Julie Smith, a nurse practitioner for VistaCare Hospice, will be presenting a program called “Dealing with Inappropriate Behavior” on Thursday at Brookside Glen Assisted Living & Alzheimer’s Care.
Smith has worked with VistaCare in various positions for the last nine years and moved into her role as nurse practitioner in February.
She said she enjoys participating in the hospice’s community education programs and has become an active public speaker for the organization over the last two years.
Smith spoke with the Ledger-Enquirer this week about what participants can expect from her presentation, how to identify some early signs of Alzheimer’s and dementia and the impact a diagnosis can have on a family. The following interview has been edited for length and clarity.
Without giving away your entire presentation, can you tell me a little about what you’ll be speaking about on Thursday?
The title of it is “Dealing With Inappropriate Behavior” and it’s one that I really enjoy to give because not only in Hospice, but just in all of healthcare, the stressors that come along with chronic disease processes and terminal disease process create stress. And stress often times can create inappropriate behavior with patients interacting with clinicians or healthcare providers or even family members dealing with the stress of their loved one’s illness, whether it’s a terminal illness or not. So basically it’s going to talk about the types of behavior that you can encounter, kind of how to handle dealing with that type of behavior, possible causes of that behavior that may be we don’t know about or (are) unaware of and the awareness can help us to change our interaction with patients and families who might be dealing with that type of challenge. And really just how to look at ourselves as healthcare professionals to know how to deal with it appropriately.
How prevalent is Alzheimer’s disease and dementia and at what age do people typically start showing signs?
We do have a pretty large Alzheimer’s/dementia population, but I don’t have a specific number. As far as ages, we have had someone in their 50s all the way up to their late 90s, maybe even early 100s, so there’s an obvious large range of ages at initial diagnosis and there’s different types of dementia that can be a little more progressive than others. The age versus how long the disease lasts is usually about 10-15 years, but the age of diagnosis varies.
What is the most common first step for someone to take when symptoms of Alzheimer’s or dementia first appear?
A lot of times it’s forgetfulness. We actually have a scale and it’s called a FAST (Functional Assessment Staging) scale. It’s just a functional assessment tool and there’s all sorts of different tools that help to identify when someone may be in the earlier stages of Alzheimer’s and dementia because there’s no clear diagnostic study that tells us that they have it. So in our practice we use a FAST score because usually we receive them when they’re end stage. But in the FAST score it starts at the very top which is just forgetting where you put your keys, things that family often doesn’t notice. It’s usually down into number 4, number 5, which are things like the inability to manage your finances or take care of your checkbook any longer. Usually that’s when families start to say, ‘OK, something’s going on with mom or grandma’ and they start to pursue a diagnosis at that point.
So typically there are no steps taken until it’s further progressed?
Correct. Usually because it’s not noticed. They just say, ‘Oh that’s mom being forgetful’ or they kind of tend to justify it until it comes to a point where they realize that maybe something may not be right and then they usually pursue more help at that point.
How can a loved one’s Alzheimer’s or dementia affect the rest of a family?
Oh it’s a huge impact. Because it’s such a prolonged disease process and because there’s so many variables that go into how someone progresses and the behaviors that come along with the disease at various stages. It is a very large stressor for patients, for families. Again, which is why the talk at Brookside Glen is such a great talk, because often times the ability to cope with the stress that comes from an elongated disease that progresses, often into more of a physical care-giving need that the patient would have versus the cognitive things in the beginning of redirecting and reminding and things like that. It’s a very big burden on patients and families and it just progresses through the years. And so by the time they’re end stage, which is what we often deal with, they’ve been care-giving for 10 years already and now their care-giving needs are even greater than before. It’s a very big impact on the families of these patients.
What are some of the best local resources for obtaining additional information?
The Alzheimer’s Association is big and our marketing people, our communications people, have a good relationship with them and they have a lot of resources and from my experiences they’ll direct you to places or things that they maybe can’t -- there’s a lot of adult day care centers for the earlier stage patients, placement issues as far as maybe once their care needs are greater than what can be cared for at home, and assisted living-type facilities. So the Alzheimer’s Association is big. And then of course we provide care for patients who have end stage Alzheimer’s or dementia, so we’re a great resource to evaluate patients, see if they’re eligible for our care and if they’re eligible and they want the service, then we would also be able to provide care for patients in end stage.
What audience are you targeting with this presentation and why should someone attend?
The target audience is hopefully members of the community who may be dealing with patients who have dementia or Alzheimer’s or just care needs that are greater that provide stressors... The hope is that we (discover) how to handle each different type of inappropriate behavior that I’ll cover and mainly just how to deal with it within ourselves. Whether it’s health-care providers, whether it’s patients, whether it’s families, whoever’s interacting with someone who is showing any inappropriate behavior, to realize that we are the ones that can control how we handle it. And sometimes the way that we respond can make things worse and sometimes how we respond can make things better...
