Throughout my years of educating caregivers on dementia care, I’ve constantly stressed how important it is that caregivers understand the difference between a delusion and a hallucination. Caregivers need to be able to correctly describe what the patient is experiencing, to his or her physician. The reason being: we don’t want our healthcare professionals to start throwing heavy dosages of medications at them when our loved ones are only delusional.
A delusion is a fictional belief about something, someone or even one’s self. For instance, common conception held by a person living with dementia is that someone is continually stealing his or her stuff, when in actuality he or she has most likely forgotten where it was last placed. Suspicion and delusions will go endlessly hand in hand.
Hallucinations, however, are false perceptions of objects, people and possible events. Folks can see, hear, feel smell and taste these phenomena. They are as real to them as the ground we’re standing on.
My mom, who is now in the end stage of vascular dementia has moved into the hallucination side of this dilemma. Almost nightly, she sees and hears someone breaking into her home. The other morning, she told me that three men had broken in and had gone straight down the hallway to the bathroom—where they showered, and left. I had to chuckle at this, for this was on the lighter side of what we’ve been experiencing. A few weeks prior, she told me how some man was trying to break in to kill her, and if it wasn’t for my sister’s dog protecting her, she’d be dead. I congratulated the dog in front of her and rewarded the hound with a pat on the head, saying “You’re such a good watch dog.”
You need to just agree with your loved one and learn to go with the flow when these hallucinations start happening. Arguing or trying to persuade him or her that these people or things do not exist, is a battle you will surely lose.
Sadly, you may reach a point where attempts of redirection, and even medications, no longer work like they may have in the previous stages of these dementia-related diseases. I believe at this phase, you may find it best to play-act yourself into his or her hallucination. Become part of the illusion and attempt to gently ease everything back to reality, if possible.
One thing that has always amazed me is how someone, who no longer has any short-term memory, may have the same hallucinations day-after-day. I had one doctor theorize to me, that an advanced dementia patient’s thought patterns are now more or less stuck steaming down a train track and that there is no one left to shift rails, putting those thoughts on a different track.
I went through a four-to-five-week period with my dad when he was in the latter stage of Alzheimer’s—every morning he awoke believing he was on passenger train. He would be screaming at me to make sure he didn’t miss his stop, as if I was the conductor.
Well, we all need to hang on tightly for there may still be many miles of track left to ride. These delusions and hallucinations work in a very mysterious way, and your preparations for any predictable or unknown behaviors could be your saving grace.