When someone with Alzheimer's or another form of dementia hallucinates, they may see, hear, smell, taste, or feel something that is not really there. Some hallucinations can be frightening, while others can just involve ordinary visions of people, situations, or objects from the past.
What Are Hallucinations?
According to the Alzheimer’s Association, hallucinations are false perceptions of objects or events involving the senses. These false perceptions are caused by the changes in the brain from Alzheimer's. Hallucinations are usually experienced by people who are in the later stages of Alzheimer's. It’s common for people to see the faces of former friends or they might see something like insects crawling over their skin. Sometimes a person might hear someone talking and even engage in conversation with the person they are imagining.
Alzheimer's and other forms of dementia are not the only reason people may start to experience hallucinations, so you should always check with your doctor to eliminate other causes when hallucinations begin.
Other causes include:
- Kidney or bladder infections
- Intense pain
- Alcohol or drug abuse
- Eyesight or hearing problems
- Some medications
Even if a person with Alzheimer’s begins hallucinating, it is important to have a medical evaluation to rule out other possible causes and to decide if they need medication. Never just assume the cause of their hallucinations is their Alzheimer’s disease as this may not be the case.
Non-drug approaches to managing hallucinations, as well as other behavior symptoms, promote emotional and physical comfort.
Non-drug approaches should always be tried before any other form of intervention. They usually aim to identify and address any needs that the person with Alzheimer's has difficulty expressing as their disease develops.
We need to recognize that the person is not just acting out, but is in fact having further symptoms of their disease.
Once the cause has been identified, we need to try to understand how the symptom may relate to the experience of the person with Alzheimer's.
Sometimes it can be very effective to change the environment to remove any challenges and obstacles to comfort, security, and ease of mind.
If it is determined that the root cause of the hallucinations is Alzheimer’s or dementia, the first line of treatment should always be non-drug approaches. However, if these strategies fail and symptoms are severe, medications may be appropriate.
Antipsychotic medications can be effective in some situations, but they are associated with an increased risk of stroke and death in older people with dementia and should be used carefully.
Work with your doctor to learn about the risks and benefits of each medication before you make a decision.
How to Cope With Hallucinations
If your loved one is experiencing a hallucination, you need to be cautious.
First, observe what is happening and ask yourself whether the present hallucination is really a problem for the person experiencing it or for yourself.
Are they upset? Are they likely to do something dangerous? Is something causing them to become frightened?
If their behavior is not dangerous, then it is possible there is absolutely no reason to intervene at all. If they are emotional, there are a few things you can do to help diffuse the situation.
Remain calm and offer reassuring words and a comforting touch. Don’t argue with the person about what they see or hear. It is entirely real to them and there is little point in trying to convince them otherwise.
Maintain a peaceful atmosphere throughout your interaction and be supportive. Say things like "Don’t worry. I’ll protect you. I’m here."
If you gently pat them on the arm or back it may turn their attention towards you and away from their hallucination.
Make sure that you acknowledge the feelings behind the hallucination and try to work out what the hallucination means to the person. Using phrases like, "It sounds as if you're worried" or "I know this is frightening for you" let’s the person know that you understand how they are feeling.
Try to Distract Them
It can also be useful to distract the person away from what is happening in their mind. So suggest taking a walk or move into another room. You often find that in areas with a lot of light and people, hallucinations that are particularly frightening subside.
You could also try turning the person's attention to conversation, music, or activities that you enjoy together.
Change the Environment
Check for sounds that could be being misinterpreted, like noise from a television or an air conditioner. Remove these sounds and you may find that the hallucination is also removed.
Look for any reflections, shadows, or distortions on the floors, walls, surfaces, and furniture. If you find any, try to remove them by turning lights on or off, laying cloth on surfaces, closing curtains, etc. You never know, that shadow may have been the trigger for the hallucination.
People with Alzheimer’s-related hallucinations often think they are looking at a stranger when they see their reflection in the mirror, which can lead to distress. In this case, remove the mirrors or cover them.