There’s known to be a link between living with dementia and hallucinations and for those that experience such episodes, it can sometimes be scary and unsettling.

Hallucinations are usually suffered in the middle or later stages of dementia, and can be more common in Lewy Body and Parkinson’s dementia, but can also happen in Alzheimer’s and other types of dementia.

Hallucinations can be the result of many factors; the ageing process which results in the deterioration of sight, dehydration, medical conditions such a Urinary Tract Infections, and prescribed medications, but when dementia and hallucinations come hand in hand it’s often down to misinterpretation and misunderstanding the environment.

Not all hallucinations are upsetting, some can be quite joyful and nostalgic. However, understanding ones living environment, and how it may be perceived by someone living with dementia, can help gain an understanding of what may trigger an unsettling hallucination.

Seeing is believing

The Alzheimer’s Society explains well the complicated process of seeing and interpreting when living with dementia:

“Information comes through our eyes to the brain, where it is interpreted in relation to our expectations (of what will be seen), other senses, thoughts and memories. We then become aware of what has been seen (what is ‘perceived’).”

For someone living with dementia, it can be the “making sense” part which is difficult, as confusion and memory problems can make it impossible to perceive things properly.

So, what can we do to reduce disturbing hallucinations?

The internal environment

Many elements of an interior layout or design could trigger a hallucination, however, for this article, I will focus on the misuse of colour and patterns as well as the impact of external light sources.

We talk a lot about light reflectance values within interior design and this is because knowing a colours LRV and using it effectively can help create living spaces which are easy to navigate and don’t trigger hallucinations.

Someone living with dementia can find it difficult to see colour properly. Colours with LRV’s that sit within an 8-point difference may be seen as the same by someone with dementia. Colours with anything greater will be seen as contrasting. Also, LRV’s with a difference of greater than 30 points will be easily distinguished.

The 30 point difference can help with wayfinding and navigation, for example, someone with dementia will see a difference between the floor and the wall if the carpet and the adjacent wall paint colours have an LVR difference of 30 points. However, when it comes to flooring, adjacent colours with such a large contrast can also cause barriers in navigation and movement.

Within care settings sometimes residents have a fear of using the bathroom. This could be for several reasons. Perhaps there’s a large mirror in the bathroom and the person may not recognise their reflection and think someone else is in the room or it could be down to the colour or texture of the floor.

For example, If the colour of the bedroom carpet has an LRV of 30 and the flooring within the en-suite bathroom has an LRV 8 this would equate to a 22 point difference. A person living with dementia may feel safe and secure in their bedroom, but when expected to use the bathroom they may feel like they're crossing over into a black hole, purely down to the colours of the two surfaces.

In addition to this if the bathroom floor is shiny this may appear wet and slippery to someone with dementia and may make them reluctant to enter due to the fear of slipping and falling.

Large scale and highly patterned carpets can also cause those living with dementia to hallucinate. Swirly patterns in carpets; where the base colour is very different to the colour used for the swirl design, could be misinterpreted as something else. The pattern may be seen as snakes on the floor or a rope which needs to be stepped over, for example.

Carpets that have contrasting block colour patterns could also be seen as stepping stones to navigate or crevasse one could fall into. Such misuse of colour and patterns can cause stress and confusion for someone living with dementia and can result in an individual refusing to navigate their home and becoming isolated within a room.

It’s also important to understand how natural daylight casts pattern onto the floor at all points during the day. The shadow of a tree moving in the wind outside could be very distracting or cause regular unsettling hallucinations at certain points of the day. Therefore, it’s important to know when to pull blinds or curtains at any time during the day.

What can we do?

Drastically refurbishing your home may not be an option immediately, however, there are things you can do to establish areas that may need attention and support a person experiencing hallucinations:

• Try to anticipate the situation and explain the environment. For example, if you notice someone avoiding a room with a shiny floor or surface, walk into the area first to show the person that it’s safe.
• Offer the person plenty of support and encouragement and try not to rush the person.
• Slow down your movements and stay calm.

• To see whether your flooring colours contrast too much, take a picture of the area with your phone or camera. Put the image into a black and white mode and see how contrasting the colours are? If there is quite a contrast it could be that the colours LRV’s are not within 8 points of each other and this may need addressing.
• Always ask product manufacturers for LRV’s if they are not readily available. Using these values will help you create a safe, secure and easy to navigate the environment.

For more information about Design for Dementia please refer to our Downloads section where we have many useful guides and resources.