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Tips for Dealing with Hallucinations in People with Dementia

Hallucinations background conceptIt can be frightening to see someone you love hallucinate—to see, hear, smell, taste or feel something that isn’t there. When we first observe this symptom in someone with Alzheimer’s or other forms of dementia, our initial reaction might be to try to set the person straight or reason with them, especially if they seem upset by what is happening. Experts tell us that this may not be the best thing to do. “You can’t argue or rationally explain why something happened. That doesn’t help. It just frustrates the person. The person somehow knows that you are talking down to them, not taking them seriously, treating them in an undignified manner,” says Lisa P. Gwyther, associate professor in the Department of Psychiatry and Behavioral Sciences at Duke University and director of the Duke Aging Center Family Support Program.

Understanding the causes for hallucinations and how to cope with them most effectively is valuable information for any caregiver to have. A reputable and easy-to-understand source of information is the Alzheimer’s Association’s website and Caregiver Center, where a list of dementia behaviors includes an entire section on hallucinations. In this blog, we will summarize some of the helpful information found on that website and others.

Understanding Hallucinations

Alzheimer’s and other forms of dementia can be the cause of hallucinations, due to changes within the brain, especially during the later stages of the disease. Confusion at night in unfamiliar surroundings, such as a hospital, can be associated with visual and auditory hallucinations in the elderly. This is commonly called “sundowning.” Other causes can include:

  • Schizophrenia
  • Physical problems, such as kidney or bladder infections, dehydration, intense pain
  • Alcohol or drug abuse
  • Eyesight or hearing problems
  • Medications 

See the Doctor

If an elderly person with Alzheimer’s or any form of dementia begins hallucinating, the first thing to do is to have a medical evaluation. The doctor will try to rule out other possible causes. When visiting the GP, it will help if you bring notes about:

  • What the person saw or sensed
  • What time of day it occurred and after what event (e.g., nap, meal, exercise)
  • Where it happened and how long it lasted
  • How the person responded (e.g., if they were distressed) and the words they used to describe what they experienced
  • Medication the person is taking and the dosage (including any supplements and over-the-counter medications)
  • The person’s medical history, including any previous sight (or other sensory) conditions and mental health issues
  • The person’s use of alcohol or other recreational drugs

If non-drug approaches fail and symptoms are severe, antipsychotic medications may be prescribed. Because these medications are associated with an increased risk of stroke and death in older adults with dementia, it is wise to make careful observations and work with the doctor to learn both the risks, benefits and side effects of medication before and after making a decision to take this course of action.

Coping Strategies

The Alzheimer’s Association advises, “When responding to hallucinations, be cautious. First, assess the situation and determine whether the hallucination is a problem for the person or for you. Is the hallucination upsetting? Is it leading the person to do something dangerous? Is the sight of an unfamiliar face causing the person to become frightened? If so, react calmly and quickly with reassuring words and a comforting touch. Do not argue with the person about what he or she sees or hears. If the behavior is not dangerous, there may not be a need to intervene.”

“Go to their reality,” says Dr. Marion Somers, author of Elder Care Made Easier: Doctor Marion’s 10 Steps to Help You Care for an Aging Loved One. “Otherwise, you’re going to aggravate them, and you don’t want to increase the level of agitation. You want to calm the situation.”

Reassure them by saying something like “I see you’re scared. I would be scared if I saw those things, too.”

    • Respond in a calm, supportive manner. You may want to add, “Don’t worry. I’m here. I’ll protect you. I’ll take care of you.”
    • Gentle patting may turn the person’s attention toward you and reduce the hallucination.
    • Try to find out and acknowledge the feelings behind the hallucination. 

Use distractions like suggesting a walk or a move to another room that is well-lit. Try to turn the person’s attention to music, conversation or activities you enjoy together.

Modify the environment according to your evaluation of the situation by:

  • Checking for sounds that might be misinterpreted, such as noise from a television or an air conditioner.
  • Looking for lighting that casts shadows, reflections or distortions on the surfaces of floors, walls and furniture. Turn on lights to reduce shadows.
  • Cover mirrors with a cloth or remove them, if the person thinks that he or she is looking at a stranger.

Check out additional resources like the following. Understanding and properly dealing with hallucinations could help to protect you and the person you are caring for.








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