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Hallucinations in Dementia and How To Support Clients Using Therapeutic Reasoning™

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Hallucinations in Dementia

It is not uncommon to observe hallucinations, that is, seeing people or things that are not there, among people living with symptoms of dementia. Lewy Body Dementia is one of them.

What are Lewy Bodies?

According to the National Institute of Aging (NIA), Lewy bodies are “abnormal protein deposits that disrupt the brain’s normal functioning.”

Lewy body dementia (LBD) affects different regions in the brain. Lewy body dementia and Alzheimer’s Disease share similar symptoms and therefore, often misdiagnosed for Alzheimer’s Disease. 

The parts of the brain that are affected include those that are responsible for processing information, thoughts, language and movement. Lewy bodies have also been found in the parts of the brain that regulates emotions and behavior, sleep and forming new memories.

Hallucinations in Lewy Body Dementia

According to the NIA, visual hallucinations occur “in up to 80 percent of people” with Lewy Body Dementia even in the early stages of the disease. Further, their hallucinations are “realistic and detailed.” Medications maybe used however, if hallucinations are frightening, dangerous or disruptive.

How Do We Support People with Dementia Experiencing Hallucinations?

One thing that we should not do is ignore or make fun of the person affected by Lewy Body who is experiencing hallucinations, especially if they seem frightened, anxious or concerned. Remember – for them, these hallucinations can be very “realistic and detailed.” 

Think about it this way. You saw a slender piece of dark driftwood and you momentarily thought it was a snake. You got frightened. Your body reacted as if it was a real snake. You screamed in fear. Your heart was pounding. 

It’s similar for people living with certain types of dementia. It’s just as real to them as you mistaking the piece of driftwood and reacting to it as if it was a real snake.

A recent example made news, when we heard of a Care Aide in a Long-term Care home making fun of one of her residents who asked her where her “three friends ran off to who were at the end of her bed”.  Instead of mocking the situation or ignoring the resident by going to eat a piece of cake, maybe we could better support this resident if we used effective dementia care techniques.

To start, ideally one would want to dig deeper and investigate why this resident is asking for her friends. Is this a new behaviour?

Is there anything physical going on? Could she be experiencing pain or discomfort? Did something happen recently? Were there new staff in the facility? Once we know why, perhaps there are small changes that can be made that will make a positive impact.

Offering Support is Still Best

Offering support will need to be the next step.  We can help ease her worries by validating her concerns. We can also use a calm and supportive tone, to help reassure her.  Perhaps, we could better support this resident by using Therapeutic Reasoning™. For example, we can say: “I understand you are looking for your friends who were here earlier. Is that right? Well, I asked the Front Desk and they told me that they are coming back to see you later.” 

When we notice that this kind of response has helped to ease her worries, then perhaps the PSW could have settled her into bed and then would have been able to really enjoy that piece of cake on her scheduled break? 

Whether we are caring for someone affected by Lewy Body or another type of dementia such as Alzheimer’s disease, who is exhibiting hallucinations, let’s keep in mind that it’s best to first investigate what is going on, then do your best to offer the validation and reassurance the person requires.  This is called providing Person-Centred Care.

To learn more on how front-line professional caregivers can provide effective Person-Centred care, please visit our website to learn how you can become a Certified Dementia Care Provider.  

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