The most important thing you can do for someone experiencing visual hallucinations is stay calm and validate what they’re going through without arguing about what’s real. Whether the person is seeing figures, patterns, animals, or flashes of light, their experience feels completely genuine to them. How you respond in the moment, what you do to the environment around them, and whether you help them find the right medical support all make a real difference in how frightening or manageable these episodes become.
What to Say (and Not Say) During an Episode
Your instinct might be to correct the person: “There’s nothing there.” But contradicting what someone sees almost always backfires. It creates frustration, erodes trust, and can escalate fear or agitation. Instead, acknowledge the experience without confirming the hallucination as literal fact. Something like “That sounds really unsettling” or “I can see this is upsetting you” works far better than debating whether the image is real.
The National Institute on Aging recommends three core responses for caregivers: don’t argue about what the person sees, comfort them if they’re afraid, and redirect their attention. Distraction is one of your most effective tools. Moving to a different room, stepping outside for a short walk, or starting a familiar activity like folding laundry or listening to music can shift the person’s focus enough that the hallucination fades. Crisis intervention training from the University of Memphis similarly recommends validating the experience, gently noting that you don’t see the same thing, and then helping the person focus on you and the present moment.
Keep your voice low and even. Ask simple, direct questions: “Can I sit with you?” or “Would you like to go to the kitchen?” Avoid asking them to describe the hallucination in detail unless they want to, since that can deepen their engagement with the image rather than pull them away from it.
Change the Environment
Lighting is one of the simplest and most effective environmental changes you can make. Dim rooms, heavy shadows, and low-contrast spaces all increase the likelihood of visual hallucinations, especially in people with vision loss. Cleveland Clinic recommends spending more time in brightly lit environments, opening blinds and curtains during the day, and adding extra lamps at night. Spending extended time in dark rooms with natural light blocked out raises risk.
Beyond lighting, look for visual triggers around the home. Patterned wallpaper, busy upholstery, and mirrors can all contribute to misperceptions. Mirrors in particular can be startling for someone with dementia who doesn’t recognize their own reflection. Removing or covering mirrors in rooms where hallucinations tend to happen is a low-effort change that can help significantly. Reducing clutter and keeping rooms visually simple gives the brain less ambiguous input to misinterpret.
Television can also be a trigger. People with cognitive changes sometimes can’t distinguish between what’s on screen and what’s in the room, especially with realistic or dramatic content. If hallucinations tend to happen in the evening, try switching to calm music or turning the TV off entirely.
Grounding Techniques That Help
Grounding exercises work by pulling someone’s attention back to their physical body and immediate surroundings. If the person is willing and able to follow simple instructions, a basic breathing exercise can help: place one hand on the belly and the other on the chest, breathe in slowly for five seconds so the belly rises while the chest stays still, hold for five seconds, then exhale for five seconds. This activates the body’s relaxation response and interrupts the cycle of fear that often accompanies hallucinations.
Touch can also anchor someone to reality. A gentle hand on the shoulder, a warm blanket, or a cool washcloth on the forehead gives the brain a competing sensory signal. Progressive muscle relaxation, where you tense and then release each muscle group starting from the feet or the forehead and working through the body, is another option for someone who is anxious but not too agitated to participate.
Common Medical Causes
Visual hallucinations aren’t a single condition. They’re a symptom with several very different causes, and understanding the cause shapes how you help.
- Vision loss (Charles Bonnet syndrome): When the eyes stop sending complete visual information to the brain, the brain sometimes fills in the gaps with images that aren’t there. This is called Charles Bonnet syndrome, and it affects people with macular degeneration, glaucoma, cataracts, and other conditions that reduce vision. The hallucinations can be vivid and detailed, but the person typically knows they aren’t real. Improving lighting and treating the underlying eye condition (when possible) are the primary strategies.
- Lewy body dementia: Clumps of abnormal proteins build up in nerve cells and damage them, producing hallucinations that are often one of the earliest signs of this type of dementia. These hallucinations tend to be detailed, recurring, and may involve people or animals. The person may or may not recognize them as unreal.
- Medication side effects: Many prescription drugs can cause or worsen hallucinations, and older adults are especially susceptible because of increased medication sensitivity. These hallucinations are often dose-related and typically stop when the medication is adjusted or discontinued.
Other causes include Parkinson’s disease, delirium from infections or dehydration, alcohol withdrawal, and certain psychiatric conditions. If someone begins having visual hallucinations for the first time, a medical evaluation is important to identify and treat the underlying cause.
When the Situation Is Urgent
Most visual hallucinations are not emergencies, but some situations call for immediate help. The NHS advises calling emergency services if the person is becoming very agitated or aggressive, if hallucinations are rapidly getting worse, if the person becomes suddenly confused, if they stop making sense when they speak, or if they express a desire to harm themselves or someone else. A sudden onset of hallucinations in someone who has never had them before, especially combined with confusion or fever, can signal delirium from an infection, medication reaction, or other acute medical problem that needs urgent attention.
Supporting Someone Long-Term
For people with ongoing hallucinations from dementia or vision loss, your role shifts from crisis response to sustained support. Psychoeducation, which simply means helping the person (and yourself) understand what’s happening and why, consistently shows up as a helpful intervention. When someone with Charles Bonnet syndrome learns that their brain is generating images because of reduced visual input, the hallucinations often become far less frightening. That understanding alone can be therapeutic.
Social isolation makes hallucinations worse. Regular conversation, visits, and engaging activities give the brain real-world stimulation to process, leaving less room for it to generate false images. Eye-training exercises, where the person practices tracking objects or shifting focus, have shown promise in case reports for people with vision-related hallucinations. Keeping up with eye exams and maximizing whatever vision remains through updated prescriptions, magnifiers, or better lighting all contribute.
Track when hallucinations tend to happen. Many people notice patterns: certain times of day, after poor sleep, during illness, or in specific rooms. A simple log of when episodes occur, how long they last, and what the person was doing beforehand gives you practical information to work with and gives their doctor useful data. Even small adjustments, like ensuring the person naps less during the day so they sleep better at night, or moving their favorite chair to a brighter spot, can reduce how often episodes occur.