Not sure what to do with my 81 yr. old mother with paranoid delusions. Any advice?

This may get worse if untreated. You are doing the right thing by having her evaluated.

A geriatric psychiatrist may be a good option. Tell Mom that this person is the “complaint department” where she can discuss her grievances about her laundry, etc.

In the meantime, before adding medication, check to make sure she isn’t being over medicated. Over medication can masquerade as confusion dementia and it can look much like the problems you are experiencing.

One of my parents was over medicated and when the medication was reduced similar problems disappeared. Never reduce the medications yourself (work closely with a doctor) as any change in medication can be dangerous.

To evaluate her medications yourself …
Get a list of her prescriptions, dosage and frequency. Is she taking these according to directions now?(she could be over medicating herself by mistake).

Has she had any other medical changes? (such as weight loss, which might explain that this dosage could no longer be appropriate for her).

Chart out the warnings, dangerous interactions, side effects and proper dosages for a person your mom’s weight, etc. You can get the warnings and interactions, etc. from pharmacy printouts that are usually stapled to the medication bag or from the Internet. You don’t need to be a healthcare professional.

My mom was prescribed medications that should not be taken together, dosages that were too high for someone her weight and medications that carried warnings of hallucinations, dizziness, confusion, etc. some of these were not even absolutely necessary (bladder control).

I don’t know why the pharmacy AND her doctor didn’t notice the dangerous interaction warnings. Mom was going to the doctor for dizziness and falls and was told they were an unavoidable part of aging.

Her PC doctor was reluctant to make any changes or listen to me. He said my mom had dementia. He noted in his records, “daughter is in denial.”

I took her to a new doctor, an excellent cardiologist who listened and weaned her slowly as needed. This process took months. She reduced unnecessary medications and stopped having hallucinations, dizziness and falls. She said she felt better than she had In years.

Sometimes these problems can creep up slowly as the medication builds up in the body.

Wishing you the best.

Does your mother live alone? If she does that cannot continue. She will likley get placed in a memory care facility because of her age.
I had a homecare client whose elderly neighbor (90 years old) lived alone and was still driving. She was very coherent and seemed totally with it if you were talking to her. She was unpleasant, overly-fussy, and often downright nasty but with it. Until she called the police on me twice for trying to break into her house. I was breaking and entering when my client asked me to bring her a container of the homemade soup I made which she graciously accepted.
The second time she called 911 because I was trying to break in the cops took it a little more seriously. I told them that either they get APS out there or I would.
She ended up being placed about a week later. There was no family to take care of her. She had a nephew in another state who was her POA and he approved it.
Your mother having been a medical worker be able to 'showtime' well enough to get one over on the cops or even a psych evaluation.
This is going to sound bad, but sometimes it is the only way to get an elder who needs care placed.
Encourage her to always call the police it when she suspects people have broken into her house and stolen her clothes. Or if her electonic devices have been tampered with. Or if she thinks she's been drugged and assaulted in her sleep. Call those cops ten times a day if needs be.
Then the cops will not fall for a good bit of showtiming and they will have APS remove her from her home and place her.

At the very least, your mother needs to be checked for a Urinary Tract Infection. These sometimes cause delusions.

Is your mother on any medications? If so, you may want to look them up to see if they could possibly be contributing to the problem.
In his lifetime, my father-in-law became so violent he tore up my entire living room. When I called his homecare nurse, she told me to call the police and ambulance instead and for me and the children to leave the house immediately. We later found out he was having a reaction the one of the anti-psychotic meds he'd been placed on. Elderly people can metabolize medicines differently and some meds don't leave their system right away and can build up, even to toxi levels. Even with other meds, not just anti-depressants/anti-psychotic meds sometimes prescribed for eldery, there can be such similar side effects.
Just a suggestion.

I agree with BarbBrooklyn: get her to the Urgent Care or ER to check for a UTI.

You could set up a camera in her room to show her there's no activity, but she still may not be convinced. Dementia robs its sufferers of their reason and logic little by little.

With age-related decline and caregiving, there is often no good solution -- only a least bad option.

my husband practiced psychiatry.Another physician became extremely paranoid while in the hospital. He was able to recognize what happened just waiting outside the room and listening. In that case, it was a medication reaction. If the person is that flamboyant, a specialist can detect it pretty easily. I would call the local committee on aging after taping her more bizarre claims. I would ask their advice on how to proceed. States vary on the reasons for hospitalization or treatment against a person's will. It is very difficult to get a paranoid person to accept different medicine. I would not agree with her about what is happening, but I would not confront her or argue. I would just say something like it sounds terrible, I sure don't know what is happening. Can she describe any possible way she can feel safer? A camera in her room, a lock of some sort (that you can still open)? You might discuss it with an elder care attorney; there may be some options you don't know. He may also know a medical specialist who can deals with such problems. Delusions can often be improved by medication, either administered or stopped; a psychiatric reaction like this can be caused by conditions other than dementia. I would not assume this is a dementia without a good medical work up. If it is, they may decrease as the dementia worsens, but other problems will certainly present themselves. You really do need some expert help. In fact, in the case I described first, the gentleman was having an unusual, but not unheard of, response to a common over the counter stomach medicine. Good luck, it is a very difficult problem, but it is possible that some investigation and expense at this time, might make things easier in the future.

My 89 yo mother was paranoid in her home for years. The same stories your mom tells plus hiding her money and then accusing me of stealing it. It did get worse in ALF. She ended up in a senior psych ward and they took her off Xanax, said it was really bad for dementia and wouldn't help paranoia. Put her on Seroquel. Her paranoia seems less but she has advanced to other issues. They have found that Ativan only agitated my mom and keeps her from sleeping.
My uncle thought a man was going to kill him. Would even grab the wheel when my cousin was driving. He went to psych ward and then a lockdown ALF. He eventually was satisfied that the man couldn't get in and calmed down.
I would find out if you have a senior psych ward nearby. You don't have to be suicidal to get in. I understand it will still be hard to get her there but you need some experienced professionals. What about a geriatric Dr?

Unfortunately there is not much you can do until she hits a crisis stage or some catastrophic event occurs where she would need medical care.
If she has not been declared incompetent then she has the right to refuse treatment, she has the right to remain in her home.
If she has not listed you on HIPAA release then her doctor(s) can not talk to you about her or her medical condition.
Once a doctor has declared her incompetent then you would have to obtain Guardianship unless a lawyer feels that she is cognizant enough to appoint you POA for Health and Finances. if is not something you would want to do the Court would appoint a Guardian.
Determining if this is a Mental Health issue or if it is a form of Dementia is important.
Medication can help with paranoia, hallucinations and anxiety.
Medication can help in the case of some Mental Health issues but medication is not going to "fix, stop or cure" the decline of dementia.

Unfortunately, this isn’t uncommon with people who have dementia. I know two people right now who are doing the same thing. One of those is a nurse, and so is her daughter. Since she now hates her daughter, the daughter can’t get near her and has decided to let things proceed as they are until something happens that causes her mom to go to a hospital. She feels that then the mom will be forced to get care. The other friend who has delusions posts them on Facebook and people and her son check on her that way. Something sad will eventually happen to her too. It’s very hard for families. I think these folks could be more proactive but they are exhausted with all of it already.

My MIL (87 at the time and now almost 89) had similar delusions but was not in a medical field. She ended up calling her nephew who would come over when he could. When he couldn’t, she would call the police. The police calls became so frequent, my husband (her son) was notified.

The police were going to take her in for a 96 hour hold and evaluation. We were able to get her into assisted living and cut off access to a phone. If the 96 hour hold had occurred, it would have been difficult to find an assisted living facility willing to accept her.

My husband was so angry and frustrated with years of bad behavior n her part, he was ready for her to be committed to a state mental institution or out on the streets like a homeless person.

I heard and saw her bad behavior in action and was on the receiving end as well but didn’t think it was right to let her end up like that. She was afraid. I suggested she try different places and finally when she moved in with her sister, the nephew said he would call the police to have her removed, which was the out we were looking for and she was taken to assisted living. She blamed him and her son for being there as if it were jail. It isn’t jail. It is a lovely place. She isn’t happy anywhere, I asked that the facility please bring in a psychiatrist/neurologist to treat her, provide anxiety medication, and other medication to treat her delusions. She still has them.

I’ve asked my husband if they can possibly change or increase the dosages so she isn’t stressed.