Handling Hallucinations In The Elderly

Handling Hallucinations In The Elderly

Hallucinations can sometimes be a frightening symptom of several health conditions, so understanding what causes them and how best to manage them can help to put your mind at ease if you are looking after an older person who experiences these regularly. Here, we are taking a closer look at what causes hallucinations, when they may be concerning, how they impact daily life, how best to manage them as a family, and how home care could provide additional support.  

At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about hallucinations in older adults, we can help. 

What causes hallucinations? 

There are several potential causes of hallucinations, some temporary and treatable, and some the result of a more long term condition. 

Temporary reasons for hallucinations that can be treated include severe lack of sleep, for which getting adequate rest or speaking to a GP about sleep medications could help. Similarly, severe dehydration can cause something called hyponatremia, which is a low level of sodium in the blood, potentially causing hallucinations. Although dehydration of this severity can be dangerous, it can be treated to reduce hallucinations. You can learn more about this in our guide to symptoms of dehydration in the elderly.

Certain medication side effects and combinations of medications could also lead to hallucinations, such as anti-seizure medications, certain antibiotics, sleep medications, certain antidepressants, and certain painkillers. If this happens, it is important to return to the prescribing doctor and make them aware of this side effect, as often it can be fixed by adjusting the dose or switching to a more agreeable medication.

Other causes of hallucinations include: 

Urinary Tract Infections (UTIs)

Although still a temporary condition, older people may contract these frequently (chronic UTIs), so they could experience associated hallucinations on a regular basis, particularly if they also suffer from dementia. Older people are also more susceptible to UTIs. If an older person starts to have hallucinations suddenly, UTIs are usually one of the first things a doctor will check for, as this is a common symptom. 

Older adults with a UTI may experience hallucinations, confusion, agitation, dizziness, reduced motor skills and falls. With antibiotics, UTIs are very treatable, but it is important to seek medical help as soon as possible if you notice symptoms of a UTI. 

Vision or Hearing Issues 

Many older adults lose their vision or hearing over time, and in both cases, sometimes they may experience visual or auditory hallucinations due to the brain misinterpreting sensory signals. This could cause them to hear words and phrases that were not said, hear noises, or see things that do not exist. 

Hallucinations in those with vision loss are usually associated with a condition called Charles Bonnet Syndrome When visual input is reduced or lost,  due to conditions like macular degeneration or cataracts, the brain’s visual processing areas are deprived of their normal stream of signals. In response, the brain essentially “fills in the gap,” spontaneously generating images, shapes, and colours that have no basis in the external world. In this sense, the hallucinations are a compensatory response by the brain to a loss of incoming visual information, rather than a malfunction of the eyes themselves.

Psychosis/Schizophrenia 

Psychosis is a symptom of schizophrenia, and the three main symptoms of psychosis are hallucinations, delusions, and disordered thinking or speaking, which is when thoughts and ideas come to mind very quickly, making it difficult to speak. 

Schizophrenia, severe depression and bipolar disorder can all cause psychosis, and therefore hallucinations, but they are most commonly associated with schizophrenia, which is an imbalance in brain chemistry. Research suggests that auditory hallucinations are by far the most common type of hallucination for those with this condition, followed by visual hallucinations. 

Dementia

In older people, dementia may be one of the most common causes of hallucinations, as these are a common symptom of certain types of dementia like Alzheimer’s disease or Lewy Body dementia (LBD). As the brain deteriorates over time due to this disease, hallucinations can begin to occur, and these sometimes feel very realistic to the person experiencing them. Visual hallucinations are thought to be more common in those with Lewy Body dementia and Parkinson’s disease.  

While hallucinations can be a common symptom of conditions like dementia, schizophrenia, or a UTI, they should always be checked by a medical professional to ensure there is no unknown or underlying condition causing them, and to adjust medications or commence treatment if needed. Sudden, persistent or worsening hallucinations are cause to see a GP straight away, and you should call 999 or go to A&E immediately if a loved one expresses desire to harm themselves or someone else, hears voices telling them to harm themselves or someone else, has a seizure, or becomes suddenly confused or nonsensical.

What types of dementia cause hallucinations?

As dementia is one of the most common causes of hallucinations in older adults, it is important to understand the different types of dementia that could cause this. Not everyone who has dementia will experience this symptom, and most often they are experienced in the later stages of dementia or during episodes of “sundowning”. Knowing whether or not this could occur for a loved one with a particular type of dementia could help you to identify the signs and seek help more quickly. 

Lewy Body Dementia 

Hallucinations are common in the later stages of Lewy Body dementia, which is a type of dementia that causes disturbed sleep, uncontrollable shaking, and slower movements, among other symptoms. Visual hallucinations are the most common in this type of dementia, and in a 2018 study, 60.5% of patients had visual hallucinations of mostly people or animals, while 35.5% had auditory hallucinations of mostly human voices. 

In addition, 90.9% who experienced auditory hallucinations also had visual hallucinations. A 2006 study found that most Lewy Body dementia patients experienced hallucinations daily, and these typically lasted a few minutes at a time. 

You can learn more in our guide to understanding the 7 stages of Lewy body dementia.

Parkinson’s Disease 

Parkinson’s disease is a degenerative brain disease that can cause shaking, stiffness, balance issues and communication issues. It can also cause hallucinations. Although this can occur at any time, it is more common in the later stages of the disease, and hallucinations are mostly visual in nature. 

Studies suggest around one third of Parkinson’s patients experience visual hallucinations, but importantly, up to 75% of Parkinson’s patients develop hallucinations over a period of around 20 years, so this symptom may be mild and infrequent at first.

Hallucinations are also a rare side effect of certain Parkinson’s medications, so if your loved one is taking medications for Parkinson’s and has developed hallucinations, you should speak to their doctor to see if anything can be done to limit or stop this side effect. 

Alzheimer’s Disease 

Alzheimer’s disease is the most common form of dementia, affecting 60-70% of cases. In the later stages, this can lead to hallucinations, and around 44% of those with Alzheimer’s disease could experience some form of psychosis, such as hallucinations, relating to their condition.

Hallucinations in Alzheimer’s patients may be things like seeing someone’s face that isn’t there, seeing bugs crawling on their skin, or having a conversation with a person who isn’t there. Delusions such as paranoia are also associated with Alzheimer’s disease.

Vascular Dementia 

Vascular dementia is the second most common type of dementia, and this occurs due to reduced blood flow to the brain, which can occur due to strokes or other damage to blood vessels. This can cause symptoms like memory issues, behavioural changes and cognitive function issues, including hallucinations due to issues processing information and reasoning. 

Research suggests that visual hallucinations are more common in Lewy body dementia than in Alzheimer’s and vascular dementia, but they can still occur in some cases. 

You can learn more in our guide to understanding vascular dementia.

How do hallucinations impact daily life, and how can home care offer support? 

Hallucinations can have a significant impact on the daily life of an older person, as well as their caregivers and family members. These can be distressing for everyone involved, and can go on to affect their mental health and overall wellbeing, as well as impacting their independence at home. 

When things regularly confuse a person, or they fear they don’t know what is real, they may become socially withdrawn, isolated within the home, or distrustful of people, medications, foods, going to sleep, and more. All of this can have a highly negative impact on their life, and can make everyday tasks like personal care or cooking more challenging. 

While the first thought for many families may be to move their older loved one to a care home for their own safety, in fact, it is possible for the person to remain in their own familiar home environment where they feel safe, with the help of professional home care. 

With care providers like Home Instead, families can manage hallucinations and benefit from:

• Experienced, trained caregivers who can help with things like dementia-related hallucinations to enable older people to continue living in the home they love
• Caregivers who are trained to respond with patience and understanding, and can gently reassure people while reducing environmental triggers
• Emotional support from experienced caregivers for both the person and their family 
• Advice on home adaptations that could better support an older person during distressing hallucinations
• Assistance with medication management, hydration, personal care, and more 
• Respite care to address and prevent carer’s burnout 
• Companionship so there is always a familiar, trusted face around to bring comfort 

Our experienced, supportive Care Professionals can provide the help needed to manage hallucinations effectively within an older person’s own home, where they feel safe and at ease. For support with hallucinations, reach out to your local Home Instead office to discuss your options.

We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.