Why do elderly people talk incoherently and experience hallucinations where they see people? What should be done about it?

In general, elderly individuals speaking incoherently or experiencing hallucinations—such as seeing people who are not present—may be caused by environmental factors, medication side effects, sensory decline, Alzheimer's disease, schizophrenia, and other conditions. Treatment under a doctor’s guidance may include general supportive measures and medication. Specific causes are analyzed as follows:

1. Environmental Factors

Loneliness, isolation, and lack of social interaction can lead to mental disturbances in older adults, including incoherent speech and hallucinations. It is recommended to increase social engagement through activities such as joining senior clubs or community programs, and encourage family members to spend more time with the elderly to reduce feelings of loneliness.

2. Medication Side Effects

Elderly individuals often take multiple medications for chronic conditions, such as anticholinergics, sedatives, hypnotics, or antidepressants. Long-term or excessive use of these drugs may cause psychiatric symptoms like hallucinations and disorganized speech. It is important to consult a physician to adjust dosages or switch medications to minimize adverse effects.

3. Sensory Decline

Age-related deterioration in vision and hearing can distort an older person’s perception of their environment. In poorly lit or noisy settings, seniors may be more prone to illusions or hallucinations—such as seeing nonexistent people or objects—and may talk to themselves incoherently. Regular check-ups for vision and hearing are recommended, along with maintaining a balanced diet rich in vitamins and minerals.

4. Alzheimer’s Disease

Alzheimer’s disease results from degeneration and death of brain neurons, leading to damage in the cerebral cortex and impairing memory, thinking, language, and other functions. This can manifest as hallucinations (e.g., seeing people) and incoherent speech. It is typically accompanied by symptoms such as memory loss, disorientation, and declining ability to perform daily activities. Patients may take medications such as donepezil tablets, memantine hydrochloride tablets, or rivastigmine tartrate capsules as prescribed by a doctor.

5. Schizophrenia

Schizophrenia may arise from imbalances in brain neurotransmitters, particularly abnormalities in dopamine and serotonin systems. In late-onset schizophrenia among the elderly, symptoms such as hallucinations and disorganized speech may occur. Common accompanying symptoms include emotional blunting, abnormal behavior, and social withdrawal. Under medical supervision, patients may be treated with medications such as risperidone dispersible tablets, ziprasidone hydrochloride capsules, or clozapine tablets.

Older adults should maintain regular social activities, undergo routine physical and sensory evaluations, use medications appropriately to avoid overdosing, and maintain a balanced diet and positive mindset to help prevent symptoms like incoherent speech and hallucinations.