My family first recognized that my aunt might have Alzheimer's disease when she began having hallucinations. She thought that someone had stolen her money and that a woman had moved into the top floor (which didn't exist) of the house and was having an affair with her husband. Another aunt, who is in the late stages of Parkinson's disease, is having similar hallucinations. A wrinkle in the bedclothes is perceived as an unidentified body. But her hallucinations are caused by side effects of the drugs she is taking for tremors.
Approximately 20 to 40 percent of Alzheimer's patients experience hallucinations at sometime during the course of the illness. They can be frightening for the person experiencing them and for the caregiver. People with Lewey body dementia, the second most common type of progressive dementia after Alzheimer's, are more prone to hallucinations. These hallucinations usually revolve around people, objects or animals that are not seen by a healthy person. Having hallucinations can lead to unusual behavior by the person, who might have conversations with these people or animals.
How does a caregiver deal with the imagined friends and foes of someone with dementia?
1. Try to determine if the hallucinations are a result of the side effects of prescription drugs, lack of sleep, alcohol or drug abuse, an unrelated mental illness, visual or auditory problems, or a secondary illness such as a urinary tract infection of other physical discomfort.
2. Don't leave the person who is having hallucinations alone. Hallucinations are frightening enough to endure alone. Provide comfort, reassurance and kindness, but do not try to reason with the person.
3. Remove objects such as rugs, lamps and paintings that have a bold design or cast shadows that might confuse or frighten the person.
4. Provide adequate lighting to enhance good visibility and reduce shadows.
5. Remove glass tables and cover up mirrors that can confuse the person into thinking that there is another person wandering in the house. It isn't uncommon for a person with dementia to see his or her image reflected back to him/her, only to think that they are seeing a stranger.
6. If the person thinks she/he is being watched by someone outside the house, close the blinds, shades and curtains.
7. Keep a record of when the person has hallucinations and note if they are associated with a certain time of day, with fatigue, eating particular foods, etc.
8. Speak with your physician about changing or adding a medication, and whether a traumatic event, such as the death of a loved one, has recently occurred to trigger the hallucinations.
9. After everything is said and done, probably the most effective way of dealing with someone who has dementia and hallucinations is to be kind. Become familiar with The Best Friends Approach™. Developed by Virginia Bell and David Troxel, this philosophy suggests that more than anything, a person with Alzheimer's needs a best friend, a caregiver, family member or friend who empathizes with the patient's situation and remains loving and positive while helping the person feel safe, secure and valued. This approach teaches clever strategies for dealing with potentially difficult situations. For example, if the person is hallucinating that someone is trying to steal his or her money, you might give him/her a wallet filled with a small amount of money, and put it in a place that is visible. This offers reassurance that you are listening to their fears and that you are there to help them.
According to Mike Tribby, who reviewed Bell's and Troxel's book The Best Friends Approach to Alzheimer's Care on Booklist, "The best Alzheimer's caregivers, say Bell and Troxel, become friends with the knack for calmly directing sufferers through their frightening confusion. Responding with the knack guides a patient to acceptable behavior while providing 'cuing about roles and identities.' For instance, to a patient's inappropriate sexual advance toward his daughter, a 'no-knack approach' would be to angrily respond,’ You dirty old man! Stop that’; one with the knack would be, 'Daddy, it's Mary, your daughter. Look what I have here--a photograph of Mother. Isn't she pretty?' The responses suggested for other situations are similar. Bell and Troxel stress that Alzheimer's victims are usually confused, not malevolent or willful, and compassion and indulgence will keep situations from worsening