Senior Living Care Blog

How To Deal With Dementia Related Hallucinations And Paranoia

Posted by Joe Gilmore on Nov 26, 2018 11:00:00 AM

According to the Alzheimer’s Foundation of America, seniors above a certain age who have been diagnosed with Alzheimer’s disease may experience major psychiatric symptoms such as hallucinations, delusions, and paranoia. Roughly 40% of individuals with dementia experience delusions, wherein the time, location, or person being spoken to is mistaken for someone or something else. In about 25% of hospitalized Alzheimer’s patients, hallucinations are a common occurrence. If your senior is experiencing hallucinations or delusions, it can be difficult to provide adequate care.

Trying to care for a senior with Alzheimer’s disease who is experiencing hallucinations and delusions can difficult and even dangerous. It is not always helpful to try and explain the situation to seniors because they may grow frustrated or angry. It seems logical that reinforcing reality would be the right thing to do, but family caregivers need to be prepared to handle the behaviors of seniors with Alzheimer’s in a way that allows the senior to feel respected and safe. It starts with understanding the differences between hallucinations, paranoia, and delusions. All three are symptoms of disease that we do not fully understand but that is related to aging and the natural decline of cognitive functioning. Here is the breakdown:




Hallucinations are sensory experiences that are false, and can be either auditory, visual, or tactile. These perceptions are false but it is not helpful to deny their existence or refute something a senior says or try to correct them. In the senior’s mind, this experience is as real as anything happening to you. They may be hearing music or seeing butterflies when there aren’t any.




A delusion is any kind of fixed and false belief that is refuted by reality. Delusions are often caused by lapses in memory and can range from harmful to negligible. For example, a senior with Alzheimer’s may have the delusion that a caregiver is stealing from them or is trying to seduce them. Or, they may simply forget the name of someone or believe them to be a family member when they are not




Paranoia is similar delusions but are centered around suspicions. Seniors with Alzheimer’s may develop extreme feelings of suspicion for seemingly no reason and will exude hostility or frustration onto caregivers.



How to Cope with Dementia Related Symptoms

An elderly woman in distress wiping her eye

When it comes to handling your senior’s Alzheimer’s and dementia related symptoms, doctors recommend not being confrontational about their beliefs. Instead, try joining in on the experience and finding ways to subtly defuse the scenario. Try to refrain from using explaining that what they are seeing is not real or all in their head. Confronting them may cause aggravation and resentment, so validate how they are feeling. Ask them what they say and explain that you can’t see it but would like to know more about what is happening to them.


A reassuring touch may help to soothe your senior loved one, but be careful of invading someone’s personal space, especially if you are a caregiver and not very close to the senior in question. You can say things like, “That is interesting? What else do you see? I can’t see those things but I’m sorry that you’re experiencing them.” You can suggest moving on to a new subject or switching to a different room or going for a walk. Some hallucinations caused by dementia may be reassuring, such as remembering a loved one, experiencing an old memory, or reliving a pleasant event, so don’t be quick to shut down your loved one’s experience. You should only convene when the hallucination is harmful, scary, or disruptive, or if the experience puts your loved one or yourself in danger.


Dementia related symptoms can also be exacerbated by the loss of eyesight, hearing loss, medications, and other age-related physical issues. If your senior is experiencing severe symptoms related to dementia, it may time to consider trying anti-psychotic medications in order to reduce symptoms. Medications need to be evaluated and prescribed by a clinician so that medicines do not counteract one another or act in harmful ways.


For delusions, anti-psychotic medication may not be the correct answer. Delusions most commonly occur when a senior is trying to make sense of situation but is unable to, and thus fills in the blank with either assumptions or false beliefs. For example, if a senior cannot find something in their purse, they may assume that someone stole something. Delusions can be harmful for both seniors and their caregivers. If your senior loved one is accusing you or a caregiver of serious offenses, you must first consider that dementia related symptoms are causing them to have delusions. Don’t take these accusation personally and instead reassure the senior that they are alright. In the event that a senior continually misplaces an object and accuses you or a caregiver of stealing, one possible solution could be to purchase a duplicate of the item.


It is also possible distract your senior to draw attention away from a harmful delusion. It may not work for every patient or scenario, but if a loved one is experiencing a mild delusion you can try and switch subjects by introducing an activity, asking a question about something else, or offering their favorite snack. In cases where a senior gets upset over a delusion and cannot be deterred, then reassurance and calming may be the only viable solution. It is crucial to avoid trying to convince them they are wrong and getting into an argument. All you can do is placate and move on.


Paranoia is troublesome but not as problematic as delusions and hallucination. Medications oftentimes play an important role in the development of paranoia, so speak with your senior’s doctor about possible side effects from medication.



Next Steps

If someone is experiencing dementia symptoms, it is important to empathize and do your best to determine the cause and work with them. Recognizing the causes and possible solutions for dementia related symptoms can help you and your senior keep calm during an episode and to endure symptoms healthily.



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Topics: dementia care

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