Hallucinations and Fears

November 9, 2010


Dementia patients’ perceptions of the world around us often bear little or no resemblance to reality.

Reflections: A woman looks at her own reflection in the mirror and sees a long-dead relative, a stranger, the hussy she believes her husband is having an affair with, a friend with whom to have a conversation — any number of comforting or frightening images.  As time goes on, most dementia sufferers lose their ability to see themselves in the mirror, because they remember themselves as much younger people.  Windows or any type of reflective glass can cause the same problem.  If the patient begins seeing frightening images in reflections, take down or cover the mirrors.  This is especially important in the bathroom, where a patient may become violent if he sees a stranger (i.e. his reflection) in the mirror while a caregiver is getting him undressed to bathe.

Television / Movies: What happens on the television or on a movie screen is often very real to a dementia patient.  Dr. Potts’ grandmother believed that Dan Rather came personally to her house every afternoon to tell her the day’s news.  Every afternoon before Dan arrived, she would put on her make-up, fix her hair, and make certain she was dressed well.  This is a humorous and harmless hallucination.  However, when the patient believes the war is occurring in his living room, or the criminal on a police show is in her house, the hallucinations can turn frightening or violent.  The key is to monitor what the patient is watching and to know your loved one’s triggers.  If you see signs of agitation (increased breathing, repetitive motion, general upset, etc.), turn off the TV / movie.  Instead of watching the news or other programs, play recordings of familiar comedy shows (The Carol Burnett Show, Sanford and Son, All in the Family, etc.), whatever the patient enjoyed years ago.  Other helpful DVDs would be those of familiar music groups or of family gatherings.  If the patient believes the family is actually in the room visiting, so much the better!   Music and videos are often used by caregivers to calm their loved one during times which might be upsetting to them.

People’s Identities: My father-in-law would look at a picture of himself and believe it to be his son.  Spouses have been known to run their husband or wife out of the bed, because they would not commit adultery with the stranger getting into bed with them — who was in actuality their spouse.  My grandfather would have an entire conversation about his son, Wendell, not realizing that he was talking to Wendell the entire time.

The Past: We all know dementia patients may not remember the past.  Additionally, they may remember the past as something completely false. Mrs. Smith tells her daughter about Mr. Smith’s repeated physical abuse, beatings, injuries — all things that never occurred.  These type accusations — those that anger and hurt us at the very core of our being — are the most difficult to ignore. We feel we must argue, correct, reorient.  The truth is that this reorientation will not work and very likely will only succeed in upsetting the patient.  It may be that the caregiver needs a “time out” at this point.  It is ok (and probably the best thing you could do) to leave the room, to give yourself time to cool off, tell yourself yet again that the patient is not responsible for her actions.  Redirect the patient if at all possible.  If you must say something in defense, try, “You know how much I love you,” or something similar.

In General: Keep in mind always that the patient’s perceptions, reasoning, understanding — everything is skewed by this disease.  These things that seem irrational to us are very real to them.  Trying to convince them otherwise, rather than soothing their fears, going along with harmless hallucinations, or distracting / redirecting them, will only cause upset, confusion or agitation in your loved one and could cause a violent outburst.

Share tips on techniques that have worked for you!

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