If your mom has started seeing people, animals, or objects that aren’t really there, she is experiencing visual hallucinations. This is more common in older adults than most people realize, and it almost always has an identifiable medical cause. The important thing right now is not to panic, but to get her evaluated by a doctor, because the cause determines what happens next, and some causes are both treatable and reversible.
Why Visual Hallucinations Happen
Visual hallucinations are caused by disruptions in how the brain processes what the eyes see. In older adults, the most common triggers fall into a few categories: dementia-related brain changes, infections, medication side effects, and vision loss. Sometimes more than one factor is at play.
The cause matters enormously because the response is completely different depending on what’s behind it. Hallucinations from a urinary tract infection can resolve within days of treatment. Hallucinations tied to Lewy body dementia are a chronic symptom that needs long-term management. That’s why a medical workup is the essential first step.
Dementia Is the Most Common Long-Term Cause
Among the dementias, Lewy body dementia is the one most strongly linked to visual hallucinations. Up to 80% of people with Lewy body dementia experience them, often early in the disease, sometimes before memory loss becomes obvious. The hallucinations tend to be vivid and detailed: people, children, or animals that look real. Your mom may describe them matter-of-factly or may be frightened by them.
Lewy body dementia can be tricky to recognize because its early symptoms can look like Alzheimer’s or even a psychiatric condition like schizophrenia. A key distinguishing feature is that people with Lewy body dementia often have unpredictable swings in alertness and attention throughout the day, along with physical symptoms like slow movement, muscle stiffness, or difficulty walking. If your mom has these symptoms alongside hallucinations, mention all of them to her doctor.
Alzheimer’s disease can also cause hallucinations, though less frequently. Reported rates vary widely, but visual hallucinations occur in roughly 19% of people with Alzheimer’s. Parkinson’s disease dementia falls somewhere in between, with visual hallucinations affecting around 28% of patients, though some studies report rates as high as 75%. Vascular dementia, caused by reduced blood flow to the brain, can produce hallucinations as well.
Infections Can Cause Sudden Hallucinations
If the hallucinations came on quickly over a few days rather than gradually over months, an infection is one of the first things to rule out. Urinary tract infections are a well-known culprit in older adults. Unlike in younger people, a UTI in a senior may not cause the typical burning or urgency. Instead, it can trigger delirium: sudden confusion, agitation, difficulty paying attention, and hallucinations.
Research from Cedars-Sinai has found that the hallucinations and confusion likely happen because the immune system’s inflammatory response to the infection causes changes in brain neurons. Pneumonia and other infections that cause fever can do the same thing. The good news is that once the infection is treated, the delirium and hallucinations typically clear.
Delirium is considered a medical emergency. If your mom’s confusion and hallucinations started suddenly, especially if she’s also been unusually sleepy, agitated, unable to follow a conversation, or recently ill, she needs to be seen by a doctor right away. The U.S. Department of Veterans Affairs notes that delirium can be “underactive,” meaning the person seems drowsy rather than agitated, which makes it easier to miss.
Medications That Can Trigger Hallucinations
Hallucinations are a side effect of more medications than most people expect. If your mom recently started a new prescription or changed a dose, that’s worth investigating. Some of the most common offenders include:
- Parkinson’s medications (dopamine agonists) can produce hallucinations ranging from brief, fleeting images to elaborate and disorienting scenes.
- Blood pressure medications, particularly beta-blockers, can cause people to see shimmers or halos around objects.
- Certain antibiotics, especially cephalosporins and sulfa drugs, are among the antibiotics most frequently linked to hallucinations.
- Antiseizure and psychiatric medications can produce vivid, detailed hallucinations that feel very real.
- Osteoporosis drugs (bisphosphonates) have caused visual, auditory, and even smell-based hallucinations starting anywhere from two hours to a week after beginning the medication.
Don’t stop any of your mom’s medications without talking to her doctor first. But do bring a complete list of everything she takes, including over-the-counter drugs and supplements, to her next appointment.
Vision Loss Can Create Hallucinations on Its Own
There’s a condition called Charles Bonnet syndrome that surprises many families. When the eyes lose significant vision from conditions like macular degeneration, glaucoma, or cataracts, the brain sometimes fills in the gaps by generating images on its own. People with Charles Bonnet syndrome are mentally sharp. They often know the hallucinations aren’t real, and they may feel embarrassed or reluctant to mention them for fear of being thought “crazy.”
If your mom has been losing her vision and is seeing patterns, faces, or small figures, this is worth raising with both her eye doctor and her primary care physician. Diagnosis involves a thorough eye exam and neurological testing to rule out dementia or other brain conditions. In some cases, hallucinations from Charles Bonnet syndrome fade on their own as the brain adjusts to reduced visual input.
What the Doctor Will Check
When you bring your mom in, the doctor will likely run a set of tests designed to rule out the most common and most treatable causes. This typically includes blood work to check for infection, electrolyte imbalances, blood sugar problems, kidney and liver function, and thyroid issues. A urine test is standard to check for UTIs. If there’s any suspicion of a brain-related cause, such as a recent fall, new weakness on one side, or a sudden drop in consciousness, a CT scan or MRI of the head may be ordered. An EEG (a test that measures brain wave activity) is sometimes used if seizures are suspected.
The goal of all this testing isn’t just to confirm hallucinations. It’s to find the specific cause so treatment can be targeted. Many of the causes, especially infections, medication reactions, and metabolic imbalances, are reversible.
How to Respond When She’s Hallucinating
Your instinct may be to correct her or explain that what she’s seeing isn’t real. That’s a natural reaction, but it usually doesn’t help and can make things worse. The National Institute on Aging recommends a gentler approach.
Don’t argue about what she sees or try to convince her it’s not there. If she’s frightened, comfort her. Acknowledge her feelings rather than debating her reality. Sometimes simply moving to a different room or going outside for a walk is enough to break the episode. Make sure her environment is safe and that she can’t access anything that could hurt her if she becomes confused or disoriented.
Be mindful of what’s on TV. Violent or dramatic programs can be perceived as happening in the room by someone with dementia-related hallucinations. Turning off the television or switching to something calm can prevent unnecessary distress.
Evening Hallucinations and Sundowning
If you’ve noticed the hallucinations get worse in the late afternoon or evening, your mom may be experiencing sundowning, a pattern of increased confusion and agitation that’s common in people with dementia. The exact cause isn’t fully understood, but fatigue, overstimulation from a busy day, and low lighting all appear to make it worse.
Keeping your mom’s environment well-lit during the day can help. A simpler daily schedule with fewer people, activities, and noise reduces the kind of overstimulation that often precedes sundowning episodes. At bedtime, transitioning to darkness supports better sleep. Consistency matters: a predictable routine with adequate rest is one of the most practical tools you have.
What to Tell the Doctor
The details you share will help the doctor narrow down the cause faster. Before the appointment, write down when the hallucinations started, how often they happen, what time of day they tend to occur, and what your mom reports seeing. Note whether she knows the hallucinations aren’t real or believes they are. Track any other changes you’ve noticed: new confusion, changes in sleep, difficulty walking, a recent illness, or any medication changes in the past few weeks. All of this information can point toward a specific diagnosis and get your mom the right help sooner.