Hallucinations in Elderly People - Causes, Types, Symptoms, and Treatment

Introduction

Hallucinations are the false sensory perceptions of objects or events that seem real. All the five senses, such as touch, vision, hearing, smell, and taste, can be perceived through hallucinations even if it's not there in reality. Hallucinations while falling asleep or waking up are normal and common. But if it is present while awake and occurs frequently, it can be a sign of any underlying mental condition. Studies revealed that hallucinations are more common in older age groups than in others. Most cases of hallucinations are caused by certain clinical conditions, but the link is unknown. Mental disorders and neurological conditions are also common causes of hallucinations.

What Causes Hallucinations in the Elderly?

As age advances, sensory perceptions become weaker, along with nerve degeneration. These can be caused by certain diseases or natural physiological changes associated with aging. There are numerous causes of hallucinations in the elderly. Some of them are:

1. Schizophrenia: It is a severe mental disorder where the person interprets the real situation abnormally, which affects the thoughts, feelings, and behavior. Delusions, hallucinations, disorganized speech and thoughts, and abnormal behavior are some of the common symptoms of schizophrenia.

2. Parkinson’s Disease: Parkinson’s disease is an age-related neurodegenerative condition characterized by problems in cognitive functions such as focus, memory, and thinking and other functions like walking, writing, and swallowing. Symptoms include tremors, muscle stiffness, constipation, low voice, amnesia, and depression.

3. Alzheimer’s Disease: It is an age-related gradual degeneration of nerves in the brain which causes symptoms like memory loss, disorientation, hallucinations, language problems, and self-neglect.

4. Lewy Body Dementia: It is the most common type of dementia after Alzheimer’s disease and is caused by the deposition of proteins called Lewy bodies. The symptoms of Lewy body dementia are similar to Parkinson's disease and include hallucinations.

5. Charles Bonnet Syndrome: This condition is characterized by visual hallucinations that occur when there is partial or complete visual impairment.

6. Seizures: Seizures in older people can cause auditory and visual hallucinations as the cerebral subsystem is affected. Hence, symptoms like hallucinations, delusions, and illusions can be experienced.

7. Migraines: Migraine is a neurological condition that causes severe pain and numbness in the head. Visual hallucinations can occur in association with migraine.

8. Urinary Tract Infections (UTIs): UTIs can cause sleep deprivation, depression, anxiety, delusion, hallucinations, and paranoia in older people.

9. Certain Medications: When a person takes two or more medications, the risk of drug interaction is higher, which can induce hallucinations. Some medications that cause hallucinations are antipsychotic drugs, antibiotics such as Cephalosporins, dopamine agonists like Levodopa, Viagra for erectile dysfunction, and nitroglycerine. Medication-induced hallucinations are more common in older people than younger people.

What Are the Different Types of Hallucinations?

1. Visual Hallucinations: A person may see non-existent people, objects, animals, or figures. Visual hallucinations are common in Charles Bonnet syndrome (a condition with visual hallucinations that occur as a result of problems in vision), delirium, dementia, or Schizophrenia (a serious medical condition with episodes of psychosis).

2. Auditory Hallucinations: Sounds of tapping, climbing steps, somebody talking, or playing music may be heard in auditory hallucinations. These may be experienced by people with schizophrenia and other psychotic disorders.

3. Olfactory Hallucinations: Pleasant to pungent odors can be experienced in olfactory hallucinations and are found in people with brain tumors, Parkinson’s disease (an age-related neurodegenerative disorder that affects motor functions), seizures, and Covid-19 infection.

4. Gustatory Hallucinations: A person may experience taste that is not present, and this type of hallucination is found in epileptic patients (a neurological condition that makes the activities in the brain abnormal, leading to seizures).

5. Tactile Hallucinations: Non-existent things are perceived through touch in tactile hallucinations, such as insects crawling over the skin.

What Are the Symptoms of Hallucinations?

The following are the symptoms of hallucinations:

• Hearing voices when nobody is speaking.

• Seeing lights, flashes, objects, or people which are not there.

• Feeling abnormal and unreal sensations in the body.

• The feeling of a pleasant or pungent smell.

• Tasting something different in the mouth.

• Changes in behavior and personality.

• Confusion and poor memory.

• Difficulty in expressing thoughts and feelings.

• Self-harming tendencies.

How Are Hallucinations Treated in the Elderly?

Before starting treatment, a proper diagnosis is very important. The doctor inquires about a detailed medical history with medications taken. In addition, mental health, cognitive abilities, personality, and neurological changes, are also assessed. The symptoms of hallucinations are asked about or observed by the doctor.

After coming to a proper diagnosis, a treatment plan is made that can be either non-pharmacological or pharmacological based on the underlying cause and symptoms.

1. Non-Pharmacological Treatment: This treatment mode is preferred for elderly patients to avoid medication risks. Corrective lenses and removing cataracts can be beneficial for patients with visual impairment who experience visual hallucinations. A trained psychotherapist can reduce the symptoms of hallucinations through talk therapy.

2. Pharmacological Treatment: This treatment is preferred in patients who experience severe symptoms and violent behavior. Antipsychotic medications, both first and second generations, are commonly prescribed to treat hallucinations in schizophrenia, bipolar disorder, and other psychotic conditions. Repetitive transcranial magnetic stimulation helps in managing the severity of auditory hallucinations.

What Are Some Self-Help Techniques for the Elderly to Cope With Hallucinations?

• Checking and correcting the light that casts shadows or reflections.

• Involving in stimulating activities in the evening.

• Exercising and practicing yoga, meditation, breathing exercises can relieve the symptoms to a certain extent.

• Listening to pleasant music.

• Singing a repetitive song.

• Talking with family members and friends.

• Ignoring unnecessary voices.

What Can Be Done by the Family or Caregivers When Older People Hallucinate?

• Be Patient: It is easy to get irritated when someone reacts to things or people that are unreal. It is important to understand their situation, be patient and try to find a solution.

• Create Distractions: The effective method is to divert their mind by changing their focus. This can be done by involving them in activities like playing games, looking at an old album, or listening to music.

• Make the Person Comfortable: Instead of laughing or creating stress and confusion, make them feel comfortable, as awkwardness and discomfort can enhance the symptoms of hallucinations.

• Stick with a consistent routine and let them in surroundings familiar to them to avoid hallucinations.

• If the hallucinations are unmanageable, call an emergency.

Conclusion

Hallucinations can be a disturbing condition for older people. It can occur due to mental, neurological, and other conditions. Sometimes, patients experiencing hallucinations find distinguishing between real and unreal objects and surroundings difficult. Older people should seek professional help when the first symptoms of hallucinations appear, as it helps in knowing the underlying condition. With proper care and support from the medical team, caregivers, and family, hallucinations can be treated in elderly patients.