Hallucinations in Older Adults: A Practical Review

Johanna C. Badcock; Frank Larøi; Karina Kamp; India Kelsall-Foreman; Romola S. Bucks; Michael Weinborn; Marieke Begemann; John-Paul Taylor; Daniel Collerton; John T. O'Brien; Mohamad El Haj; Dominic ffytch; Iris E Sommer


Schizophr Bull. 2020;46(6):1382-1395. 

In This Article

Summary and Directions for Future Research

Hallucinations are common in older adults. The character of these experiences is varied and for many, though not all, they can cause significant distress. Understanding the diverse origins, nature, and reactions to hallucinations is vital in helping clinicians to provide the best level of care (see Resources). There is currently no consensus on the most suitable tool(s) for assessing hallucinations in older individuals, with or without a co-occurring clinical disorder. A range of valid and reliable measures is available for the screening and assessment of hallucinations, though these were largely not designed specifically for older age groups. Variation in the scope and content of these measures means that: (1) the phenomenological features, emotional reactions, and impact on the life of hallucinations in older patients may be incompletely captured and (2) differences in the experience of hallucinations across age groups or diagnostic categories may be missed. Clinicians also need to maintain awareness of potential barriers to disclosure of hallucinations and the value of gaining information from multiple sources (self, informant, and clinician) when discussing these experiences with older clients. Similarly, although treatment and management approaches are slowly being tailored to the needs, views, and context of older age groups, considerably more effort is needed in studying how to provide a personalized response to older clients with hallucinations and those who care for them.[88] Finally, future research would benefit from a more detailed investigation of the profile of similarities and differences in hallucinations across clinical disorders and age groups to facilitate differential diagnosis, and the detection of early features ("red flags") warranting a referral to more specialized services.