My mom is having detailed auditory hallucinations that upset her but is otherwise physically ok. She won't go to a doctor. What should I do?

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Over the past year my mom has been having fairly vivid and detailed hallucinations (primarily auditory, occasionally visual). They began "simple" such as people speaking and singing at night (which wasn't really likely as she lives on a farm in a rural area with no close neighbours). Her hallucinations have evolved to become more complex and are now causing her stress and anxiety. She is currently focused on the many visits she has from her German relatives (her birth country) who are constantly harassing her. My evil drug addict cousin was operating a tour company from Germany to bring tourists to her house all summer (helicopters included). Also my aunt and uncle (her brother) continue to harass her about selling the house. She loves her cat dearly and is often worried someone will hurt it. In reality her family is very nice (not evil drug addicts) and no one has visited from Germany. I was there last week (she lives about 5 hours away). After a couple of days she told me that my fiancee (who was to arrive that day) and I wouldn't be able to sleep in the guestroom as that room belonged to her friend (who helps protect her from the evil relatives). When I was last visiting I overheard her having a conversation with my aunt - she was talking outloud and there were pauses in the conversation (so like she was "listening" to a reply).

Her symptoms are completely intermittent. Two days ago I had a 40 minute phone call with her where she was 100% normal. Then last night she called me because she heard my cousin in the house with a realtor! (I calmed her down - I stayed on the phone while she checked all the doors and put things (like a bag of cat food) in front of them so people couldn't get in).

A few other bits of information:
-she's 75
-she's not on any medication
-physically she's totally fine. The house is spotless, the large garden and yard is immaculate, she's active outside, is cooking healthy food, taking good care of the cat and herself. She's not a danger to herself or others. I'm not worried about her safety.
-she lives alone in a small rural town. My father passed away 3 years ago. I'm an only child and we have no other family in the country.
-she loves her house and is adamant that she doesn't want to move
-her memory is decent enough (other than occasionally misplacing things and then blaming "people" for moving/taking them!)
-she's pretty anti-social, but always has been.
-she's *very* anti-doctor, anti-medicine. She always has been.
-she doesn't have a family doctor and hasn't been to the doctor in probably 15-20 years. Her philosophy is she feels fine, so why would she need to go?

To her, everything that is happening is 100% real. I'm not sure what (if anything) I can/should be doing. I'm at a total loss! Any advice or suggestions would be appreciated.

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Thank you so much for your reply! Her gait is ok, she has a bit of side to side motion when she walks, but it has been like this for a long time. No falls. Both arms swing when she walks. I was reading about LBD and was looking for anything parkinsonian-like when I last visited. One thing I did notice was she taps her thumb repeatedly (on the table for example). It's definitely not like a shaking tremor though.

When all this first started happening I thought she was dreaming everything, but I've never seen her flailing her arms while sleeping. From what I've seen she sleeps deeply.

I pay her bills for her online. I've been doing this for a number of years (even while my dad was still alive). It was just simpler. I did notice that when my dad died she went down hill a bit in terms of banking - she was always super on the ball with balancing her cheque and then she started to make mistakes sometimes. But 2 days ago I told her what the balance was in her account and it matched exactly with what she has recorded.

There isn't really anyone she sees on a regular basis like a friend or minister. She doesn't really have any friends (but she never did - this isn't new behaviour). My parents weren't social people when I was growing up - there was no dinner parties or fun outings with friends really. I have one friend I went to elementary school with who lives in the town who has been extremely helpful - she brings my mom her mail, takes her grocery shopping, etc. I'm in contact with her quite a lot. She has also noticed the odd behaviour and stories (and she does much the same as me, tries to calm her down and then changes the topic of conversation).

My recent visit was 3 days. I talk to her on the phone every 2 days for about 30 minutes. Some days she's fine, other days she has lots of stories about all the crazy things going on at the house.
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BTW, How is she at managing her finances? Any overdue bills, or bills paid multiple time? Any confusion about her checking accounts? From your distance, do you think you'd be aware of these things before they reached a crisis?

Is there someone who knows her well that you might be able to talk to? A minister or priest, a friend who play bridge with her once a month ... anyone you know in her town that you could chat with once in a while?

How long was your most recent visit? Often people in early stage dementia can "showtime" -- hold it together for several hours or even days in front of others.

Good luck.
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Hallucinations are often associated with UTIs in the elderly. Since this has been going on for more than a year, I'm not sure how likely that is, but you should at least be aware of it.

Hallucinations are often one of the very first symptoms of Lewy Body Dementia. Again, if this has been going on a year with no other symptoms I'm not sure how likely that is. Has she had any difficulty with her gait, with being unsteady walking, with falling? Is she having vivid dreams that she acts out? (Flailing her arms and legs, for example.) You mention the disappearance of objects and the accusations about them. Would you be aware of other kinds of memory lapse, do you think?

I'm sure that UTIs and LBD are NOT the only conditions that could be associated with hallucinations, but those two very different possibilities point up how difficult this will be to pin down if Mom won't see a doctor.

Meanwhile, I think you are doing exactly the right things by calming her down and getting her to take steps that reassure her.

I'd be extra careful now to observe any other out-of-the-ordinary behaviors or symptoms. Ultimately, though, if this continues or progresses, getting her to a doctor is going to be important, in my opinion. She has so much going for. If catching and treating something early would enable her to continue living on her own in her own home longer, that would be worthwhile.

In case things do get worse, perhaps you should consider researching doctors in her area. I suggest looking for a geriatrician, even if she'd have to travel a bit to see one.
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