GeriPal - A Geriatrics and Palliative Medicine Podcast

What level of evidence do we need for POLST to use it ourselves, to advocate for wider usage, and for establishing POLST completion as a quality metric?  The answers to these questions will vary.  Reasonable people will disagree.  And today, on our podcast, our guests disagree.  Firmly.  AND we are delighted that our guests modeled respectful disagreement.  With no hard feelings .  Respectful disa...

For surgeons and patients, deciding if and when to operate can be challenging. Often, the way surgeons communicate about these decisions doesn't make things any easier for themselves or their patients. And, surgeons often spend the majority of their conversations with patients describing anatomical details and exactly how they plan to 'fix it' , with little discussion of what that 'fix' will do fo...

Communicating about a serious illness is hard. Last week's podcast we talked about the challenge around miscommunication in serious illness. This week we dive into the challenges with communication when it comes to life sustaining treatments and CPR. Take for example the simple question: "If her breathing gets any worse, she will need to be intubated." This seems like an innocuous statement of fac...

Medical communication is tough, although fundamentally at its most basic unit of delivery, it includes really only three steps. First, a clinician's thoughts must be encoded into words, then transmitted often via sounds, and finally decoded back to thoughts by a patient or family member. Simple, right? Not so much, as each one of these steps is fraught with miscommunication. For example, a surgeon...

The proportion of people living with dementia who identify as Black/African Americans is on the rise , and so too are the proportion of caregivers who identify as Black/African American.  As our guests talk about today, caregiving for people living with dementia takes a tremendous toll, and when this toll is set atop the challenges of racism in all its forms, the reality of caregiving while Black...

Hospitals are hazardous places for older adults. These hazards include delirium, malnutrition, falls, infections, and hospital associated disability (which about ⅓ of older adults get during a hospital stay).  What if, for at least some older adults who need acute-level care, instead of treating them in the hospital, we treat them at home? That's the focus of the hospital-at-home movement, and the...

The comprehensive geriatric assessment is one of the cornerstones of geriatrics.  But does the geriatric assessment do anything?  Does it improve outcomes that patients, caregivers, and clinicians care about? Evidence has been mounting about the importance of the geriatric assessment for older adults with cancer, the subject of today's podcast.  The geriatric assessment has been shown in two landm...

How do people react when they hear they have a serious illness?  Shock, "like a car is rushing straight at me" (says Bill Gardner on our podcast).  After the shock?  Many people strive, struggle, crawl even back toward a " normal " life.  And some people, in addition or instead, engage in deep introspection on how to make meaning or live with or understand this experience of serious illness.  Toda...

I hear the word dignity used a lot in the medical setting, but I'm never sure what people mean when they use it.  You'd imagine that as a seasoned palliative care doc, I'd have a pretty good definition by now of what "maintaining dignity" or "loss of dignity" means, but you'd be sadly wrong. Well that all changes today as we've invited the world's foremost expert in dignity at the end of life, Dr....

It's been over two years since one of the worst product launches of all time - Aduhelm (aducanumab).  Praised by the FDA, Alzheimer's Association (AA), and Pharma as a "game changer", but derided by others for the drug's lack of clinical efficacy, risk of severe adverse effects, absence of diversity in trial populations, high costs, and an FDA approval process that was in the kindest words "rife w...

Insomnia. We've all had it. Lying in bed at 2 am staring at the ceiling, getting anxious every hour that you're not falling asleep as you have a busy day coming up. Insomnia sucks.  Chronic insomnia sucks even more. For those with serious illness, sleep problems and insomnia are all too common.  Instead of reflexively jumping to melatonin or ambien, on today's podcast we talk with two sleep expert...

There's a saying, "never let a crisis go to waste."  The pandemic was horrific in many ways.  One positive change that came about was the lifting of restrictions around the use of telemedicine.  Clinicians could care for patients across state lines, could prescribe opioids without in person visits, could bill at higher rates for telemedicine than previous to the pandemic.  Many patients benefited,...

Today's podcast is a follow up to our 2018 podcast with Randy Curtis about the Jumpstart intervention.  On that podcast he and collaborators tested a combined patient and clinician facing communication priming intervention to promote goals of care conversations.  Today we discuss a new paper in JAMA that tests a stripped down version of the clinician only facing intervention in a pragmatic randomi...

You may have heard of Area Agencies on Aging, but do you really know what they do or how they do it?  What about State Departments of Aging or state master plans for aging?  Do you know how these agencies fit in with programs like Meals-on-Wheels or other nutritional support programs? Is your brain hurting yet with all these questions?  No?  Ok, what about Aging and Disability Resource Connection...

I don't know 'bout religion I only know what I see And in the end when I hold their hand It's both of us set free These are the ending lyrics to Bonnie Raitt's song "Down the Hall", an ode to the Pastoral Care Workers who care for their fellow inmates in the hospice unit at the California Medical Facility in Vacaville, California. On last week's podcast we interviewed the medical director and the...

    In the early 1990's, California Medical Facility (CMF) created one of the nation's first licensed hospice units inside a prison. This 17-bed unit serves inmates from all over the state who are approaching the end of their lives. A few are let out early on compassionate release.  Many are there until they die. Today's podcast is part one of a two-part podcast where we spend a day at CMF, a medi...

Artificial Intelligence, or AI, has tremendous potential.  We talk on this podcast about potential uses of AI in geriatrics and palliative care with natural language processing guru Charlotta Lindvall from DFCI, bioethicists and internist Matt DeCamp from University of Colorado, and prognosis wizard Sei Lee from UCSF. Social companions to address the epidemic of loneliness among older adults Augme...

Diabetes is common.  When I'm on nursing home call, the most common page I receive is for a blood sugar value.  When I'm on palliative care consults and attending in our hospice unit we have to counsel patients about deprescribing and de-intensifying diabetes medications.  Given how frequent monitoring and prescribing issues arise in the care of patients with diabetes in late life, including the e...

Our guests today present an important rejoinder to the argument that we should refocus away from advance care planning (ACP).  Sarah Nouri, Hillary Lum, and LJ Van Scoy argue that diverse communities are asking for ACP.  Sarah Nouri gives an example from her work in the LGBTQ+ community of a trans woman who was buried as a man because existing laws/rules did not protect her wishes.  Others cited t...

Hot off the press is a brand spanking new updated 2023 AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults .  The Beers Criteria is one of the most frequently cited reference tools in geriatrics, detailing potentially inappropriate medications to prescribe to older people. We've invited two members who helped update the criteria including Todd Semla and Mike Steinman.  ...

We've had multiple GeriPal episodes about treatments for dementia, including aducanumab ( here , here , and here ) and lecanemab ( here ).  As today's guest, Kristine Yaffe notes, part of the reason for that emphasis is that in the US we prioritize treatment, whereas other countries are ahead of us in prioritizing prevention.  Deb Barnes and Kristine Yaffe published a landmark paper in Lancet Neur...

I haven't worked with many adolescents and young adults (AYA, roughly teens to twenties).  But when I have, I find that they're often some of the hardest patients to care for.  Why?  We talk about why it's so hard with Abby Rosenberg (chief of PC at DFCI and Boston Childrens), Nick Purol (clinical social worker at DFCI and Boston Childrens), Daniel Eison (pediatric PC doc and co-host of PediPal). ...

We have a special extra podcast this week.  During the last AAHPM - HPNA meeting in Montréal, we went around asking attendees what one thing that they are most worried about and one thing they are most hopeful for when thinking about the future of our field.  We couldn't fit everyone's responses in but came up with the big themes for questions and edited them into this weeks podcast / YouTube vide...

In 1990 11% of homeless persons were older than 50.  Today half are over age 50.  Today we talk with Margot Kushel about how we got here, including: That sense of powerlessness as a clinician when you "fix up" a patient in the hospital, only to discharge them to the street knowing things will fall apart. Chronic vs acute homelessness What is the major driver of homelessness in general?   What is t...

Social connections impact our health in profound ways, whether it is the support we receive from family and friends in navigating serious illness, the joy from shared social activities, or connecting with our community. Experiencing social isolation , the objective lack of contact with friends, family, or the community, or loneliness , the subjective feeling of lacking companionship or feeling lef...