Paranoid Symptoms Among Older Adults

Muzumel A. Chaudhary, MD; Kiran Rabheru, MD, CCFP, FRCP, ABPN


Geriatrics and Aging. 2008;11(3):143-149. 

In This Article


Paranoid symptoms in older persons without cognitive impairment have been linked to the development of dementia, higher mortality, impaired functional ability, depression, and poor physical health.[2,6,7,9,10,11,12] Suicidal ideation and suicide attempts occur at a significantly higher rate among individuals with psychosis than in the general population.[24] Approximately 60-80% of persons with chronic psychotic symptoms manifest suicidal ideation, 20-40% actively attempt suicide, and 10-15% successfully commit suicide.[24] The most predictive factor for suicide risk is the severity of psychiatric symptoms experienced by the individual prior to the suicidal act. The presence of delusions and hallucinations and, more importantly, depressive symptoms confers a much increased suicidal risk.[24] Therefore, older persons experiencing paranoid symptoms and, more particularly, those experiencing paranoia in the context of an underlying mood disorder are at significant risk of harm to self. They require prompt intervention and close follow-up to ensure safety.

In the case of dementia, persons with AD with delusions have a faster rate of functional and cognitive declines and a more rapidly deteriorating course than persons with AD without delusions.[17,20] Moreover, psychotic symptoms are associated with the presence and also later development of aggressive behaviours, which have the potential to result in harm to the individual, co-residents, and caregivers.[20] Additionally, the presence of agitation and aggression among persons with AD with paranoia is a predictor of caregiver stress and, resultantly, premature institutionalization.[17,20]


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