Grandma and the Little Green Men

It’s common for geriatric patients to hallucinate or exhibit other behavior that might be considered odd. But sometimes there’s a perfectly reasonable explanation.

Joan Somes, a former bedside nurse and department educator and a current paramedic at Regions Hospital in St. Paul, Minnesota, led a session last week at Emergency Nursing 2019 that educated attendees about the difference between hallucinations and delusions.

In the session, “Grandma Says She’s Talking With the Little Green Men! Hallucinations in the Older Adult,” Somes explained that hallucinations are false sensory experiences generated by the mind, while delusions are false beliefs not supported by reality and might be caused by faulty memory.

It’s common for an older person to experience an illusion based on the distorted perception of a real stimulus — but that’s not necessarily a hallucination, Somes further explained, offering an example of a busy wallpaper that might look like spiders to someone who’s having a hard time seeing it accurately. It’s also common for older patients to misidentify things, but incorrectly identifying an object doesn’t equate to a hallucination either, she added.

When a patient visits the emergency department with an altered mental status, Somes said the first goal is to understand the underlying cause. Often, it might actually be for a physical — and treatable — reason. Somes said functional reasons for hallucinations include:

  • Migraines
  • Epilepsy/Seizure disorders
  • Head injuries
  • Aneurysms in the brain
  • Encephalitis
  • Infarction of brain tissue
  • Intracranial tumors
  • Multiple Sclerosis
  • Penduncular hallucinosis
  • Charles Bonnet Syndrome

If a patient seems to be presenting with dementia, Somes said to check for the following possible — and reversible — causes:

  • Infection and immune disorders
  • Metabolic and endocrine problems
  • Dehydration or a lack of vitamins and minerals
  • Medication side effects
  • Loss of vision/hearing
  • Normal-pressure hydrocephalus
  • Subdural hematoma and other space-taking lesions
  • Hypoxia or sleep apnea
  • Poisoning or alcohol or drug use

“Before you assume the [altered mental status] is behavioral, you need to consider — is it a physical thing going on with that person?” Somes asked. “Because if it’s physical, it may kill them.”

Somes hit home that hallucinations in geriatric patients are common.

“Hallucinations are out there,” she said. “A lot of patients simply don’t tell us about it.”