Hallucinations In The Elderly: Causes, Symptoms and Treatment | Guest Post by Kate Mallord

There are many studies that have been conducted and they all indicate that hallucinations in the elderly are quite common than in any other age group. There is also a lot of stigmas that are associated with hallucinations and it so happens that many people don’t report when it happens. Some facts about hallucinations are still not clearly known, especially with the connection to some clinical disorders.

Hallucinations are not limited to the elderly, though. There are also younger adults and youths that actually have episodes. There is, therefore, a need for improved professional and public knowledge so as to understand the very nature as well as significant as we advance in age.

Hallucinations are very significant today since they can be an indication of mental illness. However, you should note that they still happen to individuals who are healthy within the general population.

It is not easy to pin down what hallucinations are but they are characterized by the presence of some abnormal perception of things that do not exist. The beginning of hallucinations is rather dynamic. There is the issue of the cognitive-perceptual process as well as adaptive processes that are involved.

Despite how depressing and frustrating hallucinations are, there are people who try to learn how to hallucinate just for the fun of it. It is also a method used to try and understand what hallucinations are and what it is like to have them.

Current data indicates that around a quarter of the start of hallucinations is usually at 40 years. This means that hallucinations should be given more attention, especially when they happen in people without any kind of mental disorders or diseases.

It is important to understand the causes of hallucinations as well as the consequences, especially in elderly persons. Understanding hallucinations help in planning as well as providing the kind of care services that are required.

Some important definitions

1. Charles Bonnet Syndrome: this usually has to do with visual hallucinations. Such experiences are not real and can also happen in people who are alright mentally speaking. The perception may involve images that are familiar or unfamiliar. The images can be of patterns, inanimate objects, animals, and people.

Types of visual hallucination

Hallucinations can be complex or simple. For the simple form of hallucinations, they are non-formed hallucinations as well as the elementary hallucinations. The terms are in reference to indiscreet objects, geometric shapes, colours, lights and so on. With the complex hallucinations, they are also called formed visual hallucinations and in such a case, lifelike scenes or images of objects, animals, and people can be expected and they can be very clear.

2. Hallucinations: can be defined as a perception of events or objects but without external stimulus.

3. Musical hallucinations: this is where one experiences music or different musical aspects that can have or not have any lyrics or voice when there is evidently nothing being played.

4. Minor hallucinatory phenomena: this is where there is sensed the presence, visual illusions, and passage hallucinations.

5. Passage hallucinations: this is when the perceiver experiences some sort of stimulus passing within a peripheral field.

6. Out of body experiences: this involves sensing as if you are floating somewhere outside the body. In this case, you can also feel as if you are observing your own body from a position away from it.

7. Sensed presence: this is a kind of vivid sensation that there is the presence of a known or an unknown person quite close but just behind them. It is also called guardian angel or continued presence when referring to when you sense that there is a presence of someone who is already bereaved.

8. Visual illusions: these are misperceptions that occur briefly that there is an object or a living thing which differs from the reality.

9. Tinnitus: this is a perception that there is sound while in truth, no external source of sound is present. The sounds are usually simple like buzzing, hissing, or ringing even though there are some complex percepts such as music.

Distress and stigma

Distress and stigma

The studies conducted regarding visual hallucinations happening to older adults give qualitative evidence that they are quite reluctant to tell their experiences because of the fear of being told off as being mad or even demented. This is self-stigma.

There is also the fear of how the public will actually treat them if they do share their experiences, which falls under the public stigma. Post-bereavement hallucinations are also under-reported. Elderly people do not like sharing such experiences with people, including professionals, friends, and family. Most people who do not disclose their experiences do not want to be ridiculed.

The way people respond to hallucinations is different and every individual has their own way of dealing with it. For older people who have been bereaved, it has been observed that indeed hallucinations are a great help to them.

However, when hallucinations come as a result of Charles Bonnet syndrome, the perceiver can be distressed and the hallucinations can actually be more persistent. Also, people with Tinnitus are also greatly distressed under such circumstances.

There are also studies that show that there is an association that exists between suicidal behaviour and hallucinations especially in younger and older people.

If someone close to you or you have ever experienced hallucinations, then you most likely understand just how troubling that experience can be. Having a sensory experience that something which doesn’t really exist is there can be traumatizing, to say the least.

A hallucination can make you hear or see things that aren’t there. There are many reasons as to why a person can hallucinate, but there are some causes that actually tend to affect the elderly. When some symptoms are recognized, it is always important to get help so as to ease or eliminate the hallucinations altogether.

There are many things that can cause hallucinations and that are why they are not easy to diagnose. The first thing that medical professionals should do is to rule or all sorts of psychiatric disorders. There are some disorders that can cause some kinds of hallucinations.

These include depression, schizophrenia, and bipolar disorder. After psychiatric disorders are ruled out, it is important to investigate if there are any causes of hallucinations in the elderly.

What causes hallucinations in the elderly?

⇒ Alzheimer’s or dementia: hallucinations serve as some of the very first signs of the two diseases. It is important to investigate this further if an elderly person starts hallucinating.

⇒ Charles Bonnet Syndrome: this is a condition that leads to visual hallucinations, especially in elderly persons that have severe or partial blindness.

⇒ Side effects from medication: drugs can have some side effects and there are some that are closely related to hallucinations. Drugs that treat erectile dysfunction and hypertension can actually cause hallucinations. Also, medicines used to treat disorders such as Parkinson’s can have such an effect. There are some antibiotics too, that could lead to one have hallucinations.

⇒ Bereavement: there is research which indicates that quite a significant percentage of elderly person’s experiences hallucinations once they lose their spouse.

⇒ Delirium: the hallucinations that come as a result of delirium are usually experienced together with UTIs or after surgery.

⇒ Illness: kidney failure, liver failure, and even brain cancer can cause serious hallucinations as well.

⇒ Dehydration: dehydration is an issue that affects the elderly. When our bodies do not have adequate water, it may cause malfunctioning of the brain and this can cause hallucinations and lethargy.

⇒ Hearing and vision loss: as we get older, nerves deteriorate and they don’t operate as they did when we were younger. However, when an elderly person has some hearing and vision loss to a certain extent, there is a risk that the brains can get hyperactive and cause hallucinations. This is true for conditions such as otosclerosis and glaucoma.

⇒ Sleep deprivation: when you don’t get adequate sleep, you may get cranky and this can lead to hallucinations regardless of age.

Other issues that can cause hallucinations to include alcohol, drug abuse, and epilepsy.

How to tell when a person is hallucinating?

You need to note that hallucinations don’t always involve one seeing things which are not present. As we age, we lose senses and they become a bit duller. This means that the areas within our brains that are responsible for senses get hyperactive because they do not have proper stimulation.

It is possible to have hallucinations involving a single sense or all 5 because of the nervous system overreacting. Depending on the reaction, you may not necessarily be able to tell when something is happening. The elderly person may not realize it either.

For you to notice that an elderly person is actually hallucinating, it will have to be severe to a certain extent. One indicator of hallucination is the behaviour of an elderly person changes. You can get a bit more anxious and irritable than usual. They can also seem to be more forgetful and confused more than usual.

This is aside from signs like smelling, hearing, or seeing things that are not there to start with. When an elderly person is hallucinating, they can sense that there is something totally wrong and because of this, they may start isolating themselves because of the shame and embarrassment that is usually associated with such things.

Symptoms associated with hallucinations

Symptoms associated with hallucinations

If you do not observe carefully, you may end missing the symptoms associated with hallucinations. The other thing is that elderly persons don’t like talking about such episodes and so they may not even disclose them to anyone. Some of the symptoms that you could stay alert for include:

  • Talking about people or things that aren’t there, to begin with
  • Withdrawal
  • Insomnia
  • Difficulty expressing thoughts and speaking
  • Delusions
  • Memory lapses and confusion
  • Poor judgment
  • Great sense of judgment
  • Irritability and anxiety
  • A drastic change in mood and behaviour

Helping the elderly

When a loved one has hallucinations, it is important to take them to see a doctor. When a diagnosis is made, treatment can commence. You notice that most hallucination causes can actually be treated and this can also help in the reduction or the elimination of the same. Some of the tips that could help include:

Stick with it: it is important to understand the fact that hallucinations tend to feel very real for the perceiver. It is therefore important to show as much empathy as you can. You should take time to actually access the hallucinations and find out whether they are upset or not so that you can find the best solution.

Distractions: you should try to calm the perceiver down. The best thing to do is to shift focus to other things that the elderly person may possibly enjoy. You can try a game or some music.

Routine: when you are dealing with a senior who experiences hallucinations, it is important to stick to a routine which is consistent. Make sure that you let them remain in surrounding that they are familiar with so as to avoid further hallucinations.

Comfortable environment: you should keep the elderly person in an environment that is unfamiliar and confusing as this can make the hallucinations even worse. The things that can help prevent hallucinations and confusion includes signs in cabinets and doors, large clocks, and great lighting.

Hallucinations can be alarming for the perceiver and those around him/her. If a loved one experiences hallucinations, you should not let them go through it alone.

Caregivers who have been trained can tell the symptoms of hallucinations and this can help them respond in a quick and way so as to offer the much-needed help. When treated, hallucinations can go away, but it takes time.

If you are taking care of an elderly person with such an issue and you are not in a position to offer full support, it is important to get help from people who specialize in this area. This will ensure the safety and the peace of mind of your loved one.

Hallucinations are not like dreams. In a dream, you can do just about anything. Your life is different and it is possible to have some abilities. However, you can also have a nightmare where you are trapped and the experience is not good. Once we awake from a dream, all things are normal immediately.

With hallucinations, the visions do not end even with eyes open. Our reality can change a lot if we suffer from hallucinations when we are awake. It can be frightening and disconcerting regardless of how old we are and it is even worse when an elderly person is concerned because there can be an underlying condition that is present.

You should not conclude that a disease or condition is causing the hallucination. Instead, do proper research so that you can find the true issue because only then can proper action be taken.

When the reason behind hallucinations is discovered, treatment should start immediately and this usually depends on what is actually causing the hallucination to start with. The way conditions are treated can differ to a great extent.

For example, dementia is handled very differently from say Charles Bonnet syndrome. There are some medications that are common with people who have hallucinations, such as sleep aids, sedatives, and even muscle relaxers.

These are meant to calm nerves so that agitation can be reduced together with the chances of getting a hallucination episode.

You should never tell an elderly person that the hallucination is not real. Try as much as you can to help and start by asking what they are hearing and seeing exactly. This is the only way you can find the best way to help them. Try as much as you can to get their attention to some other things as this can end the hallucination.

Hallucinations are not always distressing and can actually be pleasant some extent. A caregiver should seek help for the elderly person as soon as they notice any of the symptoms. Comfort them as they have a hallucination as this can bring about some level of peace even in a distressed setting.

Understanding differences between conditions

Paranoia, delusions, and hallucinations can indicate disease and are not always a part of the ageing process. Though they are similar, they are different to many levels.

Hallucinations are usually a sensory experience that is false and it can be tactile, auditory or visual. The auditory hallucinations causes include mental illness, brain tumours, epilepsy, and hearing loss.

Such perceptions cannot be corrected by simply telling someone that they didn’t exist. The best example is when a dementia patient hears music while nothing is playing. They may also see bugs on a surface when in reality nothing is there.

Hallucinations vs. Delusions

As for delusions, one has a fixed false belief that is not really supported by reality. They happen as a result of a faulty memory. A good example is when caregivers are accused of infidelity or even theft. Understanding the hallucinations vs. Delusions can help you deal with each should they arise.

Paranoia, on the other hand, has to do with suspiciousness. The elderly persons can actually show great hostility as well as frustrations towards the caregivers. This is because of the paranoid behaviours that they have.

How to cope

How to cope

You may opt to join the elderly person in their hallucination. Join them in their reality as this can help them to a great extent. When you can tell exactly what they are experiencing, it becomes easier to defuse the current situation.

Don’t explain what they are feeling, seeing, or hearing as this will just aggravate them. Do not agitate them unnecessarily. Try to validate their feelings and try to show them that you understand their reason for being upset. It is important to actually assure them that they are safe regardless of what they are experiencing.

Comfort them by touching them and try as much as you can to make them focus their attention on you as this can reduce the hallucination greatly. Take them to another room or even try to take a walk with them so that you can remove them from the circumstance that could have caused the experience in the first place.

Some hallucinations can actually be comforting such as hearing music or even seeing children. If you feel that an elderly person is being comforted by a hallucination, there is no need to stop it. Respond to the things that tend to be disruptive and scary. Just ensure that the elderly person gets enough help under the circumstances.

How to change the environment?

There are several tips that can help in changing an elderly person’s environment so as to stop the hallucinations.

The first thing is the lighting. Try to see if there is any kind of issue with lighting. Check if there are any shadows that are cast when lighting is on or off. Check for reflections and distortions on the walls, on the floors and even on the furniture since they could all contribute greatly to one having some visual hallucinations.

Keep an ear open for any kinds of sounds such as conditioning and TV noise which the elderly person could be misinterpreting. You can remove mirrors or cover them if you feel like they could make the elderly person feel as if there is someone in the room with them.

Sleep and hallucinations

It is not uncommon for elderly persons to experience some sort of hallucination just as they are about to fall asleep. This is the hypnagogic hallucination. It is also common to experience some sort of hallucination as you wake up (hypnopompic).

You may feel like you have seen a moving object or even a formed image like a person and this may cause you to think that you have actually seen a ghost.

Hypnopompic and hypnagogic hallucinations are common in healthy individuals without narcolepsy or other kinds of disorders. They are considered more of dreams and they are not something that you should be too worried about. It is not clear how long you can go without sleep before hallucinating.


We have clearly established that hallucination is a perception that is not normal and it can be visual or auditory in its nature. It can also involve the sense of smell and taste, but this happens in very rare circumstances. These presentations usually happen when an elderly person is wide awake and very conscious of the surroundings.

What you notice is that these perceptions didn’t really have any real triggers. This means that you hear or see things that don’t exist. You can hear voices when no one is speaking, see lights as well as patterns and forms that are not real, and you may even feel some crawling sensation on your skin.

Kate Mallord
Written By Kate Mallord Kate Mallord is a health blogger. In the year 1988, She graduated from the University of Texas School of Medicine at San Antonio. Kate is an exemplary doctor. She has always devoted herself to caring for older adult patients. Read More