Husband with memory loss wants his wife to leave the house because he does not recognize her and thinks she should not be there. Any ideas?

Is the patient becoming agitated because of the presence of this stranger?

I would consult with a geriatric psychiatrist about meds to counteract the agitation. Have the spouse watch some Teepa Snow videos about dealing with dementia patients. She may need to agree that she's "a friend here to keep you safe because the doctor said you need someone around in case you fall" or some other therapeutic fib that will lessen the agitation and upset around this "stranger".

He may not know her as an older lady. He may remember her as a younger person. Tell her to show him a younger picture of herself and see if he recognizes her.

Thinking she is a stranger is not unusual. Like said, tell a little white lie.

The same thing happened to a friend of mine.
She would leave the room, go out one door and come back in another way and he was fine.
The other options are....
She can say..."oh, "Sally" had to go to the store, she will be back in a little while"
or
"Sally asked me to come by and see if you wanted to play a game of cards while she went to get her hair done"
The important thing is do not argue saying "don't be silly I am your wife" is not going to help. With dementia you deal with the reality of the moment. You learn to redirect, deflect, walk away, tune out.

I want to say when I was a DSP, Direct Support Professional one of the programs we caregivers were required to go through was from an expert on Dementia by the name of Teepa Snow. Google “Positive Approach to Care Teepa’s Dementia Videos” because she deals with so many different issues and topics in the disease such as memory loss, how to de-escalate behaviors and so much more. I can’t copy and paste the link but that is the information.

Also it is vitally important that you as the wife and caregiver get to understand the disease and how the brain changes to know how to help him control the disease without the disease controlling him and taking over your household.

I hope this proves to be helpful and hope the best for you with your daily caregiving needs.

He is agitated because he probably perceives her as a stranger. His "wife" probably looks much younger/different in his memory. Try a couple of these ideas:

Create a memory book with pictures of him and her together throughout the years of their marriage. Show it to him throughout the day.

In the evening, many seniors have Sundowner's Syndrome. Turn on more lights in the late afternoon. Keep a consistent routine and a consistent environment.

Consult his doctor. He may benefit from a mild anti-anxiety medication to calm the agitation and anxiety.

Create a bedtime routine for him that allows him to go to bed earlier. He may not be as bothered by her presence earlier in the evening and can be asleep before the "I don't recognize you" phase starts.

Create a mini apartment for the wife in the home that she "can go to" when he says it is time for her to leave. He may be ok with her going to "her apartment" when he thinks it is time for her to leave.

Find someone he does recognise, and get that person to introduce her -she’s my caring friend, your long lost cousin, my aunt who needs somewhere to stay blah blah blah. It’s still distressing, but not so bad as him insisting that ‘this stranger leaves’.

My husband worked for a Government agency for thirty years and the family are his "agents".... We put him in memory care not that long ago and it was the best decision. Hang in there. Caretakers have to put themselves first.

Husband is going through a phase. My mother, who has advanced dementia, went through something like that where she didn't recognize me and told me to go when I visited her. She was living in a memory care facility. One of the aides told me what to do. She said, just go out of the room for about 5 minutes and come back in. It worked! When I came back into the room she was fine. I wasn't the only one she did this with. The phase eventually passed.

Obviously the one with healthy mind should take charge. There shouldn't be any doubt.

I suggest that she leaves and returns a few minutes later with a very positive attitude and a greeting along the lines of this: "Hi Sweetheart, I'm so lucky to be your wife."

It's important for your friend to understand the dynamics of dementia and how her husband's mind works now:

As their disease progresses, they may have access only to their first 50 years, then 40, then 30, and so on, until they go back to their childhood memories. This is not an orderly reversal – the person may remember more or less on different days and at different times during the day.

This results eventually, in the person with Alzheimer disease thinking they are much younger than they actually are. It is not as though they realize they are, for example, 81, but they can only remember their first 30 years. Instead, it is as though they are the person that they were at age 30. Consequently, they are confused, because they may not recognize their family, since they are looking for the individuals they were sharing their life with at age 30.

Your friend's husband isn't recognizing his wife because now he's at a point in time, in his mind, when they weren't married and hadn't even met yet. She's best off to go along with him and not insist on telling him she's his wife, b/c he's not going to believe her. She's just a nice friend who's there to help him and to stay with him every day. He may have days when he DOES remember her as his wife, and other days when he does not; she needs to roll with the punches to the best of her ability.

Have your friend read this article on the subject, discussing this very thing:

Dementia & Not Recognizing Spouse or Family, by Judy Cornish
https://thedawnmethod.com/dementia-and-not-recognizing-spouse-or-family/

And this 33 page booklet, Understanding the Dementia Experience, by Jennifer Ghent-Fuller which is a free download and a marvelous explanation of how the mind works of a person suffering from dementia:

https://www.smashwords.com/books/view/210580

Here is a list of useful tips from her e-book I found to be excellent:

The “Dont's”
· Do not reason and argue
· Do not demand that they reason or problem-solve
· Do not demand that they remember
· Do not demand that they get their facts straight
· Do not correct their ideas or scold them
· Do not reorient them
· Do not think that they are being uncooperative on purpose
· Do not think that they really do remember, but are pretending not
to
· Do not use a “bossy” dictatorial attitude in care
· Do not act with impatience
​

The Do's
· Enter into their frame of reality, or their 'world'
· Be aware of their mood or state of mind
· Use few words and simple phrases
· OR use no words, just friendly gestures and simple motions
· Do everything slowly
· Approach from the front
· Wait for a slow response
· Constantly reassure them that everything is 'OK'
· Keep people with dementia comfortable 'in the moment' - every
moment
· Maximize use of remaining abilities
· Limit TV or radio programs which they may feel are frighteningly
real
· Maintain privacy
· Provide a safe physical environment
Language Needs
· Use short words
· Use clear and simple sentences
· Speak slowly and calmly
· Questions should ask for a “yes” or “no” answer
· Talk about one thing at a time
· Talk about concrete things; not abstract ideas
· Use common phrases
· Always say what you are doing
· If they repeat their question, repeat your answer as you did the
first time · Give them a longer time to process information
· Wait patiently for a response
· Be accepting of inappropriate answers and nonsense words
· Speak softly, soothingly and gently

Best of luck.

I have a slightly different take on this depending on the age of the couple. If he doesn’t recognize her, and you try the leaving and coming back and it doesn’t work, you may want to place him in a memory care facility sooner rather than later. If he is agitated, he could be a danger to her. Even at 90 and frail, my FIL was very strong. No one would have believed it.

There are certain situations an elderly lady probably shouldn’t stay in and, to me, this is one of them. Like Lealonnie said, they go back further in time.

But, that doesn’t mean that they are logical about that time either.

One morning, I was sitting in front of my FIL helping him go to the bathroom. He told me he was late for work. I asked him how old he thought he was. He said 25. As I was reminding him how to go to the bathroom, he said, why? Is that not right? I said, well you are somewhat older that that. He said, “really? How old am I?” He was very calm and matter of fact so I gently told him 90. He said, “Wow!” We laughed together. Then, I got him talking about work and we finished up. He was definitely back in time, but his brain was so off at that point he made no connection that his younger DIL (I think I was about 40-42) was there holding him up so his beans didn’t go swimming🤣

A few days after that, he grabbed and bruised a caregiver and stepped up to me, this man who wouldn’t even let me vacuum in his presence, who had never even sounded cross to me in my almost 20 years with his son.

My DH was there and seeing his father do that to his wife scared him. We knew it was time. He was mean to my MIL and he would lock them in a room together and he didn’t really know her. She wasn’t strong and it just cut her up, even though she tried to talk him down. We had to protect her, she would never have left him and his real self would have chopped off his arm before he would have hurt her.

He was a true father to me and treated me so, so well. He always trusted me even when he didn’t know who I was, until that moment.

His agitation did not go away for months after that, even though he was always kind to me after that. Even with excellent Teepa Snow trained memory care. We used so many of her suggestions even at home, they were wonderful. It just wasn’t enough.

Just a different perspective from in the trenches. So many good wishes to you. This is such a hard situation, especially for his wife.

So, my girl friend's husband was suspicious and hallucinating: he started saying he thought she was cheating on him. Since she was in her 60's and quite heavy, we thought the whole scenario was funny and absurd. Later we realized that probably came about because he married her with a 20 year age difference and the thought probably festered in him for years.

Fast forward a few years and we read an article in the newspaper where a man, who had Dementia/Alzheimers killed his wife because he was sure she was cheating. We weren't laughing when we read that.

Your subject is giving the warning that his brain is not functioning; she needs to place him in order to guarantee her own safety. Some lessons are NOT taught early enough to save lives. :(

I experienced this in a very early stage of my husband’s disease progression. In my case, he believed I was an imposter posing as his wife. It was extremely distressful and frightening to me. What I realize now is how distressed and frightened he was too. As several respondents have noted, safety of both parties at this stage is paramount and judgements have to be made as to whether husband and wife need to separate for a time and to also confer with a physician about anti anxiety/antipsychotic medications. In our situation, a regimen of seroquel helped reduce his anxiety and paranoia with my presence in the house. It was also advised I enter his reality as others have noted and not insist I was his wife. Instead, I’d explain that I was a friend of his wife’s and she asked me to come to help out with getting dinners, cleaning and doing wash. I had to say this many times and at one point he even acknowledged that I could be useful to him;). Our adult children needed to intervene as well (he did know them) and reinforce that I was indeed a good person who was there to help and do no harm to him. They never acknowledged that I was mother and wife since he did not believe that and building his trust and sense of safety with me in the house was critical. I slept in a different bedroom during this period and ate my meals separately. I hid knives, scissors, and anything that could be used to harm. Certainly make sure there are no guns in the house. After a period of time on the medication and changes in how I handled my presence, his distrust of me lessened and his disease progressed past this phase to late stage as I write this. Now, he completely trusts me with his care. He is immobile and nonverbal now. I believe he knows me as a loving, caring person and perhaps he knows me as his wife. But there were times back then when I slept with the bedroom door locked, my phone and car keys by my bedside and a packed overnight bag with all my critical documents inside in case I needed to make a quick exit. Our children knew our situation and if I ever felt vulnerable, they came and stayed overnight with us. While my husband would have never harmed me in the past, I couldn’t assume that of him at this stage of his paranoia. Your friend may want to read up on safety plans designed for women living in domestic violence situations. That afforded me a sense of control in my situation. In hindsight, the one thing I would have done differently is better understand his changing reality and fear. There are many times before his diagnosis when, in my ignorance of the disease, I argued and told him he was wrong and that something was going very wrong with him. I sometimes wonder how I made him feel unsupported and even more frightened to the point where he didn’t think he could trust me. In closing, yes every situation is different but what is common to us all is making sure both caregiver and spouse have good medical care and to seek outside support and good advice. Kudos to you for reaching out to this forum. God bless.

If her husband will accept having someone come in to cook and help him with personal care, she can identify herself as the person there to help him. It is useless to try to persuade him she is his wife. Work with the husband's perception of reality and go right on keeping him safe and comfortable.

BobbyD10: If perchance showing photos of this husband's wife in her younger years to him would help, perhaps he should be seen by his geriatric neurologist.

Show him pictures with his wife in it, past and more recent. Recent memory goes first but might recognize that she has been there through the years. The police did this when my mom called the police and told them that she had been kidnapped & held captive at his house. Policeman showed mom pictures of them on the walls, her chair & her dog. She did begin to realize that my brother belonged there.

I see some recommendations to show him some photos of the two of you together. Not sure how that is going to help. My mom can't even identify herself in a photo, let alone anyone else. Thirty minutes after you show him the pictures he isn't going to remember having the conversation.

I personally would be afraid to sleep next to someone who had no idea who I was. You never know what is going on in that confused head of theirs. The type of dementia they have is also a key factor. Lewy Body tends to lean towards violent outbursts. It's one thing if you ask him if he knows who you are and he responds no and goes on about his business. I feel it's a different ballgame if he is agitated by your presence and constantly tries to get you to leave. That's worrisome.
Sounds like moving him to memory care might be in your best interest and his.

This exact same thing happened to a close friend! Her Alzheimer's dad didn't recognize her mom who was caring for him. He made it difficult for his wife since he didn't remember he was married! So their daughter had to take her dad to live with her & husband. Her mom in her 80's , still lives on her own. . living her best life. Sounds like your dad may need to be placed. Best wishes.

I wonder if there is anyone he would like to see ? and then the wife say this is who she is.

show him pictures of his wife maybe if she sing a song they like be Hope this helps

As OpenMind pointed out, it is not an unknown issue. An excellent reference is to Google "Capgras Syndrome" and/or "Imposter syndrome and dementia".