Hallucinations in the elderly are a relatively common side-effect of Alzheimer’s disease, as well as other diseases, syndromes, and aspects of aging. Delusions, paranoia, and hallucinations occur in a large minority of Alzheimer’s and dementia patients, and understanding these occurrences and experiences is a vital part of treatment and care.
Caring for seniors experiencing hallucinations can be complicated, and what seems to be the most sensible approach is often not the best. Reinforcing reality and trying to help patients understand what is real and what is not, for example, can sometimes be extremely detrimental.
It is also important to understand that hallucinations are different from the paranoia and delusions that many patients with dementia experience. Hallucinations are a form of sensory experience, while paranoia and delusions are beliefs and feelings.
In order to help carers deal with hallucinations in seniors in their care or in loved ones, it is important to understand the phenomenon. In this article we will explore the common causes of hallucinations in the elderly, before examining how to cope with these hallucinations, and providing some advice for caregivers.
Common Causes of Hallucinations in the Elderly
While diseases like Azheimer’s, Parkinson’s, and even cancer can cause visual hallucinations, many of the most common causes of hallucinations in the elderly are not actually due to a disorder or mental illness, but come from treatments for, or symptoms of disease.
Lack of Sleep
Many elderly people and people with dementia suffer from sleep deprivation, which can in turn have an impact on their perception of the world. An absence of sleep can cause a patient to become disconnected from reality (albeit usually temporarily), which can present itself in the form of hallucinations.
When someone is dehydrated, they suffer from a lack of electrolytes, excreted as waste as part of the body’s attempts to compensate. This can result in something called hyponatremia, which often presents symptoms in the form of catatonia or hallucinations.
During epileptic seizures, neurons are discharged in the brain. This alteration to an elderly person’s natural brain chemistry can cause symptoms which are only experienced by the patient themselves, resulting in certain sensory hallucinations.
Vision or hearing loss
Elderly people whose hearing is degenerating often suffer from auditory hallucinations, hearing things incorrectly or hearing things that aren’t there, as the damage to their ears produces false sensory responses. People with visual impairment also often experience hallucinations, usually described as Charles Bonnet Syndrome.
Charles Bonnet Syndrome
Charles Bonnet Syndrome describes hallucinations caused by failing eyesight. It is a physical problem, the result of degradation of the cortical nerves, rather than a result of alteration or damage to the brain. As a result it usually presents as shapes and colors, rather than fully formed hallucinations.
Hallucinations that arise in elderly people with dementia or Alzheimer’s disease happen because of changes in the brain that result from the disease itself. These hallucinations can be dramatic and extremely realistic, to the extent that sufferers often find themselves attempting to communicate with people who aren’t there.
At What Stage of Dementia do Hallucinations Occur?
Hallucinations as a result of dementia can occur at any time, but they are usually experienced in late-stage dementia, as the damage to the brain at this point is far more severe than during earlier stages.
Lewy Body Dementia
Hallucinations are a particularly common occurrence in patients with dementia Lewy Bodies, a progressive dementia that results in sleep behavior disorder, tremors and slow movement, and recurring, vivid visual hallucinations.
Elderly people, particularly those suffering from dementia and Alzheimer’s disease, sometimes fail to get sufficient nutrition in their diets. As with dehydration, malnutrition can result in a lack of electrolytes in the body, which in turn can lead to hallucinations.
Schizophrenia is caused by an imbalance in brain chemistry, and commonly causes severe cognitive disorder, including delusions and hallucinations. People suffering from schizophrenia and other psychiatric disorders will experience and interpret reality in an abnormal way, which can lead to hallucinations.
Delirium, whether caused by metabolic disturbance, infection, or the effects of drugs or alcohol on the body, can result in a number of changes to a person’s consciousness, including hallucinations. While delirium presents many of the same symptoms as dementia, it is a discrete and separate syndrome, and it is important to know the differences between delirium and dementia.
Parkinson's disease is another brain disorder which can cause significant cognitive damage, alteration of brain chemistry, and therefore hallucinations, alongside a number of other more common symptoms such as shaking, stiffness, issues with balance, and communication problems.
Hallucinations are often caused by prescription drugs, particularly when patients are prescribed a mixture of pharmaceutical solutions. This is often the case with elderly people, which means it is an important side effect to watch out for.
What medications can cause hallucinations in the elderly?
Hallucinations can be a side effect of a wide variety of prescription medications, including anti-seizure medication, some antibiotics, sleep aids, some antidepressants, and several opioids and painkillers.
Brain tumors can cause significant disruption and damage to a patient’s brain chemistry, and can often result in hallucinations.
How to Cope With Hallucinations in Elderly Dementia Patients
As mentioned at the beginning of this article, coping with and treating hallucinations in the elderly can be tricky. Attempting to assert reality can be extremely counter-productive, and what seem to be the most common-sense solutions are often the least helpful.
Assure them that they are safe and be empathetic
Staying calm and showing empathy towards elderly dementia patients suffering from hallucinations is one of the most important aspects of care. Hallucinations can be overwhelming and extremely scary, so assuring them that they are safe and secure is key.
Acknowledge their feelings
Attempting to impose reality on elderly people suffering from hallucinations is usually counter-productive, and will only cause frustration and anger. After all, what they are feeling is real to them. So start by acknowledging what they are feeling and seeking to understand what they are going through.
Speak as if their delusions are real so you can problem-solve
Trying to persuade an elderly dementia sufferer that their hallucinations are not real is unlikely to end in success, so take a different approach. Speak to them as if their hallucinations are, in fact, real, then see what needs to be done to find a solution. After all, some hallucinations may not be detrimental, and may be comforting or relaxing, and so ‘treatment’, especially for those with late-stage dementia, may not be necessary or positive.
In most cases it is important to seek professional help in the case of elderly people with hallucinations. Hallucinations can cause anxiety, stress, and even physical harm, so finding the right advice and support is important - no one can or should have to do it alone! Senior Helpers are an award-winning provider of senior care who offer help and support both in-home and in assisted facilities. Discover the full range of services here, from companion care for seniors who need daily assistance to in-depth specialized care for those with Alzheimer’s, Dementia, Parkinson’s and other chronic diseases.
Advice for caregivers
Alongside the advice listed above, there are a number of mechanisms and techniques that caregivers can turn to to support elderly people experiencing hallucinations, and improve their quality of life. Calm, comforting physical contact can be a great help, such as a gentle stroke or hand on the back, as this can redirect the patient’s attention and reduce the hallucination. Similarly, a change of environment, whether moving rooms or going for a walk, can be extremely positive.
Changing the mood of a room can also help, through adding or reducing light or removing physical objects or furniture, as this can help prevent shadows, reflections, or distortions in a room that could trigger hallucinations. Mirrors and reflective surfaces can also be the catalyst for hallucinations, convincing a dementia patient that they are seeing strangers or people who aren’t there.
If you are interested in finding out more about caring for an elderly person who is experiencing hallucinations, or exploring care options with Senior Helpers, then reach out and we will be delighted to discuss our services with you!