Geriatric Medicine/Friend's Elderly Mother


Hello Gayle:  My close friend ("Becca") is very concerned about her elderly mother ("Joan"). (I believe Joan is in her mid or late seventies).  I have only met Joan once, and she was very quiet.

Becca says that her mom gets very upset and fearful about innocent remarks and actions from others. Joan views friendly comments or questions as something very sinister, and often talks about it for several years. Here are just a two examples that I can remember:

Becca brought in her ill dog to the vet, and Joan came with.  The vet said to bring back the dog in a few days if it doesn't improve with treatment.  Joan told Becca that the "real" reason the vet said to come back is because he was arranging to have a hit man kill her right in the office!

Becca took Joan to a dental appointment.  The dentist talked about his recent vacation to Florida, and asked Joan if she had ever been to Florida.  Joan was devastated and thought that he asked this because he thought she committed crimes in Florida, and this "trick question" would lead her to talk more about what she does in Florida.

This behavior is very disturbing to Becca, and she told me that Joan refuses to see a doctor.  Have you heard of such behavior in elderly individuals?  Thank you.

Hi Alicia,

Thank you for your concern and your question regarding your friend's elderly mother.

Yes, I have heard of this before, in fact, it is fairly common among the elderly as the brain begins to atrophy (deteriorate) with age. You do not mention that Joan has a psychiatric history of schizophrenia, bipolar disorder or any other mental health issues and therefore I have initially excluded them from any potential diagnoses.

Depending upon what part of the brain is affected, certain types of dementia will present with symptoms of fear, paranoia, and distrust.

I would suggest that your friend take her mother to her primary care doctor (assuming they have a good and trusting relationship over the years) or set up a visit with a geriatrician (a doctor who treats only individuals over ~ age 65) for a complete physical exam with EKG, urinalysis, and lab work.

If the P.E. results come back within normal limits for her age, then she should be referred to a geriatric psychiatrist for evaluation.  Delusions as these misinterpretation of events are called, are caused by the brain misinterpreting the information it is receiving. Before assuming it is Alzheimer's disease or other type of dementia or a psychiatric condition, all physical or medical causes, as well as a review of all of her medications for potential interactions, should be performed to rule out a physical cause such as dehydration, urinary tract infection, pneumonia, or other disease process.

Once a physical cause has been ruled out, a psychiatrist should be consulted for a more precise determination of what is going on, making a diagnosis, and prescribing medication to help diminish or resolve these abnormal thoughts. It is important that your friend do this as soon as possible. I'm not sure if they live together but if so I wouldn't want her mom to unintentionally assume these things about her and potentially injure her or worse. She needs to be "on guard" until a diagnosis is made and treatment is started. I would also recommend making sure that there are no weapons (especially firearms) in the house, removing any potential weapons or knives, and leaving some lights on at night because darkness may add to her mother's confusion.

In the event that Joan refuses to see a doctor, your friend may have to just take her to the emergency room at a hospital for an evaluation and get her there by any means possible i.e. even if it means saying she needs to go and asking her mother to go with her. If she feels that either she or her mother are in danger, she may call the local police dept. to come to the house and do a brief psychiatric evaluation and determine if she needs to go to the hospital under a 72 hour psychiatric hold. I know these things sound extreme but your friend needs to consider her own safety, her mother's safety, as well as the safety of the public. If her mother isn't perceiving things correctly it is possible that she might do things which she otherwise would never consider or would be appalled by. My motto is safety first, mending hurt feelings second.

I hope that your friend is able to get her mother to see a doctor so that she can get the help she needs.


Gayle Gwozdz
Gerontology-C, GCM

Geriatric Medicine

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Gayle Gwozdz


My name is Gayle and I am an adult nurse practitioner (APRN)whose practice has focused on geriatrics in long term care facilities, evaluating and prescribing medications for medical and psychiatric conditions. I presently perform geriatric home assessments and physical exams in patients' homes. I can answer questions related to assisting adult children in keeping their parents at home, advising when a specialist should be consulted, advising if medications may be causing certain new problems that have arisen. Having cared for my dad with Alzheimer's for 14 years I am quite knowledgeable about what is normal and abnormal when it comes to this disease. I can help direct individuals to resources and support services that they may be unaware of. Lastly, I can make recommendations that can be brought back to the patient's doctor if he/she is willing to consider alternatives to the current treatment plan regarding a particular issue or medical problem.


I am an adult nurse practitioner with nearly 5 years experience in primary care, focusing on geriatric clients. I cared for my parents in the final 15 years of their lives interacting with healthcare providers, home nursing agencies, state agencies, Medicare and Medicaid representatives, palliative care and home hospice agencies. Prior to becoming an APRN I worked as an emergency dept. nurse for 15 years and 12 years for a large health insurance company providing medical reviews for underwriting, educating underwriters on medical conditions, utilization review and case management, requesting exceptions from medical directors to allow patients to receive medications or treatments not normally covered under their insurance plan, and I assisted in the area of reviewing complex medical claims for payment.

CT APRN American Association of Nurse Practitioners (AANP) Sigma Theta Tau International (SITT) AARP

"Walk A Corridor in My Shoes" published in November, 2004, Nursing Spectrum.

Associate Degree in Nursing from Greater Harford Community College BSN from CCSU MSN in Nursing Management from the University of Hartford MBA from Rensselaer Polytechnic Institute MSN with Adult APRN from Quinnipiac University Graduate Certificate in Geriatric Care Management from the University of Florida Reiki Master Legal Nurse Consultant

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