Such findings suggest that hallucinatory experiences in later life (i.e., in the absence of mental disease or disorder) warrant considerably more attention. However, new epidemiological data indicate that nearly a quarter of first onsets of hallucinations occur after the age of 40 years (McGrath et al., 2016). In contrast, the diversity and significance of hallucinations in healthy older adults have received much less attention (Tien, 1991). Despite this, later-onset hallucinations have mostly been examined in the context of Lewy Body disorders and dementia (Collerton et al., 2012 El Haj et al., 2015). Since compensatory processes have been well-studied in the context of normal ageing (e.g., Reuter-Lorenz and Park, 2014 Peelle and Wingfield, 2016), hallucinatory experiences in healthy older adults may provide a particularly valuable window on the underlying mechanisms involved. Thus, rather than being passive phenomena arising from deficits in cognitive-perceptual processes, this “positive” conceptualization of hallucinations maintains that a range of active, adaptive processes are involved as well, that compensate for such deficits. At the broadest level, hallucinations are characterized as the abnormal perception of something not present (see Table Table1 1 for a glossary of terms) though the genesis of these experiences seems to be far more dynamic than previously realized. Hallucinations are hard to pin down, with a standard definition remaining elusive (David, 2004 Larøi et al., 2012). Hallucinatory experiences are particularly significant in this regard since they can indicate the presence of mental illness but are also known to occur in healthy individuals in the general population (Sommer et al., 2010 Johns et al., 2014 Kråkvik et al., 2015). As a consequence, there is a growing focus on the physical and mental health needs of older adults to ensure that healthy ageing is possible. In Australia, for example, from 2002 to 2012 life expectancy increased from 78.1 to 79.9 years (for men) and from 83 to 84.3 years (for women) (Australian Bureau of Statistics, 2014). Furthermore, the average life span continues to increase. The world's population is aging, with the number of adults aged 60 years and over expected to reach 2 billion by 2050 (United Nations, 2013). We briefly summarize the implications of the literature for aged care services and interventions, and stress that far more studies are needed in this important field of research. The evidence supports a dynamic conceptualization of hallucinations, in which the emergence of hallucinations is viewed as a balance between the sensory, cognitive, or social impairments accompanying advancing age and the degree to which compensatory processes elicited by these impairments are successful. To the best of our knowledge, this is the first review of its kind in the literature. The purpose of this review is to provide a comprehensive overview, and critical analysis, of research on the prevalence, psychosocial, and neurobiological factors associated with hallucinations in people aged 60 years and over. Consequently, improved public and professional knowledge is needed about the nature and significance of hallucinations with advancing age. Furthermore, stigma and misunderstanding of hallucinations, together with ageism, may lead to under-reporting of these experiences by older adults, and misdiagnosis or mismanagement by health and mental health practitioners. Accumulating evidence shows that hallucinatory experiences are also present at surprisingly high rates in healthy older adults in the general community. Hallucinations, though common in youth and younger adults, are not the preserve of these age groups. ➢ Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement), highlighting the need for accurate assessment and tailored interventions.
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