When Loved Ones See Things: 4 Gentle Ways to Manage Dementia Hallucinations and Delusions at Home - Health's Charm

Caring for a family member with Alzheimer’s or dementia brings unique challenges, and few are as distressing as dealing with hallucinations (seeing or hearing things that aren't there) or delusions (firmly held false beliefs). As caregivers, our natural instinct is often to correct them, but for someone living with dementia, their reality is absolute. Trying to argue only leads to stress, confusion, and sometimes, agitation. The key is shifting your approach from confrontation to compassionate validation.

1. Embrace the 'Do Not Argue' Rule: Enter Their Reality

When your loved one says, "There is a stranger standing by the window," remember that trying to prove them wrong simply won't work. Instead of saying, "Nonsense, there is no one there," try validation and reassurance.

• Acknowledge the Feeling: "That sounds frightening. Tell me more about what you are seeing."
• Offer Comfort: "I understand you feel worried, but I am here right beside you, and I will make sure you are safe."
• The Power of Touch: A gentle hand on their arm can often ground them better than any logical explanation.

2. Investigate Environmental Triggers

Sometimes, the "stranger" isn't a figment of their imagination but a shadow caused by poor lighting, or a reflection mistaken for a person. Addressing environmental factors can reduce the frequency of distressing episodes.

• Ensure rooms are brightly and evenly lit, especially during ‘sundowning’ hours (late afternoon/evening).
• Check for items that might cause confusion, such as reflective surfaces, large patterns on wallpaper, or objects that look like people (e.g., a coat rack).
• Reduce background noise, like loud televisions or radios, which can distort sounds and lead to auditory hallucinations.

3. Redirect with a Smooth, Positive Distraction

Once you’ve validated their feeling and confirmed their safety, the next step is redirection. Gently guide their attention away from the delusion toward something calming or enjoyable. This works best when you physically change their setting.

If they insist they need to go home (even if they are home):

• Avoid correction. Instead, say, "That sounds like a great idea! Before we go, let's have a snack in the kitchen."
• Engage their senses with a simple activity: playing a favorite old song, looking at a photo album, or helping you fold laundry.

Key Insight for US Caregivers: Always document the occurrences. Note what happened right before the hallucination (medication timing, time of day, food consumed, etc.). This data is crucial for their primary care physician or geriatric specialist in determining if medication adjustments are necessary.

4. Prioritize Your Own Calam and Self-Care

Managing these episodes is draining. If you feel yourself becoming frustrated, step back. Take three deep breaths, or ask another family member or respite caregiver to take over for an hour. Your loved one feeds off your energy; if you are agitated, they will become more agitated. Remember, this behavior is the illness, not the person you love.

We know this journey is challenging, but by using gentle validation and strategic redirection, you can create a safer, less stressful environment for everyone in your American family home.