Hallucinations and Delusions

Often, people with dementia experience or believe things that are not real. This is called a hallucination or delusion. Hallucinations are false sensory experiences – perceiving something with your senses that isn’t real.Delusions are persistent false beliefs – believing something that isn’t real.

These moments can be frightening. “There is someone living in my bathroom, and they see me when I’m naked.”

They can also be a bit odd. “Christopher Columbus? I used to date him!”

And sometimes, 1+1=3. The blanks get filled in with erroneous information. There is a noise coming in the from the bedroom window.  Someone must be breaking in.  I am in danger and need to call 911.  (When it’s just a tree limb brushing against the window.)

Caregivers need to be investigators. What could my loved one be seeing or hearing? What conclusions could my loved one jump to?

For example, if your mom says: “There is someone living in my bathroom, and they see me when I’m naked.” She may be seeing herself in the bathroom mirror and not realize it’s her own reflection. It’s troubling to think some strange person might be lurking in your bathroom

On the flipside of that same scenario, we once had a participant who would peep into the restroom to have long conversations with “her grandmother” (in the mirror), and she was so glad that she could visit with her grandmother at Page Robbins. In this case, the false perception wasn’t disturbing to her. It was comforting.

If your loved one is experiencing hallucinations or delusions, you need to tell your loved one’s physician. It could be a side-effect of medication. It could be a sign of another issue. Or it could be a part of the disease process. Not all hallucinations/delusions require treatment. If it’s not disturbing to your loved one, it might not need to be treated, but it’s good for the doctor to be aware.

Some hallucinations/delusions are especially troubling. It’s important to be aware of these because the person experiencing them may react in ways that are potentially dangerous to themselves or others:

  • Someone is trying to break into my house, so I need a weapon to protect myself.
  • My babies are home alone, so I need to leave to go get them.
  • My spouse is having an affair, so I don’t want them to care for me anymore.
  • Someone is stealing all my money, so I need to hide it.
  • There are monkeys in the attic. I need climb up there and get rid of them.

If your loved one is experiencing a troubling hallucination/delusion, you must consider: Are there guns in your home? Kitchen knives that are not secured? Are the car keys put away? Individuals with dementia often elope because they are on a mission to do something – to go to their other house, to take care of the children, to work, to care for their mother who needs them. Be aware of the potential for a harmful situation.

How to respond when your loved one is experiencing a hallucination or delusion:

  • Listen. Don’t argue.
  • Respond calmly.
  • You don’t have to agree or disagree. Give a non-committal answer like: “I don’t hear the voices you hear, but it must be frightening to you.” (from The 36 Hour Day)
  • Reassure them that they are safe.
  • If you can, try to reorient back to reality, but if not, don’t push it.
  • Try to distract the person: “Let’s go to the kitchen to get a snack.” Once distracted, they may not see the hallucination. (from The 36 Hour Day)
  • Do what you can to calm the person. If your loved one is seeing a mouse under the bed, go in with a bag and catch the mouse. This may seem like lying, but this is your loved one’s perceived reality. You are doing the right thing by comforting them. (from The 36 Hour Day)

Accusatory hallucinations and delusions are often directed at the person who is closest to the individual with dementia. Those accusations are hurtful. It’s hurtful when your spouse of 50 years accuses you of infidelity.  It’s hurtful when your dad accuses you of stealing from him. It’s hurtful when mom blames all her troubles on you. How do you best respond?

  • Try not to take these attacks personally. This is part of the disease process.
  • Talk to your loved one’s physician about the hallucinations/delusions.
  • Learn to say, “I am sorry.” And “I will try to do better.” Even if you didn’t mess up, sometimes this will just disarm your loved one and calm the situation.
  • Try to distract and change the subject.
  • Reassure them that you love them.

If you have questions about your particular situation, give us a call (901-854-1200). We’re happy to help.