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 & Alzheimers 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 hospices 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 Alzheimers 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 youll be speaking about on Thursday?
The title of it is Dealing With Inappropriate Behavior and its 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 ones illness, whether its a terminal illness or not. So basically its 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 dont 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 Alzheimers disease and dementia and at what age do people typically start showing signs?
We do have a pretty large Alzheimers/dementia population, but I dont 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 theres an obvious large range of ages at initial diagnosis and theres 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 Alzheimers or dementia first appear?
A lot of times its forgetfulness. We actually have a scale and its called a FAST (Functional Assessment Staging) scale. Its just a functional assessment tool and theres all sorts of different tools that help to identify when someone may be in the earlier stages of Alzheimers and dementia because theres 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 theyre 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 doesnt notice. Its 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 thats when families start to say, OK, somethings going on with mom or grandma and they start to pursue a diagnosis at that point.
So typically there are no steps taken until its further progressed?
Correct. Usually because its not noticed. They just say, Oh thats 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 ones Alzheimers or dementia affect the rest of a family?
Oh its a huge impact. Because its such a prolonged disease process and because theres 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. Its a very big burden on patients and families and it just progresses through the years. And so by the time theyre end stage, which is what we often deal with, theyve been care-giving for 10 years already and now their care-giving needs are even greater than before. Its a very big impact on the families of these patients.
What are some of the best local resources for obtaining additional information?
The Alzheimers 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 theyll direct you to places or things that they maybe cant -- theres 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 Alzheimers Association is big. And then of course we provide care for patients who have end stage Alzheimers or dementia, so were a great resource to evaluate patients, see if theyre eligible for our care and if theyre 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 Alzheimers 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 Ill cover and mainly just how to deal with it within ourselves. Whether its health-care providers, whether its patients, whether its families, whoevers 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...