GeriPal - A Geriatrics and Palliative Medicine Podcast

Much has been written in geriatrics and palliative care about anticipatory grief, about the grief of caregivers, and even the grief clinicians experience following the deaths of their patients.  Krista Harrison, in a Piece of My Mind essay in JAMA , writes about something different.  She writes about coping, as an academic hospice and palliative care researcher, with personal grief from the deaths...

Today's podcast is on academic life hacks, those tips and tricks we have seen and developed over the years to succeed in academic medicine in fields that are somewhat generalist in nature. While the podcast is meant for fellows and junior faculty, we hope some of it applies to the work that all of our listeners do, even in non-academic settings.   Why are we doing a podcast on #academiclifehacks?...

"Loneliness is different than isolation and solitude.  Loneliness is a subjective feeling where the connections we need are greater than the connections we have.  In the gap, we experience loneliness.  It's distinct from the objective state of isolation, which is determined by the number of people around you." - Vivek Murthy, two time (and current) Surgeon General. We have heard a lot about loneli...

On June 7th, 2021 FDA approved the amyloid beta-directed antibody aducanumab (Aduhelm) for the Treatment of Alzheimers. This approval of aducanumab was not without controversy.   Actually, let me restate that.  The approval of aducanumab was a hot mess, inside a dumpster fire, inside a train wreck.  After the approval, three members of the FDA advisory panel, which unanimously was not in favor of...

Cannabis use by older adults has increased substantially over the last decade, a trend that has paralleled the legalization of its use for medical and recreational purposes. In that same time, there has been a decreased perceived risk associated with cannabis use in older adults as noted in a recent study published in JAGS . On today's podcast we talk with Drs. Bree Johnston and Ben Han about what...

In a new study in JAGS , Matthew Growdon found that the average number of medications people with dementia took in the outpatient setting was eight, compared to 3 for people without dementia.   In another study in JAGS , Anna Parks found that among older adults with atrial fibrillation, less than 10% of disability could be explained by stroke over an almost 8 year time period.  She also talked abo...

Older adults often turn to institutional settings like nursing homes when they need more help than they can get at home.  However, since the 1970s, there has been a program that allows older adults to receive nursing home-level care outside of nursing homes.  That model of care is known as the Program of All-inclusive Care for the Elderly, or PACE.  On today's podcast, we discuss PACE with two lea...

We have made remarkable progress in reducing the use of feeding tubes for patients with advanced dementia.  This has been due to the leadership of people like Susan Mitchell and Joan Teno, among others.  One might hope that this reduction in use of feeding tubes has been in part due to advance care planning discussions that helped align care and treatment with patients goals.   How then, do we exp...

While palliative care most traditionally grew up with a strong association with cancer care and end-of-life care, more and more evidence is coming out about how to integrate palliative care into a variety of serious illnesses from heart failure to chronic lung conditions.  Another emerging field is the integration of neurology and palliative care, something that has been coined as "neuropalliative...

What if there was a tool that could break down a neighborhood's socioeconomic measures, like income, education, employment and housing quality, to give us a sense of how those factors influence overall health, and maybe even inform where to target health resources and social interventions.   On today's podcast we talk with Dr. Amy Kind from the University of Wisconsin School of Medicine and Public...

Harm reduction, as so clearly described by our guest Monica Gandhi on this podcast, began as a public health approach that guided management of HIV.  Harm reduction represented an alternative to an abstinence-only approach, which clearly did not work.  In the harm reduction model, you acknowledge that people will take some risks, and that the goal is to decrease risk, not eliminate it.    And yet,...

In your clinical experience, you may have cared for patients receiving palliative chemotherapy and wondered, hmmm, why is that called "palliative" chemotherapy? We've written about this issue previously here at GeriPal ("a term that should be laid to rest") as has Pallimed ("an oxymoron"). Well, now we have "palliative" inotropes for people with heart failure.  And we have to ask, is this a fittin...

What is a care manager?  In this week's podcast we talk with Chanee Fabius , who after a personal experience caring for a family member with dementia, became a care manager.  Chanee explains in clear terms what a care manager is, what training is required, and what training is required.  In essence, a care manager is a "glue person" who hold things together. After observing major race/ethnic dispa...

A September 2000 New York Times article titled, "Sometimes Saving the Heart Can Mean Losing the Memory" describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG.  The syndrome was termed "pump head."  A doctor is quoted in the article as stating that older patients he might have previously considered...

Frailty.  What the heck is it?  Why does it matter? How do we recognize it and if we do recognize it, is there anything we can do about it?   On today's podcast we talk to Linda Fried, Dean of Columbia University's Mailman School of Public Health and world renown frailty researcher about all things frailty.   We talk to Dr. Fried about how she first got interested in frailty, how we define it incl...

Though origins of the term "moral injury" can be traced back to religious bioethics, most modern usage comes from a recognition of a syndrome of guilt, shame, and sense of betrayal experienced by soldiers returning from war.  One feels like they crossed a line with respect to their moral beliefs.  The spectrum of acts that can lead to moral injury is broad, ranging from killing of an enemy combata...

During the winter peak in coronavirus cases, things got busy in my hospital, but nothing close to what happened in places like New York City last spring or Los Angeles this winter.  Hospitals in these places went way past their capacity, but did this strain on the system lead to worse outcomes?  Absolutely. On today's podcast, we talk with Brian Block, lead author of a Journal of Hospital Medicine...

We know from study after study that most older adults would prefer to age in place, in their homes, with their families and embedded in their communities.  But our health system is in many ways not particularly well set up to help people age in place.  Medicare does not routinely require measurement or tracking of disability that leads many people to move out of their homes, and many interventions...

There are no currently approved disease modifying drugs for Alzheimer's disease, but in a couple months that may change.   In July of 2021, the FDA will consider approval of a human monoclonal antibody called Aducanumab for the treatment of Alzheimer's disease.  If approved, it will not only make this drug the defacto standard of care for Alzheimer's disease, but will create a monumental shift in...

One of our earliest COVID podcasts with Jim Wright and David Grabowski a year ago addressed the early devastating impact of COVID on nursing homes.  One year ago Mike Wasserman, geriatrician and immediate past president of the California Long Term Care Association , said we'd have a quarter million deaths in long term care.  A quarter of a million deaths.  No one would publish that quote - it seem...

COVID has taken a devastated toll in nursing homes.  Despite representing fewer than 5% of the total US events, at least 40% of COVID‐19–related deaths occurred in older individuals living in nursing homes.  The good news is that with the introduction of COVID vaccines in nursing homes, numbers of infections and outbreaks have plummeted.   However, only about 2/3rds of nursing home patients and on...

Hospice may not be a great match for all of the care needs of people with dementia, but it sure does help.  And, as often happens, when patients with dementia do not decline as expected, they are too frequently discharged from hospice, an experience that Lauren Hunt and Krista Harrison refer to in an editorial in the Journal of the American Geriatrics Society (JAGS) as feeling like being "expelled...

The COVID pandemic brought to light many things, including how society views older adults. Louise Aronson wrote a piece in the NY Times titled " 'Covid-19 Kills Only Old People.' Only? Why are we OK with old people dying? ".  The ageist viewpoint she was rallying against was also brought to light in a study of ageism in social media .  When looking at those tweets that were related to older adults...

So what exactly does a hospice medical director do?  Why do some choose to become hospice physicians?  What additional training is needed, if any, beyond Hospice and Palliative Medicine fellowship and boards?  Who should take the new Hospice Medical Director Certification Board Examination ?  A recent study in JAGS found high rates of hospice disenrollment ("live discharge") for people with dement...

Where are we with Alzheimers?  Are we about to see a revolution in how we diagnose and treat it with Amyloid PET scans and the amyloid antibody aducanumab (which is currently on FDA's desk for approval)?  Or are we still in the same place where there is no meaningfully effective treatment?  Or is it somewhere in between, given the data that we have on comprehensive dementia care? We talk today wit...