A Visit From Out of State: When Paranoia Put the Car in Reverse

Recently, this care manager received a call from an adult daughter who lived outside of New York. She was driving from Ohio to visit her mother in Westchester.

My contact with Joy started with a call prior to her visit. The visit was prompted by a coat of paranoia that accompanied each telephone conversation she had with her mother.  In fact, there were days her mother was so accusatory that she refused to speak to Joy.   She told me her mother was vehement about the fact that she was stealing her money and telling the neighbors that her mother was behaving in a “disreputable way.”  Those were not quite Joy’s words, but for the sake of blog civility I have refined them.

Paranoia in older adults can be caused by any number of factors. Side effects of medications, a hearing impairment that makes one think they are being whispered about.  An infection, especially an untreated urinary tract infection. A history of alcohol abuse. Parents who, in the past, have had mood disorders may experience a reemergence of symptoms later in life.

But top on my list as a cause of paranoia is dementia. Beyond forgetfulness, there are other symptoms that come along with diagnosis.  One of them is paranoia, either with hallucinations (sensory perceptions that appear real but are created by the mind) or delusions (thoughts that are believed to be real but are created by the mind).

For Joy, her mother’s paranoia sabotaged the visit. She never saw her mother.  She was driving home when she called me. Accusations were thrust from behind the door that never opened. Hurt, angry, perhaps scared, my conversation with Joy was short. I wanted to tell her it was an undiagnosed illness talking to her, not her mother. But like Joy, I was not given the opportunity.

Medications: When a Little is Just Enough

A few months ago this geriatric care manager accompanied a client  to see his cardiologist.  ‘Don’t know why, maybe the next patient canceled, but Pete got more than his twenty minutes with the doc.  He took a good look at Pete’s medications.  And then, like a teacher grading a test paper, he started to make red slashes through some medications and circles around others.  One of the first slashes was through the very medication he prescribed years ago…Lipitor. At age 88 he felt this medication was no longer necessary for Pete. He circled other medications on the list and suggested I consult with Pete’s internist about either lessening the dosage or discontinuing them totally.

There is a name for this medication overload: “polypharmacy.” Too many drugs. Each time a drug is added, it has the potential to work against another drug and cause unwelcome interactions. Add to this trying to keep accurate records of what to take and when to take it and the process can become very confusing.

But getting back to Pete, we were cutting down. At our next visit to his internist she took over where the cardiologist left off.   Pete’s diet had changed considerably over the years, so the Nexium was no longer necessary. The memory medication, well that was not the miracle drug pharmaceutical companies would have liked us to believe. He was weaned off that. “Regularity,” well it hadn’t been a problem, but she did not want to create a problem. So Senna was a stay. That, along with his blood pressure medication and a diuretic are the ones that remain.

This geriatric care manager recognizes the potential that medications have to prevent, control and cure.  But I also learned a valuable lesson from Pete’s doctors. At certain intervals it is necessary to question and re-evaluate. In this case, a reduced medication list was just what the doctors ordered and nobody was the worst for it,  except for the cash register at Walgreens.