It can be disturbing, even frightening, for both a person living with dementia (PLWD) and her or his care partner when the PLWD has hallucinations.
We are taught that hallucinations are abnormal, the hallmarks of “crazy people,” and witnessing someone having hallucinations for no apparent reason is unsettling. It’s important to first check whether the hallucinations may be caused by physical factors such as a urinary tract infection (UTI). They may also be a side effect of a wide variety of medications, a combination of medications, or over medication. Investigate these potential causes.
Also, remember that mistaking one thing for another is not “hallucinating.” For example, confusing the telephone with the TV remote is not a hallucination–it’s a misperception. If you stay calm and act normally when a PLWD has a hallucination, you can help reduce her or his anxiety (as well as your own) and keep everything on an even keel.
Imagine this for example:
Cricket and her mother Annie are alone in the kitchen of Annie’s house. They’re chopping carrots for supper. Annie is in the “amber” stage of dementia; she turns to Cricket.
“Where did the girls go?” Annie says.
“What girls Mom?”
“The two girls that were here.”
Cricket and Annie have been alone in the house for at least a week; they haven’t had any visitors during that time. “When Mom?” Cricket asks for clarification. “Two or three minutes ago!” Annie sounds annoyed. “Don’t be so stupid Cricket.”
Back in the early days, when Cricket was still a wet-behind-the-ears care partner, she would try to convince Annie that whatever other reality her mother was experiencing was not real. Cricket soon learned this approach didn’t work; it invariably ended in an argument. Cricket decided to change her behaviour. Thus:
“Oh, those girls, now I know who you mean Mom,” Cricket’s tone is calm and even.
“Well, where did they go?” Annie is still annoyed.
“I think they had an appointment. It was kind of rude of them to leave without saying goodbye wasn’t it?”
“It sure was.” Annie shakes her head.
“There’s no accounting for some people’s behaviour eh Mom?”
“No. It’s the last time I invite them here.”
“Good idea, Mom.”
In this example, Cricket defused the situation rather than fuelling it or escalating into an argument. She also turned her mother’s anger away from herself and redirected it toward the imaginary girls against whom she and her mother then became “allies.”
10 tips to deal with hallucinations
Going with the flow works wonders, but it takes awareness and practice. Here are some hands-on tips that can help:
- approach the PLWD’s preferred side
- verbally greet the PLWD
- move into PLWD’s personal space when invited
- use Hand Under Hand™
- repeat/agree/validate
- repeat/agree/validate
- take control of the situation
- allow the PLWD “off the hook”
- go with the flow
- repeat/agree/validate as required
Watch dementia care pioneer Teepa Snow demonstrate in this short video:
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