An elderly person who hallucinates may see, hear, smell, or taste something that isn’t there. While some hallucinations involve ordinary visions of people or situations from the past, others are upsetting and scary. In this article, we provide more information to help you understand and manage hallucinations in the elderly.
Why Do Elderly People Hallucinate?
A hallucination is a misinterpretation that occurs in the absence of sensory stimuli from the outside world. In other words, it consists of hearing, seeing, or otherwise experiencing the presence of things that are not actually there.
Although this phenomenon may seem rare, studies have shown that about 40% of people hallucinate at least once in their life. Hallucinations can be temporary or chronic and persistent over longer periods of time, depending on their cause.
Why do hallucinations occur?
The biological mechanisms behind the different types of hallucinations are not fully understood, but many hallucinations seem to be due to the physiology of the brain. Some people who experience hallucinations are shown to have lesions in the part of the brain that is responsible for the specific type of hallucination. Hallucinations may also be caused by faulty information processing in the sensory cortex of the brain that results in forming random images and sounds.
Types of hallucinations
Hallucinations can occur with any of the senses or a combination of senses (compound hallucinations).
- Auditory hallucinations: hearing voices and other sounds that aren’t there like floor squeaking. These are the most common types of hallucination.
- Visual hallucinations: seeing people or objects that don’t exist.
- Olfactory hallucinations: smelling something that isn’t there, like smoke or perfume.
- Gustatory hallucinations: tasting non-existing things, for example, feeling a metallic taste in the mouth.
- Tactile or haptic hallucinations: feeling something that’s not really there touching the skin.
The elderly may hallucinate for many different reasons. Below, we list the most common ones.
Common hallucination causes in the elderly
Hallucinations are usually associated with illnesses such as schizophrenia or epilepsy, but they can also be completely independent of mental health. Hallucinations in the elderly can be caused by everything from dementia to deteriorating vision and sleep deprivation.
Dementia and Alzheimer’s disease
Dementia with Lewy bodies and Parkinson’s disease dementia are among the most common causes of visual hallucinations in the elderly. These hallucinations are due to complex changes occurring in the brain and typically involve seeing a non-existent person or animal.
Vision or hearing loss
The elderly with significant vision or hearing loss may experience visual and auditory hallucinations. The intensity of hallucinations is proportionate to the severity of the impairment.
Charles Bonnet Syndrome
Charles Bonnet syndrome is vision deterioration in the elderly. It may lead to hallucinations that involve seeing people, faces, animals, and inanimate objects that aren’t there.
Brain cancer
Certain tumors compress the optic nerve, leading to visual hallucinations. Temporary hallucinations can result from high doses of chemotherapy and the use of immunotherapy for treating cancer.
Drug or alcohol abuse
Using illicit drugs and consuming excessive amounts of alcohol can cause hallucinations in the elderly.
Dehydration
Severe dehydration can lead to hallucinations in seniors. Older adults are prone to dehydration due to a lower fluid content in the body as well as the lack of thirst sensation.
Liver or kidney failure
Seniors with liver or kidney failure may experience hallucinations when accumulated toxins start affecting the brain.
Epilepsy
Hallucinations are often caused by seizures that involve the visual association cortex in the brain. Older adults with epilepsy are more likely to suffer from hallucinations than young people.
Other causes of hallucinations
- Nutritional deficits, particularly those of vitamin D and vitamins B1, B3, or B12, can lead to hallucinations.
- Some psychiatric and epilepsy medications can cause hallucinations.
- High fever can lead to mental confusion and hallucinations because it raises the body’s temperature, which can impair normal brain functioning.
- General anesthesia carries a risk of temporary postoperative hallucinations.
- Complex visual hallucinations may appear in a late stage of the migraine attack.
- A stroke can in some cases lead to hallucinations and delusions.
- Mental illnesses such as bipolar disorder, schizophrenia, and schizoaffective disorders are typically accompanied by hallucinations.
- Sleep deprivation and sleep disorders such as narcolepsy may cause a person to hallucinate.
- Hallucination is one of the first symptoms of the rare degenerative brain disorder known as Creutzfeldt-Jakob disease.
As a caregiver, it is crucial that you recognize hallucination symptoms so that you can provide necessary help to your loved one. Here are some signs you should look out for.
Symptoms of Hallucinations
Unless hallucinations are severe, they often go unnoticed. The following indicators may show that a person is hallucinating:
- Drastic changes in mood or behavior
- Mentioning things or people that are not there
- Difficulty speaking
- Headaches
- Insomnia
- Withdrawal
- Anxiety
- Depression
- Aggression
- Heightened sense of awareness
- Reduced sense of judgment
- Confusion
- Delusions
- Paranoid behavior.
As soon as you recognize the symptoms, it is important to react quickly to provide the necessary assistance to your loved one.
What To Do if an Elderly Person Is Hallucinating?
Determine if the person needs your assistance
When someone experiences a hallucination, you should first determine whether it is posing a problem. Some people experience hallucinations as being pleasant and you don’t need to do anything. But if the hallucination is frightening for your loved one, it is essential to respond immediately.
Stay calm and don’t argue
There is no point in arguing with a person who hallucinates. It may worsen the situation and lead to even more distress and confusion. Do your best to remain calm, explain to your loved one what is happening, and let them know that they are safe.
Validate their feelings
Hallucinations are real to the person experiencing them. Your loved one will appreciate it if you take them seriously and show that you understand their fears and concerns.
Remove triggers from the environment
If a hallucination is due to a specific object or sensation in the senior’s environment, like the sound of the TV or a shadow, make sure to immediately remove the trigger.
Offer reassurance
It is important to offer reassurance to the person experiencing hallucinations. Give the senior a gentle pat on the back or a hug and ask them how they are feeling. This will also divert their attention from the hallucination.
Look for patterns
Try to find out what is causing hallucinations. Track the senior’s daily activities and try to find patterns in behaviors. You may discover that hallucinations happen when your loved one is hungry, sleep deprived, or in pain.
Distract them and redirect their thoughts
If your loved one is having a mild hallucination, try to distract them with another activity, such as listening to music, doing a puzzle, or looking at a photo album.
Get support for yourself
Caring for an elderly person who regularly has hallucinations may be extremely challenging for a caregiver. It is essential to get all the support you need so that you can provide better care. For example, you may want to join a caregiver support group where you can share your experiences with other caregivers.
Talk to their doctor
Hallucinations are often treatable. If the senior has frequent hallucinations, make sure to talk to their physician. Antipsychotic medications can be effective in reducing the frequency of hallucinations or even eliminating them completely. These medications also have a calming effect that makes the situation less distressing for the elderly.
Identify an emergency and get help
Some hallucinations need to be treated as a medical emergency, in particular when:
- The hallucination involves multiple senses (multimodal hallucination)
- The hallucination causes severe distress
- The hallucination causes the person to hurt themselves or others.
Hallucinations are often confused with delusions and paranoia. In the following section, you can read more about the difference between these three conditions.
Hallucination vs Delusions vs Paranoia
Hallucination, delusion, and paranoia can be symptoms of mental health disorders and involve the alteration of the perception of reality. However, there are some key differences between the three conditions.
Hallucination
A hallucination is a false sensory perception of objects or events that causes the person to hear, see, feel, or smell something that doesn’t exist. It can be a symptom of an illness or caused by situational circumstances like substance abuse.
Delusion
Unlike a hallucination, a delusion is a false belief that occurs due to faulty memory or a misinterpretation of a situation. For example, a senior experiencing a delusion may believe that someone is stealing from them or trying to harm them. Delusion can also be diagnosed as a mental illness in itself, known as delusional disorder.
Paranoia
Paranoia is characterized by feelings of suspicion and fear. For example, a person who has paranoid thoughts may believe they are being followed by the police.
Paranoia can turn into a condition called persecutory delusion where irrational thoughts become so fixed that the person believes that what they think or feel is true. Persecutory delusions are commonly associated with schizophrenia, bipolar disorder, and severe depression with psychosis.