When Dementia Causes Hallucinations or Delusions: What Caregivers Need to Know
- Nestcare Home Care and Private Duty Nursing
- May 11
- 4 min read
What’s Really Happening—and How to Respond Without Fear or Frustration
In this blog we will discuss: dementia hallucinations, Alzheimer’s delusions, dementia paranoia, how to respond to dementia delusions, dementia and false beliefs
“He said there were people watching him through the window... but there was no one there.”
If your loved one with dementia is suddenly:
Seeing things that aren’t there
Hearing voices
Believing someone is stealing from them
Thinking their spouse is an impostor
…it can be terrifying, heartbreaking, and deeply confusing.
Are they becoming paranoid?Is this normal?And more urgently—what are you supposed to say or do?
You are not alone.And this is a common, but deeply misunderstood, part of dementia.
Let’s walk through what causes hallucinations and delusions in dementia, how they differ, and most importantly—how to respond with calm, clarity, and confidence.
What’s the Difference Between Hallucinations and Delusions with Dementia?
Before we dive into how to help, let’s clear this up:
👁️ Hallucinations
When someone sees, hears, smells, or feels something that isn’t there.
Examples:
Seeing animals in the room
Hearing music no one else hears
Feeling bugs crawling on their skin
🧠 Delusions
Fixed false beliefs, often rooted in fear or confusion.
Examples:
Believing someone is stealing from them
Thinking their spouse is cheating
Believing caregivers are trying to hurt them
Both can be deeply distressing for you and your loved one—and both are symptoms of dementia, not intentional behaviors.
Why Dementia Causes Hallucinations and Delusions
These experiences usually happen in the moderate to late stages of dementia and are caused by:
🧠 Changes in the brain that affect perception, memory, and judgment
🔁 Poor memory that leads to made-up explanations (e.g., “If my purse is missing, it must be stolen”)
😵 Sensory misinterpretation (shadows become people, reflections seem real)
🌘 Fatigue, sundowning, or overstimulation
💊 Medication side effects or infections (especially UTIs in seniors)
It’s not “crazy.” It’s cognitive decline.And the best response is compassion over correction.
Common Hallucinations and Delusions in Dementia
🔍 Hallucinations:
“There are people outside the window.”
“I hear a child crying.”
“There’s a cat in the room.”
“There are bugs in the bed.”
❌ Delusions:
“You’re stealing from me.”
“That’s not really my husband.”
“You’re trying to poison my food.”
“You took my children away.”
What NOT to Do (Even When It’s Hard)
🚫 Don’t argue or try to convince them they’re wrong
🚫 Don’t laugh, dismiss, or say “That doesn’t make any sense”
🚫 Don’t say “It’s just your dementia” (this rarely helps)
Trying to correct or reason will often escalate their fear or defensiveness.
What TO Do Instead: Calm, Validate, and Redirect
✅ 1. Stay Calm and Meet the Emotion First
Even if the belief isn’t real, their fear is.
💬 “That sounds scary. I’m here with you.”💬 “I can tell this is really bothering you. Let’s talk about it together.”
✅ 2. Validate Without Agreeing
You don’t have to confirm the delusion—but don’t challenge it either.
💬 “I haven’t seen anyone outside, but I’ll double check for you.”💬 “Let’s look together. You’re safe with me.”
✅ 3. Gently Redirect With Purpose
Offer a calming activity or shift the environment:
Show a photo
Offer a Nest Care Conversation Card
Turn on soft music
Take a short walk
Ask them to help you fold towels
🧠 These redirections shift their focus without confrontation.
✅ 4. Check for Triggers
Ask yourself:
Is the room too dark or shadowy?
Are they overtired or overstimulated?
Did they skip a meal or medication?
Could it be an infection (like a UTI)?
A change in environment or a simple medical issue may be causing or worsening the behavior.
✅ 5. Document and Track Patterns
Keep a notebook or use a caregiver app to log:
What the hallucination or delusion was
What time of day it occurred
How you responded
What helped calm them down
This helps you spot patterns—and gives you better information for your care team.
When to Involve a Doctor
While hallucinations and delusions are common, they should never be ignored—especially if they cause fear, aggression, or changes in behavior.
Call a doctor if:
The episodes are increasing
Your loved one is scared, aggressive, or paranoid
You suspect a new medication or infection
You feel unsafe or emotionally overwhelmed
Treatment options may include adjusting medications, ruling out physical causes, or involving a geriatric psychiatrist.
How Nestcare Supports Families Facing Hallucinations and Delusions
At Nestcare, we understand how distressing and isolating these symptoms can feel—for both the caregiver and the person with dementia.
That’s why we offer tools and services designed to bring structure, connection, and calm in moments that feel chaotic.
Use these gentle, memory-safe prompts to shift attention away from distressing thoughts and into soothing stories, reflections, or visual moments of calm.
Give your loved one a way to engage their hands and body in purposeful, grounding activities—a proven method to redirect agitation and delusional focus.
Our nurses are trained in behavior management, redirection techniques, and caregiver coaching. Whether it’s hallucinations, delusions, or sundowning, we help families navigate it all—compassionately and confidently.
When hallucinations or delusions show up in dementia, it’s easy to feel helpless—or even scared.
But with the right response, the right tools, and a little support, you can:
Keep your loved one calm
Avoid escalating distress
Maintain connection—even in confusion
And remind yourself: You’re doing better than you think.
You can’t control what they see.But you can control how safe they feel.
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