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Hallucinations and delusions are two conditions that may occur as dementia progresses, particularly in the later stages of the disease. These happen due to the changes in the person’s brain.

Hallucination is the state of seeing, hearing, or feeling things that other people do not perceive. A person with dementia may see, hear, feel, taste, or smell something that is really non-existent. For example, he may insist seeing an insect crawling on his leg.

Delusion, meanwhile, is a false belief or idea firmly maintained due to a misinterpretation of a situation. For example, the person with dementia may suspect that a loved one is cheating on him, or a family member is stealing his money. This kind of delusion is sometimes called paranoia.

Remember, however, that not all hallucinations are scary. Likewise, not all delusions should be equated with paranoia.

When your loved one experiences hallucination or delusion, be cautious in dealing with him.

See his doctor.

The best way to start is to consult with the person’s physician. It’s important that you coordinate closely with his doctor to help determine the appropriate intervention to make. His behavior might be caused by certain conditions like bladder or kidney infection, pain, or dehydration. A history of serious mental illness, like schizophrenia, might also have something to do with his hallucination or delusion.

It could also be that a medication he is taking causes his hallucinations or delusions. In this case, you may ask his doctor to evaluate the person to determine whether a medication needs to be adjusted, added, or reduced. Also, have the person’s eyesight and hearing checked regularly.

In whichever case, and if the doctor prescribes a new medication, watch for any reaction and side effects on the person. Report any reaction you may notice, such as tremors, over-sedation, or heightened confusion.

Non-medical solutions.

There are cases when the hallucinations or delusions are not due to any of the above-mentioned medical problems. In which case, try to assess whether or not the hallucination or delusion upsets the person. Does his behavior lead him to do something dangerous? It could be that a sight of some unfamiliar faces frighten him.

Respond with caution.

If the person does not cause a problem for himself, for you or other family members, you may just ignore his hallucination or delusion. Do not intervene unless his behavior becomes dangerous.

Find out the feeling behind his hallucination or delusion. You may respond by saying something like, “It sounds like you are worried.”

Act calmly and quickly.

Be supportive. You may give words of assurance, such as, “Don’t worry. I’m here to take care of you.”

Give him a gentle touch. A simple gesture of patting his hand may divert his attention from the hallucination as he turns his attention toward you.

Do not argue with the person about what he sees, hears, or believes.

Distract the person.

You may invite him for a walk together. You may also suggest that he does some activities, like listening to music, looking at a family photo album, or gardening. Or, you may invite him to another room where there are some other people. Usually, a frightening hallucination or delusion diminishes in well-lit rooms. But make sure that the lighting does not cast shadows or distortions on the floor and walls.

Remove or cover mirrors with a cloth to dispel his belief that a stranger is watching him.

Check for sounds that might cause a misinterpretation, like a noise from the air conditioner or the television.

Be honest.

When he asks for your confirmation, like, “Do you see it?”, avoid getting involved in an argument. Instead of giving him an outright “No”, you may say something like, “I know you are seeing something, but I don’t see it.”

Remember that the person suffering from dementia is trying to make sense of his world. And so your patience, support, and love are profoundly needed in this most challenging phase of his life.

Enjoyed the article? 

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How To Handle Paranoid Patients

About the author 

Dr Michael Chua PT, DPT

Dr Michael Chua is a physical therapist practising in Home Health, Skilled Nursing Facilities and Acute Care Hospital. His clinical interest involves pain management, geriatrics and dementia management. He enjoys treating patients and bringing out the best in them using positive treatment approaches, his dynamic work setting in a rural area provides an opportunity to treat a wide range from geriatrics to orthopaedics.

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