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Hallucination | Just the Facts

Understanding the difference between hallucinations and delusions is important. A delusion is defined as a false idea, sometimes originating in a misinterpretation of a situation. When an individual has a delusion, she may think that family members are stealing from her or that she's in another place when she's actually still in her own home.

A hallucination, in contrast, is a false perception of objects or events, and is sensory in nature. When a person with Alzheimer's has a hallucination, she can see, hear, smell, taste, or even feel something that isn't really there.

Hallucinations are caused by changes within the brain that result from Alzheimer's disease. Hallucinations are visual and auditory. The person may see the face of a former friend in a curtain or she may see insects crawling on her hand. In other cases, the person may hear people talking to her and may even talk to the imagined person.

Hallucinations can be frightening to the person and the caregiver. On some occasions, the individual may see threatening images or just ordinary pictures of people, situations or objects from the past. Although you can create an environment to manage wandering, you won't be able to control the person's hallucinations or prevent them from occurring. Some ideas to follow for handling a person with hallucinations are:

Action Steps:

Obtain medical guidance.

Ask a physician to evaluate the person to determine if medication is needed or might be causing the hallucinations. In some cases, hallucinations are caused by schizophrenia, a disease different from Alzheimer's.

Have the person's eyesight or hearing checked or make sure that the person wears her glasses or hearing aid on a regular basis.

  • The physician can look for physical disorders such as kidney or bladder infections, dehydration, intense pain, or alcohol or drug abuse. There are conditions that might cause hallucinations. If the physician prescribes a medication, watch for such symptoms as oversedation, increased confusion, tremors or tics.

Assess and evaluate.

Assess the situation and determine whether or not the hallucination is a problem for you or for the individual. Is the hallucination upsetting to the person? Is it leading her to do something dangerous? Does the sight of an unfamiliar face cause her to become frightened? If so, react calmly and quickly with reassuring words and comforting touching.

Respond with caution.

Be cautious and conservative in responding to the person's hallucinations. If the hallucination doesn't cause problems for you, the person or other family members, you may want to ignore it.

  • Don't argue with the person about what she sees or hears. Unless her behavior becomes dangerous, you might not need to intervene.

Offer reassurance.

Reassure the person with kind words and a gentle touch. For example, you might want to say: "Don't worry. I'm here. I'll protect you. I'll take care of you," or "I know you're worried. Would you like me to hold your hand and walk with you for awhile?"

  • Gentle patting may turn the person's attention toward you and reduce the hallucination.
  • Look for the reasons or feelings behind the hallucination means to the individual. For example, you might want to respond with words such as these: "It sounds as if you're worried" or "I know this is frightening for you."

Use distraction.

Suggest that the person come with you on a walk or sit next to you in another room. Frightening hallucinations often subside in well-lit areas where other people are present.

  • You might also try to turn the person's attention to other features of the room. Other distractions include music, conversation, drawing, looking at photos or pictures, or counting coins.

Respond honestly.

Keep in mind that the person may sometimes ask you about the hallucination. For example, "Do you see him?" or "Can you hear the children laughing?" You may want to answer with words such as these: "I know that you see something, but I don't see it." In this way, you're not denying what the person sees or hears or getting involved in an argument.

Check out the reality of the situation.

Ask the person to point to the area where he sees or hears something. Glare from a window may look like snow to the patient and dark squares on a tiled floor may look like dangerous holes.

Modify the environment.

If the person looks at the kitchen curtains and sees a face, you may be able to remove, change or close the curtains.

  • Check the environment for noises that might be misinterpreted, for lighting that casts shadows, or for glare, reflections or distortions from the surfaces of floors, walls, and furniture.
  • If the person insists that she sees a strange person in the mirror, you may want to cover up the mirror or take it down. It's also possible that the person doesn't recognize herself.
  • On other occasions, you may want to turn on more lights and make the room brighter.

As a caregiver, you can ease the fears of the person with Alzheimer's disease by using words that are calm, gentle and reassuring. Remember that the hallucination is very real to the individual with the disease. Your goal is to support the person's feelings without agreeing with the hallucination.

Resources

One of the best places to turn for additional help is the Alzheimer's Association. The Alzheimer's Association has more than 200 Chapters and 1,600 support groups nationwide, where family members of patients with Alzheimer's disease or a related disorder share their experiences, provide each other with emotional support, hear practical suggestions and learn to rebuild their lives.

The primary resource for this fact sheet was Peter V. Rabins, MD, a geriatric psychiatrist, and director of the Price Teaching Services and associate professor of psychiatry at the Johns Hopkins University School of Medicine, Baltimore, M.D.

Special thanks goes to the following Alzheimer's Association's:

Indianapolis Area Chapter
Eastern Massachusetts Chapter
South Central Michigan Chapter
Cleveland Chapter
Greater Youngstown Chapter
South Central Michigan Chapter

Recognition is also extended to the State of New Hampshire Division of Elderly and Adult Services of the Department of Health and Human Services.

David L. Carroll. WHEN YOUR LOVED ONE HAS ALZHEIMER'S. New York: Harper and Row, 1989.

Lisa P. Gwyther. CARE OF ALZHEIMER'S PATIENTS: A MANUAL FOR NURSING HOME STAFF. Washington, D.C.: American Health Care Association, and ADRDA, 1985.

Nancy L. Mace and Peter V. Rabins, M.D. THE 36-HOUR DAY. Baltimore. The Johns Hopkins University Press, 1991.

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