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10 Ways to Respond to Dementia Hallucinations in Seniors

Responding to dementia hallucinations in the elderly

By Connie Chow, Founder at DailyCaring

Dementia can cause hallucinations

Dementia causes changes in the brain that may cause someone to hallucinate – see, hear, feel, or taste something that isn’t there. Their brain is distorting or misinterpreting the senses.

And even if it’s not real, the hallucination is very real to the person experiencing it.

For example, if your older adult is seeing bugs crawling on the floor, nothing you say will convince them that the bugs don’t exist. Their brain is saying that the bugs are real.

Some hallucinations can be scary, but others might involve visions of ordinary people, situations, or objects from the past.

Some may even be pleasant or happy.

These dementia hallucinations usually happen in the middle or later stages and are more common in Lewy Body and Parkinson’s dementia.

But they can also happen in Alzheimer’s disease and other types of dementia.

With any hallucination, what’s most important is to validate your older adult’s experience, respond to their feelings, and keep them safe.

We share 10 ways to respond when someone with dementia is experiencing hallucinations.


10 ways to respond when someone is experiencing dementia hallucinations

1. Determine if a response is needed The first step is to determine whether the hallucination is bothering your older adult.

If it’s pleasant, you might not want to respond or call attention to it.

Just know and accept that it’s a dementia symptom and thankfully isn’t causing distress.

If the hallucination is upsetting them or causing them to do something unsafe, then it’s time to quickly step in to provide comfort or redirect to a safe activity.

2. Stay calm and don’t argue or try to convince using logic When someone is having a dementia hallucination, it’s important to stay calm and avoid contradicting them.

What they’re seeing is a dementia symptom and is very real to them.

Trying to explain that it isn’t real simply won’t work because of the damage that dementia has caused in their brain.

In fact, knowing that you don’t believe them might make them even more upset and agitated.

If they’re calm enough to explain, it may also help to understand what they’re seeing. Listen carefully and try to pick up clues to what they’re seeing.

But keep in mind that dementia damage in the brain may affect their ability to use the correct words. For example, they could unintentionally say cabbages when they mean green cushions.

3. Validate their feelings and provide reassurance Be careful not to dismiss your older adult’s experience.

Brushing off what they’re seeing by saying something like, “Don’t be silly, there’s nothing there,” is likely to upset them.

It helps to allow them to talk about what they’re seeing. Having you take them seriously and provide reassurance increases their feeling of safety and security.

Focus on being kind and responding to their feelings rather than to the hallucination itself.

If they’re scared, you could say “That sounds scary, I can see how upset you are.”

Or if they’re happy, you might say, “How wonderful, I’m glad that makes you so happy.”

Other possible responses could be, “It sounds like you’re worried,” or “I know this is scary for you.”

You don’t need to pretend that you can see or hear what they can, just be supportive and do what you can to relieve any fear or anxiety as if it was a real threat.

For example, you could say ”I don’t hear or see anyone outside the window, but you seem worried. What can I do to help you feel safe?“

4. Check the environment and remove possible triggers Oftentimes, dementia hallucinations can be triggered by things going on around your older adult.

Their dementia brain can interpret sights and sounds differently, causing hallucinations.

To remove possible triggers, check their environment for background noise or visual stimulation that could cause a problem.

For example, things like a TV or radio could make them believe that strangers are in the house, what’s happening on TV is real, or that they’re hearing voices.

Dim lighting could make shadowy corners a source of fear.

Reflections in shiny floors or windows when it’s dark outside and bright inside could make it seem like there are people in the house.

Similarly, mirrors can be another source of fear or confusion.

Advertisement 5. Offer simple answers and reassurances When someone is having a dementia hallucination, don’t give long explanations about what’s happening. Trying to process what you’re saying may add to their distress.

Instead, respond in a calm, supportive way.

You could say something like, “I’m here to protect you. I’ll make sure you’re safe. Everything is ok.”

Gently hugging them or patting their arm or shoulder may also provide the comfort and reassurance they need if they’re scared or stressed.

Connecting with you may also be a welcome distraction from the hallucination.

6. Look for patterns If hallucinations happen frequently, there could be a trigger that’s not obvious.

One way to figure out what could be causing the behavior is to track activities and try to find a pattern.

Taking notes or keeping a dementia journal may help you discover that certain hallucinations happen at a certain time of day, before or after meals, or is related to a physical need like using the bathroom or being in pain.

Or, it could be something as simple as a change in daily routine that’s making them feel confused or disoriented and causing hallucinations.

Keeping a log or taking notes helps you look for solutions and ways to avoid the situations that may be triggering hallucinations.

7. Distract and redirect Another effective technique is to distract your older adult from their hallucination.

Try to switch their focus to an activity they enjoy.

You could ask them to help you with a chore that makes them feel successful, look at favorite family photos, sing their favorite song, do a fun puzzle, eat a tasty snack, or take a pleasant stroll to look at the view – even an indoor stroll would work.

Another way to distract is to direct their attention to you instead of the hallucination.

If they’re hearing voices, try chatting with them. It’s harder to hear those voices if you’re now having a conversation with them.

Or if they’re seeing someone or something, get to eye level and try to make eye contact with them. If they’re occupied with looking at you, it could make the hallucination less intense or even fade away.

8. Get support to help you cope Caring for someone with dementia hallucinations is stressful. So it can be a big help to know that you’re not alone in dealing with issues like this. 

That’s why caregiver support groups highly recommended.

Sharing your experience and getting advice and tips from others can make life easier.

There are also many great online groups that are free and private, here are 11 that we recommend.

9. Talk with the doctor to find out if there are medical causes You may want to speak with your older adult’s doctor to find out if there could be a medical reason behind their hallucination.

This wouldn’t change the way you respond, but may help you find ways to to reduce or eliminate the behavior.

For example, some medical issues that can cause hallucinations include dehydration, urinary tract infections, kidney or bladder infections, head injuries from a fall, or pain.

Or if your older adult recently started a new medication, it could be a negative side effect of the drug or an interaction with another medication. Immediately report any changes in their behavior to the doctor.

And if your older adult is having trouble with hearing or vision, that could easily explain them hearing or seeing things that aren’t there.

10. Contact the doctor immediately if their safety or yours is at risk If your older adult is severely distressed by hallucinations or if hallucinations cause them to hurt themselves or others, contact their doctor immediately to get help.

For example, they may be hitting out to try to defend themselves against a perceived attacker, run away from something that scares them, or something else dangerous. 

These types of actions can easily lead to injury to them and you.

When you speak with their doctor, describe the symptoms, how often they happen, and if they’ve changed in intensity or frequency over time. 

It helps if you’ve kept a log or notes that could help the doctor get a clearer picture of what’s happening.

If non-drug approaches aren’t working and there isn’t a medical condition that’s causing hallucinations, careful use of behavioral medication could improve the quality of life by reducing the intensity and frequency of hallucinations.

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Author: Connie Chow, founder at DailyCaring, was a hands-on caregiver for her grandmother for 20 years – until grandma was 101 years old! Connie has an MBA from the University of Southern California and has been featured on major news outlets, including WJCL22 Savannah (ABC), KRON4 San Francisco, NBC10 Philadelphia, 23ABC Bakersfield, KAGS Texas (NBC), and KVAL13 Oregon (CBS). She has spoken at Institute on Aging, written for Sixty and Me, and been quoted in top publications, including U.S. News & World Report, HuffPost, and Society of Senior Advisors.


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