GeriPal - A Geriatrics and Palliative Medicine Podcast

Nursing home residents have been devastated by COVID.  Somewhere around 40% of deaths from COVID have been among nursing home residents, though they make up just a sliver of the US population. Prognostication among nursing home residents who have COVID is important for a host of reasons - for counseling patients and families about what to expect, for making clinical decisions, and potentially for...

Lesbian, gay, bisexual and transgender (LGBT) older adults have lived through a lifetime of discrimination, social stigma, prejudice, and marginalization.  Is the care that we are giving them in later life changing any of that or are we pushing them back into the closet? This is what we talk about in this week's podcast with Carey Candrian from the University of Colorado School of Medicine, and An...

On the one hand, every year we are fortunate to have new medications that help older adults and people living with serious illness.  New treatments for lung cancer with remarkable survival outcomes come to mind, for example.   On the other hand, the tremendous growth in medications has led to an explosion of prescribing, polypharmacy, with attendant side effects and harms.   In this week's podcast...

Most of us know we are going to die.  How often though do we actually let ourselves really internalize that understanding?   To imagine it?  To feel it?  To try to accept it? On today's podcast we invited BJ Miller back on our podcast to talk about death using as our guide his recent NY Times editorial What Is Death?  How the pandemic is changing our understanding of mortality .  In addition to be...

Many of us in geriatrics and palliative care assume that we are the experts in health care when it comes to understanding the caregiver experience.  Every once in a while, we are humbled and reminded of what we don't know. Jessica Zitter had such an experience.  Jessica, as many of you know, is an award winning author (link to our podcast about her book Extreme Measures) and was featured in an Aca...

Surrogate decision‐making around life-sustaining treatments in the hospital even in the best of circumstances is hard.   It's maybe even harder when caring for those who are conserved or have a professional guardian.  The conservator may not have known the patient prior to them losing capacity, they may not know their values or goals that can help guide decisions, and they may be restricted by sta...

"Diagnose and adios."  That's the sad phrase that I've heard quoted more than once, representing caregivers' sentiment of what it's like to be told by a clinician that your loved one has dementia.  This week we talked with Zaldy Tan, Geriatrician and Director of the Memory and Aging program at Cedars Sinai in Los Angeles.  With David Reuben at UCLA and others working LA realized that current careg...

What does it mean to create a cultural shift to the end of life experience?  Is it even possible?  How do you even start something like that?   On today's podcast, we talk to Shoshana Ungerleider about her experience making that change.  Shoshana is one of those amazing advocates for palliative and end of life care.  She started the Ungerleider Palliative Care Education Fund to support innovative...

How long does it take to see a benefit of statin therapy for primary prevention of cardiovascular events in adults aged 50 to 75 years?  That's the question we try to answer with our two guests today, Drs Lindsey Yourman and Sei Lee, the lead and senior author of a JAMA IM study that tried to answer this question . In this podcast Drs. Yourman and Lee define what time to benefit is, why it is impo...

An age friendly health system is one in which everyone, from the doctors to the nurses to the people cleaning the rooms are aware of the unique needs of older adults.  These needs are categorized around the 4 M's - Medication, Mentation, Mobility, and What Matters Most.   But we cannot achieve the ideal of an age friendly health system without, well, changing systems.  In this week's podcast, we t...

The Emergency Department (ED) is a hard place to have serious illness discussions, whether it be goals of care or code status discussions, or whether or not to consider intubation for a seriously ill patient.  Emergency physicians often don't have the time for in-depth discussions, nor have been trained on how to do so.  There often is limited information about the patient, their functional status...

In this week's podcast we talk with Kieran Quinn, author of a  systematic review and meta-analysis of palliative care for non-cancer illness, published in JAMA.  We also talk with Krista Harrison, first author of an accompanying  editorial .  JAMA editors cut out some of my favorite parts of  Krista's editorial , possibly because they were more like a blog post than a JAMA editorial.  (I was senio...

There are a lot of large numbers that involve heart failure, starting with the sheer number of patients diagnosed (6.5 million and counting), to the cost of their care (~$70 billion by 2030), to the amount of money invested by the NIH into research ($1 billion annually). But the smaller numbers deserve attention too - 50% of patients die within 5 years of their diagnosis, those older than 65 in th...

On todays podcast, we have Lauren Moo, a cognitive behavioral neurologist who has been doing video visits well before the COVID-19 pandemic to decrease the need for travel and to decrease the agitation in older adults with dementia that commonly occur when a clinic visits disrupts the usual routine.   Now with COVID among us, Lauren talks to us about her recently published JAGS article titled Home...

Last month we published a podcast with Sean Morrison that garnered a great deal of attention, in which Sean Morrison argued that Advance Care Planning is an idea that is "clear, simple, and wrong." This week, we have a fresh updated counterpoint from Rebecca Sudore and Ryan McMahan. These two published a paper this week in the Journal of the American Geriatrics Society, or JAGS, that argues that t...

In 1968 a committee at Harvard Medical School met to lay down the groundwork for a new definition of death, one that was no longer confined to the irreversible cessation of cardiopulmonary function but a new concept based on neurological criteria. Over the next 50 years, the debate over the concept of brain death has never really gone away. Rather cases like Jahi McMath have raised issues of the l...

Chris Callahan (of Indiana University) and Lee Jennings (University of Oklahoma) have some righteous anger. Why do we have comprehensive cancer care centers and not comprehensive dementia care centers? We have a body of evidence dating back 30 years to support people with dementia and their caregivers with Comprehensive Dementia Care. Lee Jennings added to this robust body of work with a study pub...

Every year, about a third of older adults fall. About one in five of those falls result in moderate to severe injury. What can we do to help not only prevent those falls but also the complications of them? On todays podcast, we talk to Tom Gill, one of the authors of the recent Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study published in the NEJM. The STRIDE study was...

No dear listeners and readers, that is not a typo. Eric Widera is indeed our guest today to discuss his first author publication in the New England Journal of Medicine, Family Meetings on Behalf of Patients with Serious Illness. Our other guests include other authors James Frank, Wendy Anderson, Lekshmi Santhosh, me and actress and frequent GeriPal guest-host Anne Kelly. There's a story behind thi...

COVID-19 has created a perfect storm in nursing homes. As noted in a recent Journal of the American Geriatrics Society (JAGS) article by Joe Ouslander and David Grabowski, the storm is created by the confluence risks, including a vulnerable population that develop atypical presentations of COVID-19, staffing shortages due to viral infection, inadequate resources including testing and personal prot...

Sean Morrison dropped a bomb. It's a perspective I've heard before from outside of palliative care, most clearly by bioethicists Angie Fagerlin and Carl Schnieder in their landmark article Enough: The Failure of the Living Will. But Sean Morrison, Director of the National Palliative Care Research Center and Chair of the Department of Geriatrics and Palliative Medicine at Mt. Sinai, former Presiden...

In this week's GeriPal podcast we talk with Louise Aronson, author of the Pulitzer prize finalist Elderhood (https://www.amazon.com/Elderhood-Redefining-Transforming-Medicine-Reimagining/dp/1620405466). Louise has been one of the (sadly) few voices beating a loud and urgent drum in the medical and lay press about the insidious ageism taking place in the time of COVID. In a prior podcast we discuss...

Despite being in the field over 15 years, I've never felt so far outside my comfort zone as as palliative care provider as I have felt in the last four months. A worldwide pandemic of a novel virus had me questioning how I communicate prognostic information when uncertainty was one of the few things I was certain about. It also pushed me to have these conversations via telemedicine, something I wa...

If you looked at the academic literature, you would think that elder abuse and neglect, collectively called elder mistreatment, did not exist before the 1990s. Of course that's not true at all, it was hidden, covered, and not a major subject of research. Several pioneers have placed elder mistreatment firmly on the map, including XinQi Dong, Mark Lachs, and today's GeriPal podcast guest, Dean Laur...

This was a remarkable podcast. Eric and I were blown away by the eloquence of our guests, who were able to speak to this moment in which our country is hurting in so many ways. Today's topic is the impact of COVID19 on minority communities, but we start with a check in about George Floyd's murder and subsequent protests across the country. Our guest Monica Peek, Associate Professor of Medicine and...