Download sensory hallucinations in older people

An introduction to
sensory
hallucinations
in older people
Do you see or hear hallucinations, or do you know
someone who does?
Do you have a visual or hearing impairment, or both?
Do you know someone who does?
There may be a simple explanation…
Dafydd
“These hallucinations can be very
distressing when you don’t know
what’s going on.
“I read a lot as I live alone. I enjoyed
reading but one night an arm appeared
around my shoulder as if trying to take
my book. I was scared. I would turn
around but there was nothing there.
I also play the piano and I can
sometimes hear someone singing.”
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Visual hallucinations
Charles Bonnet syndrome
Charles Bonnet syndrome (CBS) is a common condition among people who
have become visually impaired. It causes people who have lost a lot of vision
to see things that are not really there, known as visual hallucinations.
The condition can affect anybody whose sight is failing at any age but is
most common among older people, most likely because this is the largest
group of people with visual impairment. Visual hallucinations can affect
people with eye diseases across the entire spectrum – from cataracts
through to retinitis pigmentosa and macular degeneration.
Although there has been limited research carried out regarding CBS,
it has been estimated that between 11 per cent and 15 per cent of
people with moderate or severe visual impairment have experienced
visual hallucinations.
■ What kinds of hallucinations occur?
The answer to this is just about anything and everything. The most
common image is a geometric pattern, but a wide array of often bizarre
hallucinations have been ‘seen’ such as disembodied faces and animals
among many others. These hallucinations are always brilliantly clear in
comparison with the blurred perception of real objects a visually impaired
person will experience.
■ How long do the hallucinations last?
These images can last for periods ranging from seconds through to hours
at a time and typically appear without any kind of trigger. For some
people though they may be triggered by things like tiredness, stress and
both high or low levels of lighting.
Hallucinations tend to begin soon after someone’s eyesight has
deteriorated and early on will be at their most frequent and for the longest
periods. Over time most, but not all, people’s hallucinations will become
less frequent and may actually stop. Recent research suggests that a large
proportion of people experience these hallucinations for five years or more.
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■ What causes the hallucinations?
There has been limited research into the causes of CBS and as yet there is
no real agreement of the exact cause or causes. It is widely believed to be
a normal response of the brain to reduced visual input.
■ What problems can CBS cause?
The main potential problems appear to relate to people who develop CBS
fearing that they are developing mental ill health but they are more likely
to feel this way if they have never heard of the condition or have not had
the syndrome explained to them.
Until this point, and especially when the hallucinations first begin, this can
be a frightening time. The person with CBS may often wrongly fear that
the hallucinations mean that they have developed serious mental health
problems. They should be reassured that this is not the case and that it is
not the result of any other problems such as dementia.
A few people with CBS report that they actually find their hallucinations to
be a pleasant experience while most are indifferent towards them. About
a third find the experiences distressing and unpleasant. People whose
hallucinations are very frequent and hinder their day to day activities are
more likely to find CBS unpleasant. People with CBS may not tell anyone
else about it.
■ Are there treatments available?
If somebody is concerned about their CBS they should visit their GP. Some
GPs will be unfamiliar with CBS so it is worth taking along this information.
The GP may recommend some tests to be sure that it is in fact CBS and
not something else that may require treatment. People may also seek
some counselling if the hallucinations are causing distress.
Currently the best treatment is probably the provision of information
and reassurances to the person with CBS that their experiences are far
from unusual and that they are not facing issues related to mental health
problems or dementia.
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There have been examples of drugs successfully treating CBS but there is
currently a lack of evidence as to which might be the best one to try.
There are some practical ways for a person with CBS to help manage
their hallucinations:
• Some form of eye movement, shifting gaze to the left and right
alternately, can make the hallucinations go away, at least for a
short while.
• Distracting yourself, such as getting up to make a cup of tea, or going
out for a while works for some people with CBS. For unknown reasons
hallucinations most often occur in times of quiet restfulness so doing
something to occupy your brain may help.
• Increasing the light you are in can be helpful as hallucinations are most
common in dim lighting.
• Joining a social group may be beneficial as social isolation is thought to
be a contributory factor to CBS.
■ Treatment in the future
A five year study of CBS has been launched by King’s College London and
South London and Maudsley NHS Foundation Trust with the intention of
creating a comprehensive set of guidelines on the clinical management of
visual hallucinations to be made available to both clinicians and patients
by 2017. They will also create an evidence-base from which to plan future
NHS services.
Auditory hallucinations
■ What are they?
A range of sounds that are not actually there can sometimes be
experienced by people who have lost some or all of their hearing in later
years. These hallucinations range from simple sounds (often described as
tinnitus) to more complex sounds such as music. It can come as a surprise
to people as tinnitus is more commonly known as ‘ringing of the ears’
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caused by exposure to loud noises. This view can be unhelpful as it does
not take into consideration the wide array of different sounds someone
with tinnitus might hear. Nor does it acknowledge that tinnitus often
occurs as a consequence of hearing loss.
Tinnitus as a result of ageing is poorly understood, but what seems to
happen is that signals are sent from the ear, down the ear nerve, to the
hearing part of the brain. It is not clear why these are sent but the brain
interprets these signals as noise. The noise may also originate somewhere
else in the hearing nerve pathways in the brain. The same is true of
musical hallucinations.
■ What do people with tinnitus hear?
Commonly, older people with tinnitus will hear ringing, chirping, buzzing,
roaring, clicking or whooshing sounds.
■ Musical hallucinations
Sometimes older people with hearing loss hear recognisable musical
sounds, or even complete tunes or singing. Quite often these people have
a strong musical interest.
They may have a constant, clear perception of music pieces, such as
marches, country music, and hymns. Some people identify one musical
instrument in particular. The musical tones have a vibrating quality similar
to the sound produced by blowing air through a paper-covered comb.
However, these hallucinations are not confined to hearing musical tones.
People can also hear voices singing, although the words are usually not
clear. The voices range from soprano, through tenor and baritone, to bass,
but the predominant voices heard are deep in tone. Voices talking to you
or about you may suggest another illness and you should let your GP
know about them.
■ Are there treatments available?
If somebody is concerned about their tinnitus they should visit their GP.
The GP may recommend some tests to be sure that it is in fact tinnitus and
not something else that may require additional treatment. People may
also seek some counselling or the use of anti-depressants if the tinnitus
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is causing distress. A GP should be able to discuss the possible solutions
mentioned below.
As mentioned already, musical hallucinations in older people are most
likely the result of hearing loss but can on occasion be caused by other
more serious physical problems. To err on the side of caution, a person
experiencing these should always consult their GP and should be especially
mindful to do so if they experience changes in their vision, dizziness, severe
headaches, problems with their speech or difficulties with movements.
They should also consult their GP if hearing people who are not there talk
to or about them.
■ Hearing aids
Straining to hear things makes tinnitus worse and so ensuring the person
has the most effective hearing aids possible can lead to improvements.
Improving the person’s hearing will mean they can hear sounds they
would not otherwise which will help override the sounds of the tinnitus.
■ Sound therapy
Tinnitus is most noticeable in quiet environments. Some people find that
having the radio or television on helps mask the sound of tinnitus, while
others prefer natural sounds such as recordings of the sound of the sea or
a babbling stream. There are also sound generators that can be placed at
the person’s bedside that distract them from the tinnitus, allowing them
to fall asleep.
■ Self-help
Stress can make a person’s tinnitus worse so regular exercise however
gentle, such as yoga may help relaxation.
Sharing your experiences with other people who have tinnitus may
help some people. Action on Hearing Loss (0808 808 0123) and the
British Tinnitus Association (0800 018 0527) can help people find their
local group.
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