When a person with dementia insists that something is wrong, respond with calm, empathy, and practical safety measures rather than arguing about facts. Use short reassurance, simple clarification, gentle distraction, and a check for medical or environmental triggers while documenting episodes for the care team[3].
Why this approach helps
– Dementia can change perception, memory, and reasoning, so insisting on logical proof often increases fear and resistance rather than resolving the issue[1].
– Validating feelings reduces distress; focusing on emotion (for example, “You sound upset”) is more effective than correcting the belief[2][3].
Practical steps to use in the moment
– Stay calm and use a soft, steady voice to reduce agitation[2][3].
– Acknowledge the feeling: say something like, “That must feel scary” rather than “That is not true”[2][3].
– Use a simple, brief response: one or two sentences that reassure and redirect attention away from argument[2].
– Check safety immediately: remove hazards or guide the person away from anything that could harm them if the belief leads to risky behavior[3].
– Offer a plausible, comforting explanation when helpful (for example, “Sometimes shadows look like people when the light is low”) rather than trying to prove them wrong[2][3].
– Distract gently with a familiar activity or sensory comfort — a drink, a favorite song, a walk, or looking at photos — which often reduces the intensity of the belief[2][3].
– Use touch only if the person accepts it; some people find holding a hand reassuring, others do not[3].
What to look for and record
– Note triggers or patterns: time of day, lighting, medication changes, new infections, fatigue, hunger, or changes in routine[1][3].
– Keep a brief log of when episodes happen, what was said, what helped, and any medical or environmental changes around that time[1][2].
– Share this information with the person’s clinician because new or worsening delusions and hallucinations can have medical causes that need evaluation[1][3][5].
Longer term strategies
– Simplify and adapt the environment: reduce clutter, improve lighting, label storage, and remove reflections or items that can be misinterpreted[4][2].
– Establish predictable routines, consistent caregivers, and visible memory aids (calendars, photos, pill organizers) to lessen confusion that can spark distressing beliefs[4].
– Use nonpharmacological interventions first (reassurance, environmental changes, behavioral strategies); medications are sometimes necessary but carry risks and should be considered with medical guidance[1][3][5].
– Educate family and staff that hallucinations and delusions are symptoms of the illness, not intentional behavior, so responses remain calm and consistent[5][1].
– Seek specialist input (neurology, psychiatry, geriatric medicine) if episodes are new, severe, persistent, or associated with sudden change in thinking or function[1][3][5].
Communication tips for caregivers
– Avoid arguing, reasoning, or trying to force reality; this usually escalates distress[2][3].
– Use short sentences, simple words, and one idea at a time to match processing ability[2].
– Validate emotion, not the false premise: “I can see you are worried. I am here with you”[2][3].
– Prepare caregivers with a short script and a few reliable calming activities so responses stay consistent across people and settings[1][6].
When to seek urgent medical attention
– Sudden onset or rapid worsening of hallucinations or delusions, high fever, signs of infection, sudden lethargy, or confusion out of keeping with the person’s usual pattern require prompt medical evaluation[1][3].
– If the person becomes violent, severely disoriented, or at risk of hurting themselves or others, seek emergency help while keeping the environment as safe and calm as possible[3][5].
Sources
https://www.usagainstalzheimers.org/alzheimers-talks/coping-hallucinations-delusions-dementia
https://dailycaring.com/10-ways-to-respond-to-dementia-hallucinations-in-seniors/
https://www.medicalnewstoday.com/articles/hallucinations-and-dementia
https://www.betterhelp.com/advice/paranoia/signs-of-paranoia-in-older-adults-and-how-to-provide-support/
https://www.droracle.ai/articles/601398/what-is-the-recommended-treatment-approach-for-dementia-related-psychosis
https://www.dementia.org.au/about-dementia/dementia-expert-webinars/webinar-understanding-hallucinations-and-delusions
