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Coping with Dementia: Handling Hallucinations

By Debbie Selsalvage Posted on February 12, 2021

Hallucinations can be one of the most difficult challenges a care partner for an individual living with dementia can face.

A hallucination is a sensory experience that appears real, but is fully created by the mind.  It is not the same as a delusion, which is a misinterpretation of fact.  For a hallucination, there is no factual basis.  And it is not only visual; it can also be heard and smelled by the person experiencing the hallucination. 

The occurrence of hallucinations can be a useful tool for properly identifying different forms of dementia.  For example, hallucinations appear much more frequently in Lewy Body Dementia than in Alzheimer’s, and some of the psychotropic meds prescribed for Alzheimer’s disease can make Lewy Body hallucinations worse.  So, the presence of hallucinations is a good indication that you should see a psychologist or neurologist who has experience in this field. 

But diagnosis and medication aside, what do we do when hallucinations arise?  These moments can be frightening for a care partner because they know they are dealing with a total fabrication of the mind. 

There are two rules of care that apply.  The first is the principle of Validation Therapy that teaches us that we should never deny, discount, or ridicule our loved one’s reality.  The second is to try to step fully into that reality and ask the kind of non-judgmental questions that let your loved one describe what they are experiencing.  Remember that their reality is as valid to them as yours is to you!

None of this is easy, but let me share a true story told by a member of one of my care partner support groups. 

Successfully Handling Hallucinations: A True Story

One evening, she was sitting on the couch with her husband with dementia, eating apples and watching television.  Out of the blue, her husband said, “I think there are Russians in the house!”  She responded, “Are they wearing their uniforms?”  Her husband leaned forward from the couch to get a better view, and said, “No, I don’t think so. 

What do you think they want?”  His wife responded, “Maybe they just want to eat some apples, then they will leave.”  Her husband said, “Oh, okay,” and sat back to eat his apple and watch the television.  Not another word was uttered about the Russians!

I thought this was absolutely brilliant.  Notice that the care partner did not challenge the hallucination.  She stepped fully into it and asked a factual question.  This validated her husband’s reality and began a conversation. 

When he wondered why the Russians were there, his wife brought the discussion right back to their reality . . . Apples!  This connected the Russians’ intentions to something “normal” and totally non-threatening.  End of discussion!

What do you think might have happened if she had said in a scolding voice, “Oh, stop it, there are no Russians here!”  The reaction likely would have been an angry and protracted battle of realities that could have ruined the evening.

Granted, this is not easy.  One must have experience and be quick-witted, but when done skillfully, a validating response can lower the anxiety and fear of the person with dementia, and possibly even eliminate the concern in his mind that created the hallucination. We are talking about “normalizing” a hallucination, and that in itself is a challenging idea, but it can be done. 

About Debbie Selsavage

Debbie Selsavage is a Certified Trainer and Consultant in the Positive Approach to Care and a Certified Dementia Practitioner.  She authors a monthly column to assist caregivers in coping with Dementia. Her company, Coping with Dementia LLC is dedicated to making life better for individuals living with dementia.  Contact Debbie at [email protected].


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