As an experienced , I understand the challenges faced by terminally ill patients and their families when dealing with , especially in conditions like Lewy Body Dementia, Parkinson's disease, and other neurodegenerative diseases. can be distressing and confusing for patients and their loved ones, but with the right approach and a combination of pharmacological and methods, we can help manage these symptoms to improve comfort and quality of life.

Understanding Hallucinations

Sometimes, people may see, hear, or feel things that are not there. These are called hallucinations. Hallucinations can happen to anyone, but they are more common in people who have certain health problems, such as Lewy Body Dementia or Parkinson's disease. These health problems can affect the way the brain works and make it harder to tell what is real and what is not.

Hallucinations can be scary or confusing for the person who has them and for the people around them. They can also make it harder to do everyday tasks, such as driving, working, or taking care of oneself. That is why it is important to understand what causes hallucinations and how to cope with them.

Best Practices for Managing Hallucinations

Hallucinations can be hard to deal with, but there are ways to help yourself or someone else who has them. There are two main types of methods: medicine and other strategies. Medicine can help reduce the frequency and intensity of hallucinations by affecting the brain chemicals that are involved in the disease process. However, medicine may not work for everyone or may have side effects. Therefore, we must try both methods as well as medications as appropriate.

Non-Pharmacological Interventions

Non-pharmacological methods are ways to help yourself or someone else who hallucinates without using medicine. These methods can make the person feel more comfortable and less upset by the hallucinations. They can also help the person stay in touch with reality and focus on other things. Some of the non-pharmacological methods are:

  • Reality Orientation: This means helping the person remember where they are and what is happening. You can gently tell them the date, time, and place. You can also show them things that are familiar to them, such as photos, calendars, or clocks. This can help the person feel more grounded and less confused.
  • Distraction and Redirection: This means helping the person pay attention to something else when they have a hallucination. You can ask them to do something they like or are good at, such as playing a game, doing a puzzle, or making a craft. You can also talk to them about something that interests them, such as their family, friends, or hobbies. This can help the person forget about hallucination and enjoy themselves.
  • Validation and Empathy: This means listening to the person and understanding how they feel. You can say things like “I can see that you are scared” or “I know this is hard for you”. You can also ask them to tell you more about what they see, hear, or feel. You can say things like “What does it look like?” or “What does it say to you?”. This can help the person feel that you care and that you are not judging them.
  • Optimizing the Environment: This means making the place where the person lives or stays more comfortable and familiar. You can reduce the noise, such as turning off the TV or radio, or closing the windows. You can also make sure there is enough light, such as turning on the lamps or opening the curtains. You can also put things that the person likes or recognizes, such as pictures, flowers, or stuffed animals. This can help the person feel more relaxed and safer.
  • Reassurance from Caregivers: This means having someone who is kind and supportive to help the person. This can be a family member, a friend, or a professional. The caregiver can stay with the person, hold their hand, or hug them. The caregiver can also say things like “You are not alone” or “I am here to help you”. This can help the person feel more calm and secure.

Pharmacological Interventions

Sometimes, non-pharmacological methods may not be enough to help yourself or someone else who hallucinates. In that case, you may need to use medicine to reduce the hallucinations or make them less bothersome. However, medicine is not always the best option, especially in , where we want to make the person as comfortable and safe as possible. That is why you should always talk to your doctor before using any medicine and follow their instructions carefully.

There are two main types of medicine that may help with hallucinations:

  • Antipsychotic Medications: These are medicines that can affect the brain chemicals that are involved in the disease process. They can help lower the frequency and intensity of hallucinations. However, they can also have side effects, such as , confusion, or movement problems. They can also interact with other medicines that the person may be taking. That is why they should be used in low doses and only when necessary.
  • Anxiolytics: These are medicines that can help reduce and that may be caused by hallucinations. They can help the person feel calmer and more relaxed. However, they can also have side effects, such as , dependence, or withdrawal symptoms. They can also interact with other medicines that the person may be taking. That is why they should be used sparingly and only when needed.

If your loved one has Lewy Body Dementia or Parkinson's Disease, you should ask the doctor to confirm with a pharmacist before using any medicine. This is because these diseases can make a person more sensitive to the effects of medicine and may cause more problems. The doctor and the pharmacist can help you find the best medicine and dose for your loved one.

Conclusion

Managing hallucinations in requires a compassionate and personalized approach. As hospice nurses, we strive to provide comfort, empathy, and support to both patients and their families during this challenging time. By combining non-pharmacological techniques with judicious use of medications, we can create a care plan that respects the unique needs of each patient and helps them find peace and comfort in their final journey.


Resources

Management of visual hallucinations in dementia and Parkinson's disease – PubMed

New evidence on the management of Lewy body dementia

Antipsychotic Use in Patients with Dementia with Lewy Bodies

Responding to and Treating Hallucinations in Lewy Body Dementia

An Overview of Parkinson's Disease Hallucinations

Non-pharmacological interventions for Lewy body dementia: a systematic review

Hallucinations: Clinical aspects and management

Managing hallucinations and changes in visual perception in Lewy body dementia

Lewy body dementia – Diagnosis and treatment

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Validation Therapy: A Valuable Tool for Families and Healthcare Teams

Best Practices for Approaching Combative Dementia Patients

The Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer's Disease and Other Dementias

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