What does it mean when elderly people start seeing things that aren't there?

According to the American Mental Wellness Association, hallucinations can occur in the elderly for a variety of reasons, including bereavement, delirium, and vision loss. Understanding what does it mean when elderly people start seeing things that aren't there is a critical first step toward getting a proper diagnosis and treatment for your loved one.

Quick Summary

Seeing things that aren't there, or experiencing hallucinations, in an older adult can be caused by various medical issues such as dementia, delirium, medication side effects, or sensory impairment like Charles Bonnet Syndrome. Identifying the underlying cause with a doctor is essential for determining the correct course of action, which could range from treating an infection to adjusting medication.

Key Points

• Medical Evaluation is Crucial: Seeing things is not a normal part of aging and requires professional medical assessment to determine the underlying cause.

• Dementia is a Major Cause: Conditions like Lewy Body Dementia and advanced Alzheimer's can trigger vivid, realistic hallucinations due to brain changes.

• Check for Delirium First: A sudden onset of confusion and hallucinations may be delirium, often caused by a treatable issue like a UTI or dehydration.

• Medication Side Effects are Common: Many prescription drugs, including those for Parkinson's or sleep, can cause hallucinations, especially in sensitive elderly individuals.

• Vision Loss Can Cause Phantom Images: Charles Bonnet Syndrome involves visual hallucinations resulting from vision loss, not cognitive decline, and sufferers are often aware they are not real.

The Medical Reasons Behind Hallucinations in Seniors

When an elderly person begins seeing things that aren't there, it is a distressing symptom for both the individual and their caregivers. This phenomenon is known as a hallucination and is not an inevitable part of aging. Instead, it is a clinical symptom that points to an underlying medical or neurological issue that requires investigation. Unlike delusions (false beliefs) or illusions (misinterpreting real stimuli), a hallucination is a sensory experience that seems real but is entirely created by the brain. A thorough medical evaluation is necessary to uncover the specific cause, which can vary widely.

Differentiating Hallucinations, Delusions, and Illusions

To understand the experience your loved one is having, it's important to distinguish between these terms:

• Hallucination: Seeing, hearing, smelling, or feeling something that is not present. This is a sensory experience without an external stimulus.
• Delusion: A false, fixed belief that is not based in reality. For example, believing that family members are stealing from them.
• Illusion: A real external stimulus is misinterpreted by the senses. For instance, seeing a shadow and believing it is a person.

Dementia-Related Hallucinations

For many families, dementia is a primary concern when hallucinations occur. Indeed, certain types of dementia are strongly linked to this symptom. The vivid visual hallucinations associated with Lewy Body Dementia (LBD) are particularly well-documented. In LBD, these detailed and realistic images often appear early in the disease progression. While hallucinations are also possible in Alzheimer's disease, they tend to be less frequent and occur in later stages, as the disease causes damage to the brain's ability to process visual information correctly. In both cases, the brain's confusion can lead to the creation of these phantom sensory experiences.

Delirium: A Sudden and Reversible Cause

One of the most crucial distinctions a doctor will make is between dementia and delirium. Unlike the gradual decline of dementia, delirium has a sudden onset and often signals a serious underlying medical problem.

Common causes of delirium in the elderly include:

• Infections: Urinary tract infections (UTIs), pneumonia, or skin infections can trigger delirium.
• Dehydration: A lack of proper hydration affects the brain and is a common, often overlooked, cause.
• Electrolyte Imbalance: Imbalances can disrupt brain function and perception.
• Post-Surgical Complications: Stress from surgery and anesthesia can cause temporary delirium.
• New Medications or Dosage Changes: Introducing new drugs or changing dosages is a frequent trigger.

Medication Side Effects

The elderly population often takes multiple medications, which increases the risk of drug interactions and side effects. Many common drugs can cause or worsen hallucinations. These include:

• Parkinson's medications: Dopamine agonists used to treat Parkinson's disease can induce psychosis and vivid visual hallucinations, particularly in older patients.
• Sleep medications: Certain sedative-hypnotics like zolpidem (Ambien) have been associated with hallucinations.
• Painkillers: Strong opioids and other pain medications can have mind-altering effects.
• Anticholinergics: Found in some medications for bladder control, allergy relief, and other conditions, these can cause confusion and hallucinations.

Sensory Impairment: Charles Bonnet Syndrome

One of the most surprising and often misunderstood causes of seeing things is Charles Bonnet Syndrome (CBS), which results from significant vision loss due to conditions like macular degeneration or cataracts. When the brain no longer receives a reliable visual input, it begins to generate its own images to fill the gaps. These hallucinations can be simple (shapes, colors) or complex (people, animals, landscapes). A key feature of CBS is that the individual retains insight, meaning they know that what they are seeing is not real, even though the image is vivid. This is not a sign of cognitive decline or mental illness.

Recognizing and Responding to Senior Hallucinations

When dealing with an elderly loved one who is hallucinating, your response can significantly impact their well-being. Keeping a calm and supportive demeanor is essential.

What Caregivers Should Observe and Document:

• Timing: Note when the hallucinations occur (e.g., specific times of day, before bed).
• Triggers: Did the hallucinations begin after a change in medication, a recent illness, or a stressful event?
• Content: What is the person seeing, hearing, or feeling? This helps doctors differentiate causes.
• Insight: Does the person know the hallucination isn't real, or do they believe it is? This is a key differentiator for conditions like CBS.
• Medical History: Consider any vision loss, Parkinson's disease, or known cognitive changes.

How to Respond Effectively and Compassionately:

1. Stay calm and reassuring. Your reaction sets the tone. Panicking will only escalate the person's anxiety.
2. Do not argue or contradict. Telling them "that's not real" is unhelpful and can cause anger or fear. For them, the experience is very real.
3. Validate their feelings, not the hallucination. Instead of saying, "There is no dog in the room," try, "I can see that you're scared by the dog, but you are safe with me."
4. Try redirection. Change the subject, offer a distraction like music or a different activity, or move to another room. Often, changing the environment can stop the hallucination.
5. Adjust the environment. Poor lighting and reflective surfaces like mirrors can trigger illusions or misperceptions. Increase lighting and cover mirrors if needed.
6. Seek professional help. A medical evaluation is the most important step. Notify their doctor immediately about any new or worsening symptoms. This may involve adjusting medication, treating an infection, or providing better support for sensory loss.

Comparison of Common Hallucination Causes

Feature	Dementia with Lewy Bodies	Delirium	Charles Bonnet Syndrome
Onset	Gradual, often early in disease progression.	Sudden, over hours or days.	Tied to significant, often sudden, vision loss.
Course	Persistent, recurrent, often worsens over time.	Fluctuates, can improve with treatment of underlying cause.	Comes and goes, can improve over time but may persist.
Associated Symptoms	Parkinson's-like movement issues, sleep disorders, cognitive fluctuations.	Marked confusion, disorientation, difficulty focusing, agitation.	Limited to visual hallucinations; mental clarity remains intact.
Sensory Modality	Primarily vivid visual hallucinations of people or animals.	Often visual, but can affect other senses.	Exclusively visual hallucinations; not tied to other senses.
Insight	Insight can be lost over time, leading to agitation.	Varies, but confusion often makes insight difficult.	Typically maintained; the person knows the images are not real.
Treatability	Progression can be managed with medication.	Reversible once underlying cause is treated.	No specific cure, but coping strategies can help.

Conclusion: Next Steps and Medical Consultation

Experiencing a loved one seeing things that aren't there is a serious and often frightening situation. However, understanding that this is a symptom of a treatable or manageable condition is the first step toward effective care. Causes can range from temporary issues like an infection (delirium) or medication side effects to chronic conditions like dementia or vision loss (Charles Bonnet Syndrome). The most important action is to schedule a medical consultation with a primary care physician or a neurologist. This will ensure the underlying cause is correctly diagnosed and a proper management plan is put in place, bringing clarity and reassurance to both the individual and their family. For more information on differentiating various types of cognitive decline, visit the Alzheimer's Society website.

Frequently Asked Questions

Can a UTI cause an elderly person to see things that aren't there?

Yes, a urinary tract infection (UTI) is a common cause of delirium in the elderly, and delirium frequently leads to confusion and hallucinations. When the infection is treated, the symptoms typically resolve.

How can you tell if an elderly person is hallucinating?

Look for signs like talking to or interacting with people who aren't there, pointing at empty spaces, or reacting to things others can't see or hear. The key is that the individual is experiencing a sensory event that has no external source.

Should you argue with an elderly person about their hallucinations?

No, arguing is counterproductive and can cause distress and agitation. The hallucination is very real to the person experiencing it. Instead, stay calm, validate their feelings (e.g., 'That sounds frightening'), and gently redirect their attention.

Are all hallucinations in the elderly a sign of dementia?

No, while dementia is a potential cause (particularly Lewy Body Dementia), other factors like medication side effects, vision loss (Charles Bonnet Syndrome), or delirium due to an infection must be ruled out. Only a doctor can determine the specific cause.

What is Charles Bonnet Syndrome and how does it relate to elderly people seeing things?

Charles Bonnet Syndrome is a condition where people with significant vision loss experience visual hallucinations. The brain, lacking sufficient input, generates phantom images. Unlike dementia-related hallucinations, the individual usually knows the images are not real.

Is it possible for an elderly person to know their hallucinations aren't real?

Yes, this is known as retaining 'insight'. It is very common in conditions like Charles Bonnet Syndrome, where the person understands that what they are seeing is not grounded in reality, even though the experience is vivid.

What are the first steps to take when an elderly person starts seeing things?

The most important first step is to schedule a medical evaluation with their doctor. It's helpful to gather information about when the hallucinations started, recent medication changes, or any signs of illness to share with the doctor.