GeriPal - A Geriatrics and Palliative Medicine Podcast

If you develop dementia, odds are you will spend the last months to years of your life in a nursing home or assisted living facility.   While we like to think about how our goals and preferences will influence what that life looks like, including whether you will get potentially burdensome interventions, your fate is probably influenced more by factors like where you live and what nursing home you...

A little over a decade ago, Ken Covinsky wrote a GeriPal post about a Jack Iwashyna JAMA study finding that older adults who survive sepsis are likely to develop new functional and cognitive deficits after they leave the hospital. To this day, Ken's post is still one of the most searched and viewed posts on GeriPal. This idea that for critically ill patients in the ICU, geriatric conditions like d...

There is a lively debate going on in academic circles about the value of Advance Care Planning (ACP).  It's not a new debate but has gathered steam at least in palliative care circles since Sean Morrisons published a JPM article titled " Advance Directives/Care Planning: Clear, Simple, and Wrong ."  Since then there has been a lot of back and forth, with even a couple of podcasts from us, several...

My mom is an Asian woman in her 70s with osteoporosis.  She tried an oral bisphosphonate and had horrible esophagitis.  She said never again, though she eventually tried an IV bisphosphonate.  She had terrible flu-like symptoms.  She said never again.  But based on reports that symptoms are worse the first time, she tried the IV again the next year and fortunately experienced no symptoms.  (Story...

This week many of our listeners will gather for the annual American Academy of Hospice and Palliative Medicine (AAHPM) & Hospice and Palliative Nursing Association (HPNA) annual meeting.  While the majority of this meeting is focused on subspecialty care in the US, the majority of individuals who are in need of palliative care live in low and middle-income countries without even basic access to pa...

In prior podcasts we talked about racism and COVID , lack of diversity in the palliative care workforce , racial and ethnic differences in end of life care , and implicit bias in geriatrics and palliative care . Today our focus is on structural, institutional, and interpersonal racism, and how these different but related constructs negatively impact the care of older adults and people with serious...

Patients with end stage liver disease and decompensated cirrhosis have an average life expectancy of 2 years without transplant .  Outcomes are worse among those who are frail .  Symptoms are common, including pain, ascites, encephalopathy, and pruritus.  Patients with end stage liver disease are often some of the most disadvantaged patients we care for.  Caregiver burden is immense; divorce is co...

More Health Policy this week! Today, we discuss "SNPs" but this is not a podcast about haircuts during the pandemic. We take a deeper dive into the world of Medicare Advantage and what it means for vulnerable patients facing serious illness and those at the end of life.  We are joined by UCSF geriatrics fellow Alex Kazberouk to talk to Dr. Claire Ankuda (Assistant Professor at Icahn School of Medi...

Investor money and venture capital funding is pouring into Medicare Advantage (MA) plans. Enrollment in MA plans has more than doubled from 12 million members in 2011 to 26 million in 2021. What does this mean for us and our patients? Do these plans deliver better care for vulnerable older adults? Or are they a money making machine driving up healthcare costs in the name of profit?  On today's pod...

Three months ago we did a podcast with Randy Curits about his recent diagnosis of ALS in March and what it was like for someone who studies and cares for people living with serious illness, to now be someone who is living with serious illness.  It was one of our favorite podcasts we've done, but also got us to think "wait, how come we've never done a podcast on ALS?" We fix that on today's podcast...

It's GeriPal's 200th episode.  Yup, we started the podcast in 2016 and over the years we have grown from basically podcasting for Alex's mom to now getting over 25,000 plays per month.    So to celebrate our 200th, and given that the last two years kinda sucked in a lot of ways, we are going to pivot to appreciative inquiry.  We have invited leaders in geriatrics and palliative care to quickly sha...

Geriatric Oncology has arrived.  Yes, Louise Walter has been leading the fight to improve cancer screening in older adults for years.  But when it came to geriatricizing the way we assess and treat older adults with cancer, the evidence was thin. In our prior podcast with Supriya Mohile and William Dale on geriatric assessment in oncology, we couldn't say for certain if a geriatric assessment was...

Geriatric anesthesia is a thing.  The average age of people getting surgery is increasing .  Anesthesiologists and surgeons feel that with new techniques and approaches they can perform surgery on patients at ever older ages, patients who they previously would have excluded from surgery.   One of the key advances in geriatric anesthesia is the use of spinal anesthesia, a form of regional anesthesi...

The great resignation is upon us.  One in five health-care workers has left their job since the pandemic started .  Geriatrics and palliative care are not immune to this, nor are we immune to the burnout that is associated with providers leaving their jobs.  In today's podcast, we talk with Janet Bull and Arif Kamal about what we can do to address burnout and increase resiliency, both from an inst...

I don't consider myself spiritual.  For some in palliative care, this would be considered heresy as we are told "everyone is spiritual."  But, hey, I'm not.  So there.  However, despite not being spiritual, I do believe that spiritual care is fundamental to the care I give patients and families.  I also recognize it is the one palliative care domain I am most uncomfortable with and the one that as...

Though "breath" is in the title of Wes Ely's book (and his song choice by the Police), relationships are its beating heart. The book operates on two levels. On one level, Wes Ely's book is an autobiography of a critical care doctor's horror and shame at discovering that his ICU practice of heavily sedating patients for days on end was leading to lifelong physical, cognitive, and psychological harm...

Anyone who cares for individuals with serious illness must live in a messy space where tough conversations about treatment decisions are common and complicated.    On today's podcast we talk with James Tulsky about living in this messy space of medical decision making and the challenges that come with communication around advanced treatment decisions.  We talked about James' path to the work that...

"The secret sauce of the Transitions, Referral and Coordination (TRAC) team was including a  lawyer."  This is brilliant and will ring true to those of us who care for complex older adults who end up in the hospital for long, long, long admissions. On today's podcast we talk with Kenny Lam, Jessica Eng, Sarah Hooper, and Anne Fabiny about their successful interdisciplinary intervention to reduce p...

Most studies in geriatrics have used metrics such as survival time or disability in activities of daily living as their outcome measure.  Many palliative care interventions are evaluated on the basis of ability to change symptoms such as pain.  But these outcomes represent a thin view of the human experience.  What older adults and those with serious illness often care about most is being able to...

The FDA label for the amyloid antibody aducanumab (Aduhelm) started off exceedingly broad, basically including anyone with Alzheimer's disease, but was subsequently narrowed to to patients with mild cognitive impairment (MCI) or mild dementia due to Alzheimer disease (AD).  Should, though, the label be even more restrictive to mirror the populations studied in the two still unpublished trials of t...

"The take home message of this study is NOT that primary palliative care does not work."  So says Yael Schenker of the negative study of an oncology nurse-led primary palliative care intervention for people with advanced cancer. And we pushed Yael and Bob Arnold (senior author) on this point - we have several negative studies of primary palliative care (see links below to podcasts)  - is it time t...

Time-limited trials. We've all probably used them before. We meet with patients and families.  We agree to either start or continue a particular treatment to see if it helps in some specific way over some defined period of time. If it works as hoped, great, we continue the treatments.  If not, we stop them.  At least that is how it's supposed to go.  On today's podcast we talk all about these time...

I'm going to start this introduction the way Eric ended our podcast. You are a GeriPal listener.  Like us, you care deeply about our shared mission of improving care for older adults and people living with serious illness.  This is hard, complex, and deeply important work we're engaged in.  Did you know that most GeriPal listeners have given us a five star rating and left a positive comment in the...

Randy Curtis, a paragon of palliative care research, was diagnosed with ALS in March.   Randy is in a unique position as someone who studies and cares for people living with serious illness, who now shares his reflections on being on the other side, to reflect on the process of living with serious illness.  His reflections are illuminating and inspiring. We talk with Randy about his experience bei...

alliative care has a diversity problem.  The workforce of palliative care looks nothing like the patient population that we care for in the hospital and in our clinics.   For example, in 2019-2020 academic year only 4% of Hospice and Palliative Care fellows identified as black, compared to 12% of the overall US population using the most recent census information.   These issues are similar for hos...