Hallucinations and Paranoia


When someone hallucinates, he sees or hears things no one else does (e.g. kittens walking on the floor).  As a rule, if the hallucination is not upsetting, don’t intervene. Delusions are beliefs contrary to fact. Delusions remain persistent despite all evidence to the contrary (e.g. a paranoid delusion is that a nurse in the home took all of your money).


Possible causes:

  • Sensory changes (hearing and vision diminishes)
  • Medications or physical illness
  • Unrecognized environment or caregivers, inadequate lighting
  • Disruption of routines
  • Removal of items from the person (i.e. money or jewellery)


  • Meet with her physician to review medications and schedule hearing and vision tests.
  • Seek medical evaluation for illness, infection, bowel impaction, UTI etc.
  • When she experiences suspiciousness:  look for lost articles and remind her where the valuables are stored. Don’t scold for losing or hiding things and keep a spare set of frequently lost items (if possible). Investigate suspicions that might be true.
  • Increase lighting in the room.
  • Do not directly disagree with a false idea.
  • Use physical touch as reassurance.

Example: Kate is fearful at night because she sees spiders crawling on her bedroom walls.


  • Tell her nothing is on her walls. “You see Kate; nothing is there. Go back to bed.”


  • Validate the fear, “That must be very frightening for you.” 
  • Do not get angry and argue. This is real to her.
  • Check for shadows that could be misinterpreted as spiders and try to remove them (i.e. increase lighting).
  • Distract with music, exercise, playing cards or photos.
  • It may be useful to see if she has any hearing or vision problems at this time.
Example: Josie is convinced that a staff member has stolen her purse. She always keeps it in her bedside table and this morning it was gone!  She is sure that “new girl with the funny eyes” took it.


  • Gently explain no one stole her purse and, just like last time, she lost her bag.


  • Validate her feelings.
  • Try to alleviate the distress (e.g. look for the “stolen” purse and then distract her).
  • Investigate suspicions that could be true. She could be a victim. But if this paranoia continues, have similar purses ready as replacements.

Last Updated: 11/08/2017