GeriPal - A Geriatrics and Palliative Medicine Podcast

Home-based palliative care is booming. And with the growth of home-based palliative care come unique struggles and challenges: how can it be financed, what does the ideal team look like (or do you need a team?), retaining clinicians who may feel isolated doing this work, identifying patients who are most likely to benefit. In this week's podcast we talk about these and other issues with Brook Calt...

On this week's podcast we have the honor of talking with David Reuben about health care for older adults and how it's time to think different. It really is a smörgåsbord of topics, ranging from how to think about population health for older adults (and how we as individuals providers can provide at least some level of population health), the UCLA Alzheimer's and Dementia Care Program and its outco...

We had fun on this in-studio podcast with Dan Matlock, geriatrician and palliative care clinician researcher at the University of Colorado, and frequent guest and host on GeriPal. We most recently talked with Dan about Left Ventricular Assist Devices and Destination Therapy. Today we talked with Dan about Implantable Cardiac Defibrillators (ICD) and Cardiac Resynchronization Therapy (CRT) - everyt...

In this week's podcast we talk about food insecurity in older adults with UCSF's Hilary Seligman, MD. Hilary has done pioneering work in this area. Some of this work was funded by Archstone Foundation (full disclosure: Archstone is a GeriPal funder). Hilary's expertise runs the gamut from federal nutrition programs (including SNAP), food banking and the charitable feeding network, hunger policy, f...

Should Geriatric Assessments be part of the routine ontological care for older adults with cancer? On this weeks podcast we attempt to answer this question with national experts in Geriatric Oncology: Dr. Supriya Mohile from the University of Rochester and William Dale from City of Hope, as well as UCSF's Melissa Wong. Lucky for us, they also have a little evidence on their side thanks to a recent...

You've probably heard patients say, "Of course I'm depressed, I'm dying. Wouldn't you be?" This is a fundamental question - to what extent are depressive symptoms "normal" at the end of life? To what extent are they maladaptive, a fancy word for psychological conditions that have a negative impact on your life. In this week's GeriPal podcast we talked with Elissa Kozlov, a psychologist-researcher...

Do opioids improve breathlessness? A simple question that unfortunately doesn't seem to have a simple answer. We get into the nitty-gritty of potential answers to this question with a preeminent researcher in this field, David Currow. David is a Professor of Palliative Medicine at University of Technology Sydney. His research has challenged common practices in Hospice and Palliative Care, includin...

In this weeks podcast we talk with Kirsten Bibbins-Domingo, general internist, Professor of Medicine and Epi/Biostats at UCSF, and chair of a National Academies of Sciences task force on Integrating Social Care into the Delivery of Health Care. See Kirsten's JAMA paper summary here (https://jamanetwork.com/journals/jama/article-abstract/2752359), and the full report here (http://nationalacademies....

On this weeks podcast we talk to Julie Bynum on the question "Do Nurses Die Differently?" based on her recent publication in JAGS titled "Serious Illness and End-of-Life Treatments for Nurses Compared with the General Population." Julie is a Professor of Geriatric and Palliative Medicine at the University of Michigan, and Geriatric Center Research Scientist at the Institute of Gerontology, as well...

We have had some amazing guests on our Podcast. True luminaries in geriatrics and palliative care. This week we are fortunate to be joined by none other than Mary Tinetti, MD, to talk about her recent JAMA Internal Medicine trial of Patient Priorities Care (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2752365). In this study of older adults with multiple chronic condition...

On today's podcast we take a moment to celebrate 100 episodes of the GeriPal podcast. Yes, 100 episodes that have covered everything from cranberry juice for UTIs to medical aid in dying. In this episode, Anne Kelly, Lynn Flint and Ken Convinsky lead us down memory lane, asking Alex and me hard hitting questions about the birth of the podcast, our favorite episodes, and our most memorable moments....

Nursing homes are a tough place to do palliative care. There is extremely high staff turnover, physicians are often not present except for the occasional monthly visit, many residents die with untreated symptoms usually after multiple hospitalizations and burdensome life-prolonging treatments, and specialty palliative care - well that is nowhere to be found in most nursing homes outside of hospice...

A recent study by Vince Mor published in JAMA Oncology found that veterans with advanced lung cancer treated in Veterans Affairs (VA) Medical Centers with high hospice use were more likely to receive concurrent cancer care and also less likely to receive aggressive care. On top of that, veterans treated at facilities with high levels of hospice use also incurred lower costs of care. This is a stro...

Do you remember the scene from the movie The Graduate where Ben's dad says, "One word: Plastics"? Well, I write this blog post from the National Palliative Care Research Center's annual Foley retreat, a who's who of palliative care researchers. The words on everyone's lips: "Lay Health Navigators." This is not to draw equivalency between environmentally destructive materials and people who help th...

Before we get into this week's topic, would you please take 1 MINUTE to complete this GeriPal survey! It will really help us out. We swear, only 1 minute! Click the link below to access the survey (or copy and paste in your browser). Thank you! GERIPAL SURVEY https://ucsf.co1.qualtrics.com/jfe/form/SV_esS7pUAOgSIbNGZ Now on to this week's topic... Alex: What do you get when you mix a doctor and an...

What happens in Long Term Acute Care Hospitals, or LTACs (pronounced L-tacs)? I've never been in one. I've sent patients to them - usually patients with long ICU stays, chronically critically ill, with a gastric feeding tube and a trach for ventilator support. For those patients, the goals (usually as articulated by the family) are based on a hope for recovery of function and a return home. And ye...

Ok, I'll admit it. When I hear the phrase "the biology of aging" I'm mentally preparing myself to only understand about 5% of what the presenter is going to talk about (that's on a good day). While I have words like telomeres, sirtuins, or senolytics memorized for the boards, I've never been able to see how this applies to my clinical practice as it always feels so theoretical. Well, today that ch...

Joanne Lynn, a geriatrician and palliative care physician who leads Altarum's work on eldercare, wrote a recent JAGS editorial titled The "Fierce Urgency of Now": Geriatrics Professionals Speaking up for Older Adult Care in the United States" which is very much a call to action for those who care for older adults. We talk with Joanne about this article and some meaningful things clinicians in both...

You're the attending physician on a teaching service. Your resident says we shouldn't order a CT because CT's are over-used for this condition, and represent overuse, waste, and low-value care. In this case, however, you suspect that's not the resident's real reason. The real reason behind the resident's decision is that they are serial minimizers - residents who make little of potentially importa...

On this weeks podcast, we talk with Krista Harrison about the life of individuals living with moderate dementia, as well as what we know about their caregivers. Krista is is an Assistant Professor in the Division of Geriatrics at UCSF, a social scientist, and something that we learned in this podcast, someone who knows a thing or two about singing opera. Krista recently published a JAGS paper titl...

In this week's podcast we talk with Lew Cohen, MD, about his new book "A Dignified Ending: Taking Control Over How We Die." Eric and I approached reading this book with trepidation. We feared it would be a polemic defending physician aid in dying. It is not. Dr. Cohen does not hide his beliefs and opinions. He also does not shy away from the complexity of the issue - he interviews leading disabili...

In this week's GeriPal podcast we talk with Stacy Fischer, MD and Regina Fink, RN, PhD, both from the University of Colorado, about a lay health navigator intervention to improve advance care planning with Latinos with advanced cancer. The issue of lay health navigators raises several issues that we discuss, including: - What is a lay health navigator? - What do they do? How are they trained? - Wh...

This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End." As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care. His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times. As we discuss on the Podcast...

This weeks podcast is all about the intersection of geriatrics, palliative care, advanced care planning and surgery with our guest Dr. Vicky Tang. Vicky is an assistant professor and researcher here at UCSF. We talk about her local and national efforts focused on this intersection, including: * Her JAMA Surgery article that showed 3 out of 4 older adults undergoing high risk surgery had no advance...

There are few names more closely associated with palliative care than Diane Meier. She is an international leader of palliative care, a MacArthur "genius" awardee, and amongst many other leadership roles, the CEO of the Center to Advance Palliative Care (CAPC). We were lucky enough to snag Diane for our podcast to talk about everything we always wanted to ask her, including: * What keeps her up at...