Hallucinations are one of the many complex symptoms of dementia that can be puzzling and distressing for both the person with dementia and their caregivers. These false perceptions can vary from seeing things that aren’t there to hearing voices or even feeling things that don’t exist. Understanding what hallucinations are and how to handle them is an essential part of dementia caregiving.

Hallucinations in dementia refer to when a person experiences sensory perceptions that aren’t real. These could involve seeing things that aren’t there, hearing voices, or feeling things like insects crawling on their skin. While hallucinations can occur with any type of dementia, they are especially common in Alzheimer’s disease and Lewy Body Dementia.

Many people confuse hallucinations with delusions, but they are different. Delusions are false beliefs, such as thinking someone is stealing from them or that people are plotting against them, while hallucinations involve sensing things that are not physically present.

Types of Hallucinations in Dementia

1. Visual Hallucinations: The most common type in dementia. A person might see people, animals, or objects that aren’t there. For example, they might see a person sitting in a chair when no one is there.
2. Auditory Hallucinations: These involve hearing sounds, voices, or music that don’t exist. The person may hear voices calling their name or hear conversations when no one is around.
3. Tactile Hallucinations: These are less common but involve the sensation of something physical, such as the feeling of insects crawling on the skin or the sensation of being touched.

It’s important to remember that each individual may experience hallucinations differently, and they may vary from day to day or even hour to hour.

Hallucinations occur due to changes in the brain caused by dementia. As the disease progresses, certain brain areas responsible for processing information and reality perception are damaged, which can lead to misinterpretation of sensory input.

Several factors can contribute to hallucinations:

• Brain changes: The brain changes that happen in dementia can affect how the brain interprets sensory signals.
• Medications: Some medications, like antipsychotics, sedatives, or even certain antidepressants, can trigger hallucinations.
• Environmental factors: Things like unfamiliar places, poor lighting, or clutter can confuse the person with dementia, leading to hallucinations.
• Stress and anxiety: Being in unfamiliar or stressful situations may also trigger hallucinations, especially if the person feels anxious or unsafe.

When a person with dementia experiences hallucinations, it’s important to respond with patience, reassurance, and understanding. Here are some tips for handling these situations:

1. Stay Calm and Reassuring: It’s essential to remain calm when responding to hallucinations. A soothing, gentle tone can help the person feel safe and less anxious.

2. Avoid Arguing: Arguing with someone about what they are seeing or hearing will only increase their distress. Instead, validate their feelings. For example, you can say, “I understand that you’re seeing that, but I don’t see it.”

3. Use Distraction: Redirect their attention to something else they enjoy, like listening to music, watching a favorite show, or even a simple activity like a walk. This can often shift their focus away from the hallucination.

4. Provide Comfort: Offer reassurance and physical comfort, like a hug or holding their hand. This can help calm them down and give them a sense of security.

5. Assess the Environment: Make sure the room is well-lit and free from anything that could trigger hallucinations, like shadows or clutter. A well-organized and calm environment can help reduce confusion.

6. Medication: If hallucinations are frequent or troubling, talk to the doctor. It may be necessary to adjust medications or explore alternative treatments to reduce the symptoms.

7. Know When to Seek Help: If the hallucinations become more frequent, disturbing, or difficult to manage, it might be time to seek guidance from a healthcare professional. Keep track of when the hallucinations occur and any patterns that might help your doctor better understand the situation.

Years ago, I worked in a nursing home and one of the residents had dementia with hallucinations.

John was an old farmer who was well over 6 feet tall and pretty strong. One afternoon he was in the sunroom with 6 other residents when I heard him start yelling “Fire”.

I ran into the room to find him standing in the middle of the room with a terrified look on his face. He truly saw the room in flames. 

That fire was as real to him as the floor I was standing on. There was no way I could tell him the fire wasn’t real and he was seeing things. He would have turned on me and that fear could have easily turned into anger. I could have been hurt.

My response was “Oh my goodness John thanks for letting us know, I called the fire department and they are on the way. We have to get everyone out of this room” and that is exactly what we did.

I moved everyone out of that room and took John to another area of the building. Once we were away from the “fire” he calmed down. 

My response to his hallucination was to remain calm, validate his feelings, and then redirect him.

It’s important to monitor the frequency and intensity of hallucinations. If they’re causing significant distress or are becoming more frequent, consulting with a doctor or dementia specialist is recommended. They may suggest adjusting medications or trying new strategies to manage the symptoms more effectively.
Hallucinations that appear suddenly or are accompanied by other symptoms like confusion or disorientation may require urgent medical attention to rule out other underlying causes.

Conclusion: 

Dementia-related hallucinations can be a confusing and challenging experience, but with patience and the right approach, they can be managed effectively. Caregivers who respond with calm reassurance and adapt to the person’s needs can help minimize distress. Remember that each person’s experience with dementia is unique, so be flexible and creative in finding solutions that work for both you and your loved one.
If you’re struggling with hallucinations or any other dementia-related symptoms, don’t hesitate to reach out for support. There are plenty of resources available to help you through this journey such as my Understanding Dementia Course and the Alzlog Caregiver’s Notebook, which can assist you in managing the daily challenges of dementia care.