NIGHT HALLUCINATIONS in the ELDERLY: causes, symptoms and treatment

  • Jul 26, 2021
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Nocturnal hallucinations in the elderly: causes, symptoms and treatment

A hallucination consists of the perception of a stimulus that does not physically exist. The perception of the hallucination is experienced as if the stimulus were real. Although there is some belief about the high prevalence of hallucinations in older people, the truth is that the Research suggests that hallucinations become less common in healthy people with advancing age (Badcock, J.C., Dehon, H. and Laroi, F., 2017). However, with age, problems do appear that can cause hallucinations.

In this Psychology-Online article, we talk about nocturnal hallucinations in the elderly, their causes, symptoms and treatment.

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  1. Problems in detecting hallucinations
  2. Why does my grandmother see things that are not there
  3. What disease can cause hallucinations
  4. How Hallucinations Present in the Elderly
  5. What to do about hallucinations in older people

Problems in detecting hallucinations.

One of the problems that we can find when detecting hallucinations

it consists in distinguishing it from other phenomena that may resemble it. We must not confuse hallucinations with perceptual distortions. In this case, we do find a stimulus that is real, however, we perceive it as altered by some of its characteristics such as color, shape or size.

During the night, hallucinations can occur in the wake-sleep transition (hypnagogic hallucinations) or from sleep to wakefulness (hypnopompic hallucinations). We can also find vivid dreams. Keep in mind that this phenomenon occurs during sleep and hallucinations during wakefulness (or, at most as we have pointed out, during the wake-sleep transition and vice versa).

Another problem when it comes to detecting hallucinations has to do with stigma. Stigmatization can make people who experience hallucinations not want to acknowledge these types of experiences. This situation leads to an underdetection of the hallucinatory experience.

Why does my grandmother see things that are not there.

Generally, we associate hallucinations with the presence of a serious mental disorder. Did you know that older people can experience hallucinations without having to be diagnosed with a mental disorder? We tell you the causes:

  • Drug intake. Be aware that older people often take a lot of medication and some drugs may cause hallucinations.
  • Sensory deprivation. This cause could help us to explain the appearance of nocturnal hallucinations, since the amount of stimuli to the that we are exposed is less (For example when we go to bed there is less noise and less light in the bedroom).
  • Deafferentation. It consists of a lack or interruption of nervous stimuli due to the deterioration or destruction of the afferent pathways, pathways that carry information to the brain.
  • Cognitive impairment. This type of deterioration could contribute to the appearance of hallucinations, especially the deterioration of some functions such as inhibitory.
  • Impairment of sensory organs. Vision or hearing deteriorates with age, which can cause hallucinations in people even without cognitive impairment.
  • Sleeping problems.
  • Loneliness and social isolation.
  • The duel after the loss of a family member or loved one.

Now, keep all of these factors in mind. Older people are at greater risk of living alone (much more now with the COVID-19 crisis), of living loss of loved ones and / or their partner, they take more medication and their nervous system and sensory organs go away deteriorating. For all these reasons, nocturnal hallucinations are more likely in the elderly.

What disease can cause hallucinations.

In addition to the factors already described, hallucinations can be a symptom of a disorder or disease such as the following:

  • Substance use disorder. Some illegal substances or, as we have noted above some medications, can cause hallucinations.
  • Psychotic disorders such as schizophrenia. Hallucinations are one of the most important symptoms in the diagnosis of these disorders.
  • Dementias. They can cause hallucinations in the aging population, especially in advanced stages of the disease. It is worth highlighting the "Lewy Body Dementia" in which one of its diagnostic criteria for the DSM-5 (diagnostic classification of the American Psychiatric Association) consists of the presence of recurrent visual hallucinations, well reported and you detail. In this article you can see more information dementias, types and symptoms.
  • Sensory organ problems. In this sense, we can find problems such as tinnitus for hearing or Charles Bonnet Syndrome for vision.
  • Twilight or sunset syndrome. It consists of an episode of anxiety, restlessness, agitation and aggressiveness that some patients with Alzheimer's at sunset. Within these episodes hallucinations can also occur.

How hallucinations occur in the elderly.

The presentation of hallucinations in the elderly is highly variable. Next, we stop at two dimensions: the sensory modality and the degree of distress with which they can be experienced.

First of all, auditory and visual sensory modalities (the latter would be more frequent in dementias) are the most frequent, although, for example, in cases of hallucinations during grief, hallucinations may be experienced olfactory and even tactile (Grimby, 1993; seen in Badcock, J.C. et al., 2020). Remember that the sensory modality in which they are presented may also depend on the deterioration they suffer in any of their sensory organs.

On the other hand, though hallucinations are often distressingly experienced (as in Charles Bonnet Syndrome or tinnitus), and even more so the less is the perceived control of the situation (Badcock, J.C. et al, 2020). However, we can find exceptions, since a majority of people who presented hallucinations During the grieving process they felt useful and were a help to them and they (seen in Badcock, J.C. et al. 2020).

What to do about hallucinations in older people.

Following Echávarri, C. and Erro, M.E. (2007), if the hallucinations are mild and do not cause much fear to the patient, we can try to reassure you, using physical contact if appropriate. Also, we can try to explain the situation (He remembers that you should use short and simple sentences to promote communication).

If the hallucinations acquire great magnitude and cause great discomfort to the person, we must tell your doctor to start a drug treatment to reduce the hallucinatory experience and / or rule out other associated problems that may be causing them (such as suffering from another disease or the effect of a drug).

On a professional level, hallucinations must be managed through psychoeducation, cognitive-behavioral therapy, medication management and risk factors, and physical therapy (as electroconvulsive therapy) (Badcock, J.C. et al., 2020).

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

If you want to read more articles similar to Nocturnal hallucinations in the elderly: causes, symptoms and treatment, we recommend that you enter our category of Clinical psychology.


  • American Psychiatric Association (2014). DSM-5. Reference guide to the diagnostic criteria of the DSM-5-Breviary. Madrid: Editorial Médica Panamericana.
  • Badcock, J.C., Dehon, H. and Laroi, F. (2017). Hallucinations in Healthy Older Adults: An Overview of the Literature and Perspectives for Future Research. Frontiers in Psychology. 8: 1134 doi: 10.3389 / fpsyg.2017.01134
  • Badcock, JC, Laroi, F., Kamp, K., Kelsall-Foresman, I., Bucks, RS, Weinborn, M., Begemann, M., Taylor, JP, Collerton, D., O´Brien, JT, El Haj, M., Ffytch, D., Sommer, IE (2020). Hallucinations in Older Adults: A Practical Review. Schizophrenia Bulletin. 46(6) 1382-1395 doi: 10.1093 / schbul / sbaa073
  • Echávarri, C. and Erro, M.E. (2007). Sleep disorders in the elderly and in dementias. Annals of the Navarra health system. 30 (Suppl. 1) 155-161
  • Llanes Álvarez, C., Pastor Hidalgo, M.T., Monforte Porto, J.A., San Román Uría, A., López Landeiro, P. and Franco Martín, M.A. (2019). Sunset syndrome or "sundowning". New Hospital. 15 (1) 27-33.
  • López-Mompó, C., López-Pavón, I., Ruiz-Izquierdo, J. and Ferro, J.I. (2011). Visual hallucinations in the elderly without cognitive impairment: Charles Bonnet syndrome. SEMERGEN Family Medicine. 37 (5) 263-266 DOI: 10.1016 / j.semerg.2010.11.011
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