This guide assists you in understanding some of the potential causes of delusions and hallucinations, and how the person with dementia can be supported. The support aims to alleviate the person’s distress and minimise the impact on the person’s care.
If attempts to respond to the person are not effective, or the person becomes more distressed, it is not recommended to continue as this may lead to physical distress. Trying to listen rather than responding to the person can sometimes assist with preventing an adverse reaction. Allowing time out will assist with de-escalating the situation and ensure that the safety of the person with dementia and others involved is maintained.
Responding to delusionsWhat is a hallucination?Responding to hallucinationsUseful resources
It is important to take delusions seriously and never dismiss them as a symptom of dementia. The person is experiencing real fear or anger and distress, whether the belief is true or not. The following offers examples of common delusions, and how to respond to them.
In this situation, the person believes that someone has stolen from them. Never assume that this is a delusion at first – the person may have a good reason to believe this. Do:
In this situation, the person has suspicious beliefs that their spouse or partner is having an affair. This is a common fear and can be difficult to manage, as the spouse/partner does not want to encourage the person’s delusion of an affair by asking more questions. Do:
In this situation, the person believes that others are against them or intend to cause harm to them. For example, family members may be visiting frequently, and the person may feel that the intent of the visit isn’t honourable. Do:
In this situation, the person is having difficulty orientating to time and place; for example, an 85-year-old woman may be looking for her toddler. A natural reaction is to attempt to persuade the person and to orient them back to the current day. This is largely ineffective and will only add to the distress and create mistrust. Do:
A hallucination is a sensory experience that occurs in the absence of actual sensory stimulation. Hallucinations in dementia are most commonly visual but can involve other senses like hearing and touch.
Visual hallucinations occur when the person with dementia is seeing something although there are no cues for it in the outside world. Do:
People with dementia can experience a number of visuo-perceptual difficulties due to normal ageing, eye conditions, and sometimes from additional damage to the visual system caused by specific types of dementia.
Vision difficulties can result in illusions, misperception, misidentifications and sometimes even hallucinations. They can cause the person with dementia to misinterpret their environment, which may cause the person difficulty in explaining what they have seen.
It’s important to ensure that the person with dementia has access to regular eye care and visual health. A visit to the optometrist will ensure that the prescription is correct and that there are no physical causes, e.g. cataracts. Do:
In this case, a person with dementia has incorrectly identified an object or a person, for example, a man tries to use a black remote control as a shaver, or a woman is unable to distinguish between her son, husband, and brother. This may be caused by damage to specific locations of the visual cortex.
These can be described as inaccurate or distorted visual information. Misperception can be influenced by previous experience and expectation. Examples include walking down a long, dark corridor with benches along the wall resulting in the person with dementia thinking it was a train station; or a man approaching a lift that had three large mirrors in it, and mistaking his reflection as a crowd of people who would not move to allow him in.
In responding, do:
The DBMAS Behaviour Management: A Guide to Good Practice is a good resource for managing behavioural and psychological symptoms of dementia.
Hallucinations and delusions: how to cope with hallucinations and paranoid delusions explores how to prevent and cope with dementia-related symptoms.
Dementia Australia offers an overview of Hallucinations and false ideas.This five-minute video runs through a scenario involving hallucinations and delusions.This resource material is informed by literature and associate practice evidence. This guidance should be applied within your organisations policies and procedures. ©HammondCare Dementia Centre November 2018 (next review date November 2020)
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