a internist and as most MD was geared for patient presents with a problem and a prescription is given to cure it. But dementia is a terminal disease and there is no cure but only management. My mom had to see a geronotlogist in order to have surgery and it make a world of difference. She got tested to see her cognition (full range of testing and then a mini-cog every visit thereafter), MRI & CAT to see brain shrinkage and where. They determined she has Lewy Body Dementia and Lewy has a whole different arch on what it is like and the meds are different…in some cases some medications are totally wrong for Lewy. They weaned her off all her many meds and got her on Exelon patch and Remeron (for anxiety which is an old-school low side effects med). Trazadone is pretty massive of a drug but sometimes the only thing for those with insomnia. Seroquel is somewhat milder but better for hallucinations. If my mom was OCD her doc probably would have done Seroquel but her issue was anxiety & hallucinations so Remeron worked for her. With Lewy and proper medications, they can high function for quite a long time (much longer than ALz). To this day mom still knows who I am even with the occasional hallucination and she is now on the backside of 90 and in a NH. My mom stayed in her home till early 90's and then moved to IL. Great facility but after a couple of years, she started having issues… animals coming into her apt, the activities director would go an use her apt for a office when she went to lunch or shopping because her apt had the "special light", the morning checker (they went around to see if the resident put their hanger outside their room by 8:30 AM) would move her keys; etc. The episodes started coming closer & closer and she just could not manage her medications or ADL's so I got her moved into a NH. She bypassed AL too.

About your mom's walking, does she "shuffle"?. Like she has problems in walking so that she cannot do a full leg movement BUT instead leaves her feet on the floor and just shuffles along. If so, that is a hallmark of Lewy. Does she see the floor to be different that it actually is….my mom would see the hallway floor as being cobblestones and would walk on it as if it was irregular rather than the flat even floor it was. Or does she have a whole depth perception issue with her balance. This too is part of Lewy. It is just a part of dementia that they "see" it that way with different shadowing just like they have "false belief" that the custodian is putting plastic on the micro (love it btw). Make notes to take to the gerontologist. Good luck and keep a sense of humor.
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If the building is a rental, coop or condo, the building per se has no responsibility to watch mom. The building is represented by a management company, board or HOA, depending on what legal entity it is.

They have a responsibility to control keys and appropriate unit access. They have a responsibility to background check staff, particularly if they will have access to units. They must provide professional polite service.

I live in a condo, we have had a few tenants that have aged and created difficult circumstances, their families are responsible to arrange care. If this is a building and not a ALF, the building cannot take responsibilities and in fairness to he other owners (liability) if the management suspects a person is not able to live alone, should report it to APS. Sorry if that sounds harsh, but that would be the perspective of the condo commandos.

One thing you can do is understand the key policy. My building has 400+ units. Keys are kept in the office and are signed out, for valid reasons, with a witness and get returned. Who has access to mom's unit?

If you have a mostly elderly population in the building, they may be more sensitive. If someone is messing with plastic on the microwave, or leaving notes on the fridge, there is evidence. If there is no evidence a nanny cam can help in the short term, but she may need more companionship in the near future.

Assuming, and I would check, the custodian is just a regular guy, this is not as much about him as it is about her.

Best of luck,
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Thank you, pstiegman. She actually is taking a very low dose (10 mg) of Lexapro right now which doesn't seem to be doing much of anything. But, your suggestions regarding the nanny cam are worth considering. The building manager has all of our family contact info...not sure it would do much good for me to specifically give the custodian the info - he can access it through the office in the building - since he seems to be the genesis of much of her anxiety and frankly, I'm not a fan, either. He's probably not the right fit for the building - others have complained as well, just not in the same way as my mother. I don't think he really likes older folks and, well...this IS a building of very old people. He seems to be short on patience which is obviously a problem. So, now that I'm writing this, I'm thinking a letter about this to the organization that runs the building may be another thing I can do.
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I would set up a nanny cam to be sure no one is entering her apartment. It is possible to start her with something milder than Seroquel/trazodone, perhaps lorazepam (Ativan) or alprazolam (Xanax)? Also stay in touch with the custodian and give him your contact information; ask him to call you if she seems disoriented.
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