Hallucinations and Delusions
Written by Dr. Hao Huang
Updated at September 12th, 2025
Table of Contents
Hallucinations & Delusions in Dementia: A Caregiver’s Guide
What Caregivers Need to Know
People with dementia may experience hallucinations (seeing, hearing, or feeling things that are not real) or delusions (firm false beliefs, like thinking someone is stealing from them). These symptoms can be upsetting for both the person and their caregiver. Knowing how to respond safely and compassionately can reduce stress and improve quality of life.
First Step: Rule Out Other Causes
Before assuming symptoms are only from dementia, caregivers should work with a healthcare provider to check for treatable issues, especially if these symptoms are new or differ from the patient's usual pattern :
Infections (like urinary tract infections)
Pain, constipation, or dehydration
Substances, including alcohol
Medication side effects
Vision or hearing loss (make sure glasses and hearing aids are working)
Practical Caregiving Strategies
1. Stay Calm and Reassuring
Speak gently and avoid arguing.
Offer comfort with phrases like “I know this feels real to you. You’re safe.”
A calm tone can reduce fear and agitation.
2. Validate, Don’t Confront
Don’t say “That’s not real.” This can increase distress.
Instead, acknowledge feelings: “I understand this is upsetting.”
Shift focus to reassurance and safety.
It is important to recognize that a hallucination or delusion that is not upsetting or dangerous may not need any intervention at all.
If confronted, you can be honest and still validate. “I know you see something, but I don't see it.”
3. Redirect and Distract
Change the environment: suggest a walk, a snack, or music.
Move to a different, well-lit room if the space feels threatening.
Engage the person in an activity they enjoy.
4. Modify the Environment
Improve lighting to reduce shadows.
Remove or cover mirrors if they cause distress.
Reduce background noise or clutter that may trigger misperceptions.
5. Ensure Safety
If the person acts on delusions (e.g., accusing others, wandering to “escape”), calmly ensure they—and others—are not in danger.
Do not use confrontation or physical restraint unless absolutely necessary for safety.
Have an emergency plan: know who to call if behavior becomes unsafe.
When to Consider Medical Treatment
If hallucinations or delusions cause severe distress or unsafe behaviors, consult a doctor. In cases of emergency, call 911.
Non-drug strategies usually come first.
In some cases, medications like antipsychotics may be prescribed, but they carry serious risks for older adults with dementia. These should only be used if symptoms are dangerous, and/or if after other approaches fail.
Final Takeaway
Hallucinations and delusions are common in dementia. Caregivers can make a big difference by responding calmly, avoiding confrontation, ensuring safety, and seeking medical help when needed. Compassion and reassurance are often the most powerful tools.
Sources
Alzheimer’s Association: Hallucinations & Delusions
Alzheimer’s Association PDF: Hallucinations, Delusions & Paranoia
Cleveland Clinic: Dementia Overview