When your loved one experiences delusions or hallucinations for the first time, it can be frightening and overwhelming for everyone involved. As caregivers for our loved ones with Alzheimer’s and other types of dementia who have navigated these challenging moments, we’ve learned preparation and understanding make all the difference.

Before we share our tips, we’re sharing the definitions of delusions and hallucinations so you know the difference between them. According to the National Institute of Health:

• Delusions are thoughts — false beliefs held strongly despite evidence to the contrary.
• Hallucinations are sensory experiences — when the person sees, hears, smells, tastes, or feels something that isn’t there.

Examples of these include our care receiver:

• Not believing they’re in their own home.
• Thinking someone is stealing their belongings.
• Not recognizing who we are.
• Believing others are conspiring against them.
• Seeing people who aren’t there.
• Not recognizing themselves in the mirror.

Through our experiences, what we’ve learned from support groups, and from others on their journeys, we’ve developed six tips to help you create positive outcomes while supporting your loved one through these challenging moments.

Tip 1: Get in the Right Frame of Mind

The moment you realize your loved one is experiencing a delusion or hallucination can be shocking — like a punch in the gut. You might find yourself doing a quick reality check when they ask you “Who are you?”. You tell them your name “I’m (whatever your name is)”, and they reply “No, you’re not.” In these moments, everything in you wants to argue, to convince them what’s real, to make them understand. This natural instinct, while completely understandable, rarely helps and often makes things worse.

Instead, success requires a major shift in your approach. The moment you get that first hint of disconnect, pause, take a deep breath, and consciously shift into a different mindset — the mindset of an actor stepping onto a stage. This is your moment to put on your performance of a lifetime. Your role isn’t to convince or correct; it’s to meet your loved one where they are in their current reality and help them feel safe there.

This performance isn’t about deception — it’s about connection. It’s important for your body language, tone of voice, and overall demeanor to convey calm, acceptance, and understanding – even if you’re feeling anything but calm inside. While it’s temping to want to rush through these moments, what makes the most impact is your fully committing to being present in their reality, however long that takes.

Key points:

• Don’t argue or try to convince them otherwise
• Check your body language
• Meet them where they are
• Don’t rush through the experience
• Speak calmly and slowly
• Don’t take it personally.

Nancy’s Experience:

My mother-in-law would try to reason with and correct my father-in-law when he didn’t recognize their home, saying “No, we are home. We live here.” This would just make him more upset. When I would come over, I’d sit down next to him, look him straight in the eye and say, “Pap, tell me what’s going on.” He’d say he needed to go home because his parents didn’t know where he was. I’d calmly tell him, “They know where you are. They’re expecting you to come home, but not until tomorrow.” This approach would help him feel safe and understood.

Tip 2: Validate and Reassure

One of the most challenging aspects of dealing with delusions and hallucinations is resisting the urge to question or investigate the details. When your loved one is convinced someone has stolen their wallet or that strangers are in the house, your detective instincts kick in. You want to ask questions, gather information, solve the problem. This approach often leads to increased anxiety and agitation.

Focus instead on the emotions underlying their experience. Are they feeling scared? Confused? Angry? These feelings are very real, even if the situation causing them isn’t. Your role is to acknowledge these emotions and provide your care receiver reassurance without challenging their perception of reality. This can feel counterintuitive at first — almost like you’re playing along with something that isn’t real. To your loved one, these experiences are absolutely real, and their emotional responses are completely valid.

Think of this as emotional validation rather than factual validation. You’re not confirming that someone stole their wallet; you’re acknowledging that feeling violated and upset about a missing wallet is a normal response. This subtle shift in approach can make a huge difference in how your loved one responds to your support.

Key points:

• Don’t question the details of their delusion
• Ask how they’re feeling
• Acknowledge their emotion
• Listen without judgment
• Use reassuring phrases including “You’re safe” and “I’m right here with you”
• Show them you understand their feelings.

Sue’s Experience:

One evening, my husband looked at me and didn’t recognize me. He said ‘Who are you?’ When I said I was his wife, he responded, ‘No, you’re not. And I’m not going to sleep with anyone who’s not my wife.” While inside I was touched by his faithfulness, I simply said “I’m sorry – I got into the wrong bed.”. I left the room and closed the door behind me. About fifteen minutes later, he came out of our bedroom totally calm. He came over to where I was ‘resting’, and as clear as a bell asked me why I hadn’t come to bed. Sometimes these moments pass, and sometimes they don’t. It’s important for us to be prepared for either outcome.

Tip 3: Tell Them the Truth They Need to Hear

This concept often creates internal conflict for caregivers. Many of us were raised to believe that any form of dishonesty is wrong, and, at first glance, this approach might seem like lying. However, it’s actually about finding a way to communicate that maintains both your authenticity and your loved one’s sense of security.

The key is to understand that “the truth they need to hear” isn’t about deception — it’s about meeting them where they are and providing information that helps them feel safe and understood in their current reality. This approach allows you to maintain genuine, confident body language and direct eye contact because you’re not trying to deceive them; you’re providing comfort and security in a way they can accept and understand.

Think of it as speaking their truth rather than your truth. When you frame your responses this way, you maintain authentic energy and a confident tone of voice while helping them navigate their current experience. Sometimes this might mean ‘kicking the can down the road’ — promising something will happen tomorrow instead of now. The benefit of this approach is it provides your care receiver immediate comfort without creating long-term complications.

Key points:

• Stay confident and reassuring in your delivery
• Maintain direct eye contact and be at eye level with them
• Focus on providing them comfort and security
• It’s okay to ‘kick the can down the road’ if needed — tell them it’s happening in the future
• Give yourself grace: tomorrow is another day.

Nancy’s Experience:

One morning, while I was driving, my husband asked how I liked driving the car. Then he said ‘You’re going to like my parents. They are the nicest people.’ In that moment, I realized he had no idea who I was. While it felt like a punch in the gut, I held it together and asked him to tell me about his parents. This began a new chapter in our journey where I became ‘the caregiver who lives upstairs.’ Sometimes these changes are permanent, and we learn to adapt with love and grace.

Tip 4: Distract and Change the Environment

Sometimes the best way to help someone step out of a difficult moment is to help them transition to something else. This isn’t about abruptly changing the subject or dismissing their concerns — it’s about gently guiding them toward a more comfortable state of mind while acknowledging their current experience.

The key is to make these transitions gradual and natural. Think of it as slowly turning down one dial while turning up another, rather than flipping a switch. This approach works best when you stay connected to their current focus while introducing new elements that can help shift their attention. The goal is to help them move from a place of distress to a place of comfort without making them feel dismissed or misunderstood.

The most effective distractions are often those that connect with their preferences and past interests. Whether it’s favorite foods, familiar activities, or beloved music, these comfort items can serve as bridges between distress and calm. It’s important to introduce these elements naturally, as part of the flow of conversation and activity, rather than as obvious attempts to redirect.

Key points:

• Stay on topic while creating gentle distractions
• Use their favorite activities or treats
• Make gradual transitions rather than abrupt changes
• Keep familiar comfort items nearby
• Choose activities that align with their interests.

Sue’s Experience:

My husband would sometimes say ‘It’s time to go home’ while we were actually at home. Instead of arguing, I shared something I’d learned in a caregiver support group. I’d say “Fine, honey, no problem. Let’s go. Would you like to use the restroom before we go?” Next, I’d suggest stopping at Walmart on the way.(You can use the name of any store — I used it because of its hours.) After walking around Walmart a bit, we’d head ‘home’ — right back to our house. Later, I learned to try a distraction first. My husband loved ice cream and rarely turned it down. When I cleaned up the dishes from dinner, I got 2 bowls and spoons for the ice cream in case this situation came up. When it did, I’d say, ‘That’s a great idea. I was just getting the ice cream out. Let’s have some first.’ By the time we finished, he’d forgotten about wanting to leave.

Tip 5: Debrief and Document

After navigating a difficult episode, it’s tempting to want to put it behind you and move on. Taking time to record what happened and what strategies worked can be incredibly valuable for future situations. Think of it as creating a playbook for you, doctors, and others who are providing care.

This documentation isn’t just about recording what happened — it’s about understanding patterns and triggers that might help prevent or better manage future episodes. Pay attention to time of day, environmental factors, recent changes in routine, and other potential triggers. Sometimes what seems like random occurrences actually follow patterns we can only recognize when we track them, step back, and look at the bigger picture.

It’s also important to consider medical causes for sudden changes in behavior or new types of delusions and hallucinations. For example, urinary tract infections, medication side effects, and other medical issues can trigger or worsen these experiences. Having good documentation helps medical professionals identify potential underlying causes.

Key points:

• Document triggers and patterns
• Record successful strategies
• Share information with other caregivers
• Note any environmental factors
• Watch for medical causes like UTIs or medication side effects
• Consult with doctors about unusual patterns.

Nancy’s Experience:

When my father-in-law was having sundowning episodes, I had to prepare my brother-in-law and his wife when they needed to care for him while my mother-in-law was in the hospital. Having documented what worked and what didn’t allowed them to handle the situations effectively when they arose.

Tip 6: Care for Yourself

When you’re focused on being the perfect actor, maintaining calm in the storm, and providing endless reassurance, it’s easy to forget about your own emotional needs. These experiences can take a toll. It’s important to acknowledge and process your own feelings about what’s happening.

We weren’t trained for this role. We’re learning as we go, often navigating situations we never imagined we’d face. When someone you love looks at you with no recognition, or begs you to help them find someone (who is actually you), or becomes frightened of you — these moments can cut deep. It’s reasonable to feel hurt, frustrated, sad, and/or overwhelmed.

Give yourself grace. Acknowledge you won’t handle every situation perfectly, and that’s okay. Each experience is an opportunity to learn and grow in your caregiving journey. You can’t pour from an empty cup, so taking care of your own emotional well-being isn’t selfish — it’s self-love and it’s vitally important.

Key points:

• Allow yourself to feel your emotions
• Seek support from family, friends, or support groups
• Consider professional counseling
• Know you’re not alone
• Give yourself grace if you weren’t perfect
• Recognize each experience helps you improve.

Nancy’s Experience:

Every afternoon for weeks, my husband would beg me to help him find ‘her’ — meaning me. He would cry, asking me to take him somewhere where they would know where ‘I’ was. It broke my heart because early in his diagnosis, I had promised him I would always be there. Watching him search for me while I sat right beside him was one of the most difficult experiences of our journey.

Final Thoughts:

While delusions and hallucinations can be challenging and emotionally draining, having a strategy helps both you and your loved one navigate these moments more successfully.

Key takeaways:

• Stay calm and present
• Meet them in their reality
• Use validation and reassurance
• Provide the truth they need to hear
• Use distraction when needed
• Document what does and what doesn’t work
• Take care of yourself.

If you have tips you think others would benefit from, please share them on our Facebook page or Instagram page.

We’re all on this journey together.