A delusion is a false belief not based on fact. For example, believing that others are stealing their possessions, that their spouse is having an affair, that an intruder is moving or changing things, that the caregiver is someone else, etc. These are firmly held beliefs by the person experiencing them despite evidence to the contrary. Paranoia is a particular type of delusion which causes the person to be suspicious and distrustful of others.
Hallucinations are false sensory perceptions for example, hearing voices, seeing people who are not there, smelling odors, feeling something crawling on their skin, etc. The perception is real to the person experiencing it despite all evidence showing it is not real.
Nearly 50% of individuals with dementia exhibit delusions over the course of the disease. They are the most common in the middle stage of the disease. In particular, paranoid delusion may be associated with dysfunction in the right medial temporal lobe (2003, Mendez & Cummings). In Lewy Body dementia, visual hallucinations are common. For example, they may see little children standing at the end of the bed in their room. In delirium, hallucinations and delusions are also common.
Remember that for the residents experiencing delusions and/or hallucinations, the perception is very real. Trying to convince them that they are not real tends only to escalate the resident’s frustration and irritability because you don’t believe them. Therefore the following tips are suggested:
Usually medications, like an antipsychotic, do not completely eliminate the delusions or hallucinations but they do help to diminish their intensity and the resident’s reaction to them. Some delusions or hallucinations can be comforting to the resident. For example, perhaps they see their deceased spouse whom they miss. In cases where the delusions are not traumatic to the resident or they can be managed non-pharmacologically, the physician would not start an antipsychotic. If the resident believes that they are being poisoned and thus are not eating, losing weight, refusing medications consistently, etc., the physician may consider an antipsychotic to improve the resident’s quality of life but we must Behaviour Track to show the evidence. We avoid giving Haldol in Lewy Body Dementia.
Mendez, M. F., & Cummings, J. L. (2003). Dementia: a clinical approach. Butterworth-Heinemann.
Robinson, A., Spencer, B., & White, L. (2005). Understanding difficult behaviors: Some practical suggestions for coping with Alzheimer's disease and related illnesses. Geriatric Education Center of Michigan.
Vancouver Island Health Authority. (2014). People with hallucinations and delusions. Accessed from https://www.islandhealth.ca/sites/default/files/2018-05/delirium-hallucinations-delusions.pdf