Shows
GeriPal - A Geriatrics and Palliative Care PodcastHIV, Aging, and Palliative Care: Peter Selwyn and Meredith GreenePeter Selwyn, one of today’s guests, has been caring for people living with HIV for over 40 years. In that time, care of people with HIV has changed dramatically. Initially, there was no treatment, then treatments with marginal efficacy, complex schedules, and a tremendous burden of side effects and drug-drug interactions. The average age at death was in the 30s. Now, more people in the US die with HIV rather than from HIV. Treatment regimens are simplified, and the anti-viral drugs are well tolerated. People are living with HIV into advanced ages. The average age at death is likel...2025-05-0148 min
GeriPal - A Geriatrics and Palliative Care PodcastGeriPal Takeover! Nancy Lundebjerg and Annie Medina-WalpoleWhelp, goodbye folks! Eric and I have been DOGE’d. In a somewhat delayed April Fools, Nancy Lundebjerg and Annie Medina-Walpole have taken over podcast host duties this week. Their purpose is to interview me, Eric, and Ken Covinsky about your final AGS literature review plenary session taking place at the Annual Meeting in Chicago this May (for those attending, our session is the plenary the morning of May 10). We discuss our favorite articles, parody songs, and memories from AGS meetings past, with a little preview of a song for this year’s meeting. We co...2025-04-0351 min
GeriPal - A Geriatrics and Palliative Care PodcastHastening Death by Stopping Eating and Drinking: Hope Wechkin, Thaddeus Pope, & Josh BriscoeEric and Alex have featured discussions about complex bioethical concepts around caring for people at the end of life, including voluntarily stopping eating and drinking (VSED), and multiple episodes about the ethical issues surrounding medical aid in dying (MAID). Recently, discussion has emerged about how these issues intertwine in caring for patients with advancing dementia who have stated that they would not want to continue living in that condition: for those with an advanced directive to stop eating and drinking, how do we balance caring for their rational past self and their experiential current self? Should these patients qualify...2025-03-2051 min
GeriPal - A Geriatrics and Palliative Care PodcastThe Roots of Palliative Care: Michael Kearney, Sue Britton, and Justin SandersAs far as we’ve come in the 50 years since Balfour Mount and Sue Britton opened the first palliative care at the Royal Victoria Hospital in Quebec, have we lost something along the way? In today’s podcast we welcome some of the early pioneers in palliative care to talk about the roots of palliative care. Sue Britton was the first nurse hired on that palliative care unit. Michael Kearney on a transformational meeting in Cicely Saunders’s office, with Balfour Mount at her side and a glass of sherry. Justin Sanders wants to be sure the newer ge...2025-03-1348 min
GeriPal - A Geriatrics and Palliative Care PodcastPC for People Experiencing Homelessness: Naheed DosaniI was very proud to use the word “apotheosis” on today’s podcast. See if you can pick out the moment. I say something like, “Palliative care for people experiencing homelessness is, in many ways, the apotheosis of great palliative care.” And I believe that to be true. When you think about the early concepts that shaped the field, you can see how palliative care for persons experiencing homelessness fits like a hand in a glove: total pain envisioned by Cicely Saunders, which even its earliest sketches included social suffering like loneliness; or Balfour Mount, who coined the term “palliative care...2025-03-0646 min
GeriPal - A Geriatrics and Palliative Care PodcastPC for Patients with Substance Use Disorder: Janet Ho, Sach Kale, Julie ChildersMuch like deprescribing, we plan to revisit certain high impact and dynamic topics frequently. Substance use disorder is one of those complex issues in which clinical practice is changing rapidly. You can listen to our prior podcasts on substance use disorder here, here, here, and here. Today we talk with experts Janet Ho, Sach Kale, and Julie Childers about opioid use disorder and serious illness. We address: Why is caring for patients with this overlap so hard? Inspired by Dani Chammas’s paper in Annals of Internal Medicine titled, “Wishing for a no show” we talk about...2025-02-2751 min
GeriPal - A Geriatrics and Palliative Care PodcastPlenary Abstracts at AAHPM/HPNA: Yael Schenker, Na Ouyang, Marie BakitasIn today’s podcast we were delighted to be joined by the presenters of the top scientific abstracts for the Annual Assembly of the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Medicine Nurses Association (HPNA). Eric and I interviewed these presenters at the meeting on Thursday (before the pub crawl, thankfully). On Saturday, they formally presented their abstracts during the plenary session, followed by a wonderful question and answer session with Hillary Lum doing a terrific job in the role of moderator. Our three guests were Marie Bakitas, who conducted a trial...2025-02-1347 min
GeriPal - A Geriatrics and Palliative Care PodcastDialysis vs Conservative Management for Older Adults: Manju Kurella Tamura, Susan Wong, & Maria Montez-RathWe recently published a podcast on palliative care for kidney failure, focusing on conservative kidney management. Today we’re going to focus upstream on the decision to initiate dialysis vs conservative kidney management. As background, we discuss Manju Kurella Tamura’s landmark NEJM paper that found, contrary to expectations, that function declines precipitously for nursing home residents who initiate dialysis. If the purpose of initiating dialysis is improving function - our complex, frail, older patients are likely to be disappointed. We also briefly mention Susan Wong’s terrific studies that found a disconnect between older adults...2024-11-0747 min
GeriPal - A Geriatrics and Palliative Care PodcastCOVID Updates: A Podcast with Peter Chin-Hong and Lona ModyIn March 2020, we launched our first podcast on COVID-19. Over the past four years, we’ve seen many changes—some positive, some negative. While many of us are eager to move past COVID (myself included), it’s clear that COVID is here to stay. This week, we sit down with infectious disease experts Peter Chin-Hong and Lona Mody to discuss living with COVID-19. Our conversation covers: The current state of COVID Evidence for COVID boosters, who should get them, and preferences between Novavax and mRNA vaccines COVID treatments like Molnupiravir and Paxlov...2024-10-3143 min
GeriPal - A Geriatrics and Palliative Care PodcastStump the VitalTalk Communication Experts: A Podcast with Gordon Wood, Holly Yang, Elise CareySerious illness communication is hard. We must often deliver complex medical information that carries heavy emotional weight in pressured settings to individuals with varying cultural backgrounds, values, and beliefs. That’s a hard enough task, given that most of us have never had any communication skills training. It feels nearly impossible if you add another degree of difficulty, whether it be a crying interpreter or a grandchild from another state who shows up at the end of a family meeting yelling how you are killing grandma. On today’s podcast, we try to stump three VitalTalk expert facu...2024-08-2948 min
GeriPal - A Geriatrics and Palliative Care PodcastBetween Two Urns: Undertaker Thomas Lynch(We couldn’t resist when Miguel Paniagua proposed this podcast idea and title. And no, you’ll be relieved to hear Eric and I did not imitate the interview style of Zach Galifiniakis). We’ve talked a good deal on this podcast about what happens before death, today we talk about what happens after. Our guest today is Thomas Lynch, a poet and undertaker who practiced for years in a small town in Michigan. I first met Thomas when he visited UC Berkeley in the late 90’s after publishing his book, “The Undertaking: Stories from the Dismal Trade.”...2024-08-0847 min
GeriPal - A Geriatrics and Palliative Care PodcastOptimizing Nutrition in Aging: A Podcast with Anna Pleet, Elizabeth Eckstrom, and Emily JohnstonWhat is a healthy diet and how much does it really matter that we try to eat one as we age? That’s the topic of this week's podcast with three amazing guests: Anna Pleet, Elizabeth Eckstrom, and Emily Johnston. Emily Johnston is a registered dietitian, nutrition researcher, and Assistant professor at NYU. Anna Pleet is an internal medicine resident at Allegheny Health Network who has a collection of amazing YouTube videos on aging and the Mediterranean diet. Elizabeth Eckstrom is a geriatrician, professor of medicine at OHSU, and author of a new book, the Gift of Agin...2024-08-0151 min
GeriPal - A Geriatrics and Palliative Care PodcastAgeism and Elections: Louise Aronson and Ken CovinskyEmergency podcast! We’ve been asked by many people, mostly junior/mid career faculty, to quickly record a podcast on ageism and the elections. People are feeling conflicted. On the one hand, they have concerns about cognitive fitness of candidates for office. On the other hand, they worry about ageism. There’s something happening here, and what it is ain’t exactly clear. We need clear eyed thinking about this issue. In today’s podcast, Louise Aronson, author of Elderhood, validates that this conflict between being concerned about both fitness for the job and alarmed about ageism is exactly t...2024-07-1647 min
GeriPal - A Geriatrics and Palliative Care PodcastAnxiety in Late Life and Serious Illness: A Podcast with Alex Gamble and Brianna Williamson“Anxiety is a lot like a toddler. It never stops talking, tells you you’re wrong about everything, and wakes you up at 3 a.m.” I’m not sure who wrote this quote, but it feels right to me. We’ve all had anxiety, and probably all recognize that anxiety can be a force of action or growth but can also spiral to quickly take over our lives and our sleep. How, though, do we navigate anxiety and help our patients who may end up in the anxiety spiral that becomes so hard to get out of? On today’s...2024-06-2756 min
GeriPal - A Geriatrics and Palliative Care PodcastUrinary Incontinence Revisited: George Kuchel & Alison HuangI have to start with the song. On our last podcast about urinary incontinence the song request was, “Let it go.” This time around several suggestions were raised. Eric suggested, “Even Flow,” by Pearl Jam. Someone else suggested, “Under Pressure,” but we’ve done it already. We settled on, “Oops…I did it again,” by Britney Spears. In some ways the song title captures part of the issue with urinary incontinence. If only we lived in a world in which much of urinary incontinence was viewed as a natural part of aging, the normal response wasn’t embarrassment and shame, but...2024-06-2045 min
GeriPal - A Geriatrics and Palliative Care PodcastSexual Function in Serious Illness: Areej El-Jawahri, Sharon Bober, and Don DizonAs Eric notes at the end of today’s podcast, we talk about many difficult issues with our patients. How long they might have to live. Their declining cognitive abilities. What makes their lives meaningful, brings them joy, a sense of purpose. But one issue we’re not as good at discussing with our patients is sexual health. On today’s podcast Areej El-Jawahri, oncologist specializing in blood cancers at MGH, says that sexual health is one of the top if not the top issue among cancer survivors. Clearly this issue is important to patients. Sharon Bober, clinical p...2024-06-0651 min
GeriPal - A Geriatrics and Palliative Care PodcastHow Pharma Invents Diseases: A Podcast with Adriane Fugh-BermanWho gets to decide on what it means to have a disease? I posed this question a while back in reference to Alzheimer's disease. I’ll save you from reading the article, but the main headline is that corporations are very much the “who” in who gets to define the nature of disease. They do this either through the invention of disease states or, more often, by redrawing the boundaries of what is considered a disease (think pre-diabetes). On today's podcast, we invite Adriane Fugh-Berman to discuss the influence of industry, whether it be pharma or device manufa...2024-05-1647 min
GeriPal - A Geriatrics and Palliative Care PodcastPublic Facing Education via Social Media: A Podcast with Julie McFadden, Matt Tyler, Sammy Winemaker and Hsien SeowOn today’s podcast, we’ve invited four hospice and palliative care social media influencers (yes, that’s a thing!), all of whom focus their efforts on educating the general public about living and dying with a serious illness. Their work is pretty impressive in both reach (some of their posts are seen by millions of viewers) and breadth of work. We’ve invited: Julie McFadden (aka Hospice Nurse Julie): Julie is a social media superstar, with 1.5 million subscribers on TikTok, another 400,000 subscribers on her YouTube channel, and another 350k followers on Instagram. She covers topics on death, dy...2024-05-0947 min
GeriPal - A Geriatrics and Palliative Care PodcastThe Promise and Pitfalls of AI in Medicine: Bob WachterEric asks the question that is on many of our minds - is the future of AI more Skynet from Terminator, in which AI takes over the world and drives humanity to the brink of extinction, or Wall-E, in which a benevolent and empathetic AI restores our humanity? Our guest today is Bob Wachter, Chair of Medicine at UCSF and author of the Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. Bob recently wrote an essay in JAMA on AI and delivered a UCSF Grand Rounds on the same topic. We disc...2024-04-1844 min
GeriPal - A Geriatrics and Palliative Care PodcastPC Trials at State of Science: Tom LeBlanc, Kate Courtright, & Corita GrudzenOne marker of the distance we’ve traveled in palliative care is the blossoming evidence base for the field. Ten years ago we would have been hard pressed to find 3 clinical trial abstracts submitted to the annual meeting, much less high quality randomized trials with robust measures, sample sizes, and analytics plans. Well, as a kick off to this year’s first in-person State of the Science plenary, held in conjunction with the closing Saturday session of the AAHPM/HPNA Annual Assembly, 3 randomized clinical trials were presented. Today we interview the authors of these 3 abstracts about their findi...2024-03-2839 min
GeriPal - A Geriatrics and Palliative Care PodcastElectronic Frailty Indexes: Kate Callahan, Ariela Orkaby, & Dae KimWhat is frailty? Kate Callahan relates a clear metaphor on today’s podcast. A frail person is like an origami boat: fine in still water, but can’t withstand a breeze, or waves. Fundamentally, frailty is about vulnerability to stress. In 2021 we talked with Linda Fried about phenotypic frailty. Today we talk with Kate Callahan, Ariela Orkaby, & Dae Kim about deficit accumulation frailty. What is the difference, you ask? George Kushel probably explained it best in graphical terms (in JAGS), using the iconic golden gate bridge as a metaphor (Eric and I get to see the bridge daily dri...2024-03-2144 min
GeriPal - A Geriatrics and Palliative Care PodcastGeriPal 300th Episode: Ask Me Anything Hot Ones StyleToday we celebrate eight years, around 2 million listens, and 300 podcasts! Eric and I take questions from you, our listeners, about: why we podcast, our most controversial podcast, which podcast changed our practice, favorite song request, should all nursing home residents complete the POLST, expanding access to durable medical equipment, palliative care in rural regions, do we have an advance directive, what we’d do to improve healthcare with 7 trillion dollars, treatment for poor appetite, and Eric on how to make a latte. Thank you to Lynn Flint and Anne Kelly who serve as hosts for this...2024-02-2943 min
GeriPal - A Geriatrics and Palliative Care PodcastEMS Intervention to Reduce Falls: Carmen Quatman and Katie Quatman-YatesWe've talked about Falls a couple of times on this podcast, most recently with Tom Gill about the STRIDE study and before that with Sarah Szanton about the CAPABLE study. A takeaway from those podcasts is that fresh innovative thinking in the falls prevention space is welcome. Today we talk with the twin sister power duo of Carmen Quatman and Katie Quatman-Yates about an intervention that is both brilliant and (in retrospect) should have been obvious. The insight started when Carmen, an orthopedic surgeon-researcher, and Katie, a physical therapist- researcher participated in ride-alongs with EMS providers to pa...2024-02-1545 min
GeriPal - A Geriatrics and Palliative Care PodcastThe Nature of Suffering: BJ Miller and Naomi SaksIn 1982 Eric Cassell published his landmark essay: On the Nature of Suffering and the Goals of Medicine. Though his narrow definition of suffering as injured or threatened personhood has been critiqued, the central concept was a motivating force for many of us to enter the fields of geriatrics and palliative care, Eric and I included. Today we talk about suffering in the many forms we encounter in palliative care. Our guests are BJ Miller, palliative care physician and c-founder of Mettle Health, and Naomi Saks, chaplain at UCSF. We discuss: How to respond whe...2024-02-0852 min
GeriPal - A Geriatrics and Palliative Care PodcastRCT of Palliative Care for Heart Failure and Lung Disease: David Bekelman and Lyndsay DeGrootIn a JAMA 2020 systematic review of palliative care for non-cancer serious illness, Kieran Quinn found many positives, as we discussed on our podcast and in our editorial. He also found gaps, including very few studies of patients with lung disease, and little impact of trials on quality of life. The article we discuss today, also published in JAMA, addresses these two gaps. David Bekelman conducted a RCT of a nurse and social worker telephone intervention (ADAPT intervention) for people with heart failure and lung disease (COPD or ILD). David has been conducting outpatient trials in this space for...2024-01-2551 min
GeriPal - A Geriatrics and Palliative Care PodcastInfluence of Hospital Culture on Intensity of Care: Liz DzengOne of the things I love about Liz Dzeng’s work is the way in which it draws upon, echoes, and advances our understanding of the influence of culture on the end of life experience. This field is not new. In his book The Hour of our Death Philip Aries described a long evolution in western civilization of cultural attitudes towards dying. More recently Sharon Kaufman 's book And a Time to Die described the ways in which physicians, nurses, hospital systems, and payment mechanisms influenced the hour and manner of patient's deaths. Similarly Jessica Zitter, an intensivist and pall...2023-12-1447 min
GeriPal - A Geriatrics and Palliative Care PodcastPalliative Rehab?!?: Ann Henshaw, Tamra Keeney, and Sarguni SinghOften podcasts meet clinical reality. That’s why we do this podcast- to address real world issues in palliative care, geriatrics, and bioethics. But rarely does the podcast and clinical reality meet in the same day. Within hours of recording this podcast, I joined a family meeting of an older patient who had multiple medical problems including cancer, and a slow but inexorable decline in function, weight, and cognition. Physical therapy had walked with him that day and noted improvement compared to previous walks, suggesting that he should be discharged to a skilled nursing facility for rehabilitation on di...2023-10-2651 min
GeriPal - A Geriatrics and Palliative Care PodcastMiscommunication in Medicine: A podcast with Shunichi Nakagawa, Abby Rosenberg and Don SullivanMedical 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 may want to convey that all visible tumors were removed during surgery, but transmits that message to the patient by saying “we got it all” only to have the patient hear an entire...2023-09-2849 min
GeriPal - A Geriatrics and Palliative Care PodcastAmyloid Antibodies and the Role of the Geriatrician: Nate Chin, Sharon Brangman, and Jason KarlawishIt'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 with irregularities”. Instead of Biogen’s expected billions of dollars of revenue from Aduhelm, they brought in only $3 million in revenue for all of 2021 (here is my Twitter summary of this fiasco).2023-08-1750 min
GeriPal - A Geriatrics and Palliative Care PodcastJumpstarting Goals of Care Convos: Erin Kross, Bob Lee, and Ruth EngelbergToday’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 randomized trial for older adults with serious illness and those 80+. They found a difference of 4% in documented goals of care discussions. Is 4% meaningful? You’ll have to decide for yourself, though it likely is meaningful on a populatio...2023-07-1347 min
GeriPal - A Geriatrics and Palliative Care PodcastDiabetes in Late Life: Nadine Carter, Tamryn Gray, Alex LeeDiabetes 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 end of life, Eric and I were excited when Tamryn Gray emailed us requesting a follow up podcast on this issue. Our last podcast was with Laura Petrillo in 2018 - 5 years ago seem...2023-06-0846 min
GeriPal - A Geriatrics and Palliative Care PodcastGeriPal Special: Hopes and Worries for Hospice and Palliative CareWe 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 video. Eric and Alex DISCLAIMER While we filmed in Montreal during the Annual Assembly, all opinions expressed...2023-04-2711 min
GeriPal - A Geriatrics and Palliative Care PodcastThe importance of social connection: Julianne Holt-Lunstad, Thomas Cudjoe, & Carla PerissinottoSocial 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 left out, may be signs that our overall social life is struggling. But, should we as clinicians care about the social lives of our patients? Are there meaningful ways of assessing loneliness and social isolation in clinical settings and connecting patients...2023-04-1343 min
GeriPal - A Geriatrics and Palliative Care PodcastRCT of Chaplaincy: Lexy Torke, Karen Steinhauser, LaVera CrawleyDo we need an RCT to establish the worth of chaplaincy? Einstein once said, “Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted.” A friend of GeriPal, and prior guest, Guy Micco commented today that we need an RCT for chaplaincy is like the idea that the humanities need to justify their value in medical training: “It’s like being told to measure the taste of orange juice with a ruler.” On the other hand, all of our guests agree that chaplains are often the most vulnerable...2023-04-0648 min
GeriPal - A Geriatrics and Palliative Care PodcastBooks on Becoming A Better Mentor (and Better Person): Bob ArnoldSometimes you read a book and get a flash of insight - that “ah ha!” moment - about yourself and the ways you interact with others. That happened to me when reading “Range: Why Generalists Triumph in a Specialized World.” It helped me to understand and justify my interest in (this won’t surprise you) EVERYTHING related to geriatrics or palliative care. Also hat tip to Matthew Growdon for recommending the book. Today we talk with Bob Arnold, who has a long list of recommendations for books that have the potential to generate an “ah ha!” moment. The podcast is ost...2023-02-0249 min
GeriPal - A Geriatrics and Palliative Care PodcastOn Racism & Ageism: Ramona Rhodes, Sharon Brangman, Tim Farrell, and Nancy LundebjergThe Covid epidemic laid bare two major structural issues. First, Black and Latinx persons experienced much higher rates of mortality than other groups. Second, as we discussed in last week’s podcast, older adults, particularly those in nursing homes, were far more likely to die than younger individuals. These are structural issues because the fundamental causes of these issues were not biological issues, they were social. These worse outcomes were not due to differences in genes, they are due to structural racism and ageism. In today’s podcast we talk about the intersection of racism and ageism. We use the...2023-01-2646 min
GeriPal - A Geriatrics and Palliative Care PodcastStorycatching: Podcast with Heather Coats and Thor RinglerEric and I weren’t sure what to call this podcast - storytelling and medicine? Narrative medicine? We discussed it with today’s guests Heather Coats, palliative care NP-scientist, and Thor Ringler, poet. It wasn’t until the end that the best term emerged - storycatching. Because that really is what this is about. Clinicians “catching” patient life stories. What’s in a story? Well, as we learned, everything. Our patients aren’t “the 76 year old with heart failure in room 202,” as Heather Coats astutely noted. They’re people, and what makes us people if not our life’s stories? Our loves, our...2022-12-0846 min
GeriPal - A Geriatrics and Palliative Care PodcastNew Prognostic Models for Older Adults: Alex Lee, James Deardorff, Sei LeeDr. Faith Fitzgerald once quipped that prognostic modeling is the “punctilious quantification of the amorphous.” She has a point. Prognosis is inherently uncertain. As Alex Lee says on our podcast today, all prognostic models will be wrong (in some circumstances and for some patients); our job is to make prognostic models that are clinically useful. As Sei Lee notes, the argument for developing prognostic models has won the day, and we increasingly use prognostic scores in clinical decision making. What makes prognostic models for mortality different from models used for anticoagulation or risk of renal injury? James Deardorff replies that there...2022-10-2747 min
GeriPal - A Geriatrics and Palliative Care PodcastDemystifying the Role of HHS and ASPE in Guiding Federal Aging Policy and Priorities with Dr. Tisamarie SherryThe Department of Health and Human Services helps to guide billions of dollars in investment and direction in research, policy, and health care. The Assistant Secretary for Planning and Evaluation (ASPE), within the HHS, is the principal advisor to the Secretary of HHS on health policy, ranging from legislation to strategic planning to research. How does this relate to aging policy and research? How does coordination occur between the federal, state and local level in aging health policies? And, who within ASPE guides aging policy and connects policy to every day health challenges experienced by patients and clinicians? On today to...2022-10-2050 min
GeriPal - A Geriatrics and Palliative Care PodcastAdvanced Pain Management in Cancer: Janet AbrahmHave you had difficulty managing a particular type of cancer pain? For me it’s radiation induced mucositis/esophagitis. Janet Abrahm is one of the world’s experts in pain and symptom management for patients with cancer joins us to talk about (among other things): Ketamine for hyperalgesia and allodynia, how to treat dissociative side effects Lidocaine: worth the hype? Strengths and weaknesses of buprenorphine for cancer pain Fentanyl patch: often missed issues Hypnosis: uses and how to get training via the American Society of Clinical Hypnosis Janet is the author of the 4th edition of the book...2022-09-2946 min
GeriPal - A Geriatrics and Palliative Care PodcastShould we prioritize the unvaccincated for treatment? Govind Persad and Emily LargentIt’s been a while since we’ve done a Covid/bioethics podcast (see prior ethics podcasts here, here, here, and here). But Covid is not over and this pandemic keeps raising challenging issues that force us to consider competing ethical considerations. This week, we discuss an article by bioethicists Govind Persad and Emily Largent arguing that the NIH guidance for allocation of Paxlovid during conditions of scarcity. They argue that the current guidelines, which prioritize immunocompromised people and unvaccinated older people on the same level, should be re-done to prioritize the immunocompromised first, and additionally move up older vaccinat...2022-05-2646 min
GeriPal - A Geriatrics and Palliative Care PodcastPoetry about Aging: Marilyn McEntyre and Guy MiccoIn her essay “Why Read a Poem in a Time Like This?”, Marilyn McEntyre writes: All of us need it. We need it because good poems do something prose can’t do. They invite and enable us to notice the precarious fissures in what we think is solid ground. They direct us toward the light at the edge of things — the horizon, the fragment of dream before dawn, the feeling that’s hard to name, and can only be accurately captured by metaphor. They take us to the edge of “what can’t be said,” and ambush us into feeling...2022-03-3142 min
GeriPal - A Geriatrics and Palliative Care PodcastShould We Shift from Advance Care Planning to Serious Illness Communication?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 JAMA viewpoints, and most recently a series of published replies from leaders in the field on why ACP is still valuable (see below for references). Despite all of these publicatio...2022-02-2449 min
GeriPal - A Geriatrics and Palliative Care PodcastInternational Palliative Care: A Podcast with Kathy Foley, Stephen Connor, Eric KrakauerThis 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 palliative care. On this week's podcast, we talk with three leaders in helping improve palliative care worldwide: Kathy Foley, Stephen Connor, and Eric Krakauer. I don't think I can really sum up these three guests in a se...2022-02-1043 min
GeriPal - A Geriatrics and Palliative Care PodcastMedicare Advantage, Special Needs Plans, and the Hospice Carve-In: A podcast with Dr. Claire Ankuda and Dr. Cheryl PhillipsMore 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 Medicine at Mount Sinai and Palliative Care Physician) and Dr. Cheryl Phillips (President and CEO of the Special Needs Plan Alliance and past president of the American Geriatrics Socie...2022-01-2045 min
GeriPal - A Geriatrics and Palliative Care PodcastMedicare Advantage and the "Medicare Money Machine": Guests Dr. Don Berwick & Dr. Rick GilfillanInvestor 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 podcast, we are joined by UCSF geriatrics fellow Alex Kazberouk to talk with Dr. Don Berwick (founder of the Institute for Healthcare Improvement, former administrator of Center for Medicare and Medicaid Ser...2022-01-1347 min
GeriPal - A Geriatrics and Palliative Care PodcastCelebrating GeriPal's 200th with Leaders in Geriatrics and Pallaitive CareIt’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 share: One thing that you are grateful for in Geriatrics and Palliative Care (other than GeriPal!) One thing you are hopeful for in 2022 The guests we h...2021-12-3050 min
GeriPal - A Geriatrics and Palliative Care PodcastBurnout and Resiliency: A Podcast with Janet Bull and Arif KamalThe 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 institutional and individual perspective. Janet Bull is the Chief Medical Officer and Chief Innovations officer at Four Seasons Hospice and Arif Kamal is an oncologist, palliative care doctor and re...2021-12-0243 min
GeriPal - A Geriatrics and Palliative Care PodcastMeaningful Activities: Podcast with Anna Oh and Theresa AllisonMost 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 do the activities that animate their lives with meaning and purpose. Participating in meaningful activities is central to quality of life, and yet is poorly captured in most outcome scales. In this...2021-10-2842 min
GeriPal - A Geriatrics and Palliative Care PodcastIs nudging patients ethical? Podcast with Jenny Blumenthal-Barby and Scott HalpernI’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 podcasting app of their choice? We will assume that you are doing the same right now if you haven’t done so already, though we suppose yo...2021-09-3048 min
GeriPal - A Geriatrics and Palliative Care Podcast#AcademicLifeHacks: A Podcast About Tips and Tricks to Thrive in Academic MedicineToday’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? You will notice that at the start of the podcast, we spent a couple minutes to recognize my co-host, Alex Smith, for a particularly important award he recei...2021-08-2655 min
GeriPal - A Geriatrics and Palliative Care PodcastPolypharmacy and Deprescribing Super Special: Podcast with Anna Parks, Matthew Growdon, and Mike SteinmanIn 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 about the need for a new framework for anti-coagulation decisions for patients in the last 6 months of life, based on an article she authored in JAMA Internal Medicine with Ken Covinsky. In...2021-07-1542 min
GeriPal - A Geriatrics and Palliative Care PodcastLGBT Care for Older Adults and Serious Illness: Podcast with Carey Candrian and Angela PrimbasLesbian, 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 Angela Primbas from Stanford University (and future geriatrics fellow at UCSF!). Carey has published a wonderful article in the Gerontologist titled “She’s Dying and I Can’t Say We’re Mar...2021-01-2938 min
GeriPal - A Geriatrics and Palliative Care PodcastCrisis Communication and Grief in the Emergency Department: Podcast with Naomi George and Kai RomeroThe 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, or their prognosis. These are some of the most challenging and some of the most important conversations in medicine, as 75% of older adults visit the ED during the last 6 months of life (data thanks to...2020-11-0645 min
GeriPal - A Geriatrics and Palliative Care PodcastCrisis Communication and Grief in the Emergency Department: Podcast with Naomi George and Kai RomeroThe 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, or their prognosis. These are some of the most challenging and some of the most important conversations in medicine, as 75% of older adults visit the ED during the last 6 months of life (data thanks to...2020-11-0545 minGeriPal - A Geriatrics and Palliative Care PodcastState of Heart Failure & Palliative Care: Podcast with Haider WarraichThere 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 the hospital die even sooner at ~2.1 years thereafter, the median survival on hospice since hospital discharge is 11 days, and 2020-10-2248 minGeriPal - A Geriatrics and Palliative Care PodcastThe Geriatric 5M Approach to Telemedicine Assessment: A Podcast with Lauren MooOn 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 Video Visits: 2‐D View of the Geriatric 5‐Ms." In the article and on the podcast, Lauren walks us through assessing the Geriatric 5M framework: mind, mobility, medications, multicomplexity, and what matters most.
Lauren gets very...2020-10-1639 min
GeriPal - A Geriatrics and Palliative Care PodcastThe Geriatric 5M Approach to Telemedicine Assessment: A Podcast with Lauren MooOn 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 Video Visits: 2‐D View of the Geriatric 5‐Ms. In the article and on the podcast, Lauren walks us through assessing the Geriatric 5M framework: mind, mobility, medications, multicomplexity, and what matters most. 2020-10-1539 min
GeriPal - A Geriatrics and Palliative Care PodcastFamily Meetings for Patients with Serious Illness: Podcast with Eric WideraNo 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 this one folks. One day, Ken Covinsky walked into our office and said, "You know how the NEJM has this Videos in Clinical Medicine series? With videos like, 'How to insert a central venous catheter...2020-09-1049 min
GeriPal - A Geriatrics and Palliative Care PodcastAdvance Care Planning is Wrong: Podcast with Sean MorrisonSean 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 President of the American Academy of Hospice and Palliative Medicine, is about as inside palliative care as one can get. Sean argues in his Journal of Palliative Medicine piece that we should stop putting resources into making advance care...2020-08-2746 min
GeriPal - A Geriatrics and Palliative Care PodcastAgeism in the Time of COVID: Podcast with Louise AronsonIn 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 discussed the ways in which structural racism contributed to vast disparities in COVID, and similarly in this podcast we talk about the ways in which COVID exposes existing ageist assumptions, attitudes, and systematic forms of discrimination. To give a sense...2020-07-2843 min
GeriPal - A Geriatrics and Palliative Care PodcastCommunication Skills in a time of Crises: A Podcast with VitalTalk Faculty Drs. Back and AndersonDespite 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 was previously more than happy to leave as a tool for only outpatient providers. The pandemic and the murder of George Floyd brought to the forefront the systemic racism that permeates...2020-06-1853 min
GeriPal - A Geriatrics and Palliative Care PodcastElder Mistreatment: Podcast with Laura MosquedaIf 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 Laura Mosqueda (@MosquedaMD) of the Keck School of Medicine at the University of Southern California and Director of the National Center of Elder Abuse. Archstone Foundation, who funds our podcast, was a critical early investor in...2020-06-1248 min
GeriPal - A Geriatrics and Palliative Care PodcastOutsized Impact of COVID19 on Minority Communities: Podcast with Monica Peek and Alicia FernandezThis 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 Director of Research at the MacLean Center of Clinical Medical Ethics at the University of Chicago, notes right off the bat: COVID19 and the reaction to Floyd are related...2020-06-0446 min
GeriPal - A Geriatrics and Palliative Care PodcastRationing of Scarce COVID-19 Drug Treatments: A Podcast with Drs. DeJong, Chen, and WhiteThe question of who should get limited supplies of drugs that treat COVID-19 is not a theoretical question, like what seems to have happened with ventilators in the US. This is happening now. Hospitals right now have limited courses of remdesivir. For example the University of Pittsburgh hospital system has about 50 courses of remdsivir. They expect it to last to mid-June, enough for about 30% of patients who will present in the next 3 weeks. Who do you give it to? The first that present to the hospital (give it all away in the first week)? Random lottery? Or something else that...2020-06-0249 min
GeriPal - A Geriatrics and Palliative Care PodcastImmune Checkpoint Inhibitors: Podcast with Laura PetrilloImmune Checkpoint Inhibitors. They are revolutionary and transforming cancer care. They shrink tumors and extend lives. Plus they have a better side effect profile than traditional therapies for conditions like metastatic lung cancer, so when those with really poor performance status can't tolerate traditional chemotherapy, immune checkpoint inhibitors are an attractive option. We talk on today's podcast with Laura Petrillo, a palliative medicine clinician and investigator at Massachusetts General Hospital and Harvard Medical School. Laura was the first author of a paper published in Cancer titled "Performance Status and End-Of-Life Care Among Adults With Non-Small Cell Lung Cancer Receiving Immune...2020-05-3039 min
GeriPal - A Geriatrics and Palliative Care PodcastRamping up Tele-GeriPal in a Pandemic: Claire Ankuda, Chris Woodrell, Ashwin Kotwal, & Lynn FlintAs Ashwin Kotwal and Lynn Flint note in the introduction to their Annals of Internal Medicine essay (https://www.acpjournals.org/doi/full/10.7326/M20-1982?journalCode=aim), one year ago people were outraged at the thought of a physician using video to deliver bad news to a seriously ill man in the ICU. And look at where we are today. Video and telephone consults at home, in the ICU, and in the ED are common, accepted, and normal. What a difference a year makes. This week, in addition to Ashwin and Lynn, we talk with Claire Ankuda and Chris Woodrell...2020-05-2745 min
GeriPal - A Geriatrics and Palliative Care PodcastPalliative Care for Individuals with Parkinson’s Disease: Podcast with Benzi KlugerParkinson disease affects 1% to 2% of people older than 65 years. Most known for its distinctive motor symptoms, other distressing symptoms are pain, fatigue, depression, and cognitive impairment. About 2/3rds of individuals with Parkinson's will die from disease-related complications, making it the 14th leading cause of death in the United States. While there are great palliative care needs for this population, little has been published on how best to meet these needs. On today's podcast we talk with Benzi Kluger from the University of Rochester Medical Center and the lead author of a JAMA Neurology paper that compares outpatient integrated palliative care...2020-05-2236 min
GeriPal - A Geriatrics and Palliative Care PodcastCOVID19 in PrisonsEight of the 10 largest outbreaks in the US have been in correctional facilities. Physical distancing is impossible in prisons and jails - they're not built for it. Walkways 3 feet wide. Bunk beds where you can feel your neighbor's breath. To compound the issue, prisoners are afraid that if they admit they're sick they will be "put in the hole" (solitary confinement). So they don't admit when they're sick. Many people think of prisons as disconnected from society. Like a cruise ship. "It's happening between those walls, behind the barbed wire, not out here." But for every two people in a...2020-05-1954 min
GeriPal - A Geriatrics and Palliative Care PodcastDo Sitters Prevent Falls for Hospitalized Patients?One million inpatient falls occur annually in U.S. acute care hospitals. Sitters, also referred to as Continuous Patient Aids (CPA's) or safety attendants, are frequently used to prevent falls in high-risk patients. While it may make intuitive sense to use sitters to prevent falls, it does beg the question, what's the evidence that they work? We discussed with Drs. Adela Greeley and Paul Shekelle from the West Los Angeles Veterans Affairs Medical Center their recent systematic review published in Annals of Internal Medicine. Their review identified 20 studies looking at this issue (none of which are randomized trials). To sum...2020-05-1530 min
GeriPal - A Geriatrics and Palliative Care PodcastShould Age be Used To Ration Scarce Resources? Podcast with Tim Farrell and Doug WhiteWe are rationing in the US. We may not be explicitly rationing, as we're going to discuss on this podcast, but we are rationing - in the way we allocate fewer tests and less PPE to nursing homes compared to hospitals, in the way we allow hospitals and states to "fend for themselves" resulting in those hospitals/states with better connections and more resources having more PPE and testing availability. And in some parts of the world, ICU and ventilator resources are scare, and they are rationing by age. We talked on our last podcast about decisions Italy made to...2020-05-1239 min
GeriPal - A Geriatrics and Palliative Care PodcastLife Right After the Surge: A Podcast with NYU Clinicians Ab Brody and Audrey TanThe peak hospitalizations and deaths in New York City hit around April 7th. Life though in hospitals in New York though have not returned to normal. What were previously operating rooms, post-hip fracture units, or cardiac cath labs, are now units dedicated to the care of individuals hospitalized with COVID. We talk with two NYU clinicians, Ab Brody and Audrey Tan about what life is like right now in this new state of limbo as both palliative care clinicians and as their role as either a NP hospitlist or Emergency department physician. Ab Brody is the Associate Director of the...2020-04-2345 min
GeriPal - A Geriatrics and Palliative Care PodcastPalliative care on the front lines of COVID: Podcast with Darrell OwensMany of us with clinical roles are waiting for the other shoe to drop. Today we hear from Dr. Darrell Owens, DNP, MSN, head of palliative care for the University of Washington's Northwest campus, a community hospital in Seattle. The UW Northwest hospital has born the brunt of the COVID epidemic in one of our nation's hardest hit areas. Darrell has stepped up the the plate in remarkable, aspirational ways. First, he is on call 24/7 to have goals of care conversations with elderly patients in the emergency department under investigation for COVID who do not have an established a code...2020-03-2438 min
GeriPal - A Geriatrics and Palliative Care PodcastProject ENABLE: Podcast with Marie Bakitas and Nick Dionne-OdomProject ENABLE is a landmark palliative care intervention. And yet, I will admit (Eric did too) we didn’t really understand what it was. So we interviewed ENABLE founder Dr. Marie Bakitas and ENABLE distinguished protégée Dr. Nick Dionne-Odom to learn more about ENABLE. During the interview, we learned a great deal about ENABLE, how it has evolved, iterated, and shifted over time to include persons with diseases other than cancer, minorities with serious illness, and caregivers. We break the results of ENABLE CHF-PC, a planned plenary abstract presentation for the State of the Science meeting that was supp...2020-03-1251 min
GeriPal - A Geriatrics and Palliative Care PodcastUncovering Medication Related Problems: A Podcast with Mike Steinman and Francesca Nicosia"Tell me about the problems you have with your medications." A simple open-ended question that is probably rarely asked, but goes beyond the traditional problems that clinicians worry about, like non-adherence, inappropriate prescribing, and adverse reactions. What do you find when you go deeper? Well we talk with Francesca Nicosia and Mike Steinman about the work they have done around deprescribing and medication related problems, including a recent JGIM study that attempts to better understand patient perspectives on medication-related problems. This study also gives a pretty fascinating picture of where the overlap and divergence is between what patients and physician...2020-03-0540 min
GeriPal - A Geriatrics and Palliative Care PodcastHome-based Palliative Care: Podcast with Brook Calton and Grant SmithHome-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 Calton, home-based palliative care physician in the Division of Palliative Medicine at UCSF and Grant Smith, a recent graduate of UCSF's palliative medicine fellowship now faculty at Stanford. To supplement our podcast, Grant has...2020-02-2740 min
GeriPal - A Geriatrics and Palliative Care PodcastGeriatric Assessment in Oncology Practice: Podcast with Supriya and William DaleShould 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 recently published JAMA Oncology article that they authored titled "Communication With Older Patients With Cancer Using Geriatric Assessment - A Cluster-Randomized Clinical Trial". We discuss not only the trial results, but also...2020-01-3042 min
GeriPal - A Geriatrics and Palliative Care PodcastOpioids for Breathlessness: A Podcast with David CurrowDo 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, including randomized control trials on oxygen for breathlessness, octreotide for malignant bowel obstruction, and antipsychotics for delirium in palliative care patients. His most recent study was published in Thorax titled "Regular, sustained-release morphine for chronic breathlessness: a multicentre, double-blind, randomised, placebo-controlled...2020-01-1643 min
GeriPal - A Geriatrics and Palliative Care PodcastIntegrating Social Care into Health Care: Podcast with Kirsten Bibbins-DomingoIn 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.org/hmd/Reports/2019/integrating-social-care-into-the-delivery-of-health-care). This podcast spans the gamut from the individual clinician's responsibility to be aware of the social needs of their patients and impacts on health (think homeless person with no place to store their insulin), and adjustment to meet...2019-12-1937 min
GeriPal - A Geriatrics and Palliative Care PodcastDo Nurses Die Differently: A Podcast with Julie BynumOn 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 as a deputy editor at the Journal of the American Geriatrics Society. Overall, Julie's study found small differences in end of life care for both dementia and CHF as seen in the chart on our blog post at...2019-12-0537 min
GeriPal - A Geriatrics and Palliative Care PodcastThe 100th GeriPal Podcast Special - It's a CelebrationOn 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. We also take time to listen to the feedback that we received from our call in listener line (929-GeriPal) and maybe, just maybe, a song is sung to celebrate the occasion. Lastly, we also...2019-11-2036 min
GeriPal - A Geriatrics and Palliative Care PodcastPalliative Care in Nursing Homes: Discussion of a Multinational Trial with Lieve Van den BlockNursing 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. So what can we do to improve the palliative care outlook in nursing homes? On todays podcast we talk with Lieve Van den Block about her recent palliative care intervention that was published in JAMA IM this week. Lieve led...2019-11-1445 min
GeriPal - A Geriatrics and Palliative Care PodcastAllowing for Chemotherapy in Hospice: A Podcast About Concurrent Care With Vince MorA 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 strong case for the concept of concurrent care in which individuals can avoid the "terrible choice" between hospice and life prolonging therapies. On this weeks podcast, we interview the lead author, Vince Mor...2019-10-3135 min
GeriPal - A Geriatrics and Palliative Care PodcastArchitecture and Medicine: Podcast with Diana Anderson and Emi KyotaBefore 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 architect? Eric: An Archidoc? Alex: No a Dochitect. What do you get when you mix a gerontologist with an architect? Eric: A gerontolitect? Alex: No an...2019-10-1747 min
GeriPal - A Geriatrics and Palliative Care PodcastOpening the Black Box of LTACs: Podcast with Anil MakamWhat 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 yet we learn some surprising things from Anil Makam, Assistant Professor of Medicine at UCSF. In his JAGS study of about 14,000 patients admitted to LTACs, the average patient spent two thirds of...2019-10-1035 min
GeriPal - A Geriatrics and Palliative Care PodcastGeroscience and it's Impact on the Human Healthspan: A podcast with John NewmanOk, 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 changed for me thanks to our podcast interview with John Newman, a "geroscientist" and geriatrician here at UCSF and at the Buck Institute for Research on Aging. In this podcast...2019-10-0346 min
GeriPal - A Geriatrics and Palliative Care PodcastBecoming an Advocate for Older Adults: A Podcast with Joanne LynnJoanne 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 geriatrics and palliative care can do to be advocates for a growing population of older adults. One way I would like to plug to better advocate for our patients is through our national societie...2019-09-2641 min
GeriPal - A Geriatrics and Palliative Care PodcastHiding Behind High Value Care: A Podcast with Vinny Arora and Chris MoriatesYou'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 important findings. You feel they might be hiding their minimizing behind the sexy, trendy notion of providing "high value care." Does this sound familiar to you? It did to me. I've been in the awkward situation of being...2019-09-1942 min
GeriPal - A Geriatrics and Palliative Care PodcastThe life of individuals with moderate dementia: A Podcast with Krista HarrisonOn 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 titled "Care Settings and Clinical Characteristics of Older Adults with Moderately Severe Dementia." In this paper, which we discuss in the podcast, she gives us a snapshot of older adults in the United...2019-09-1337 min
GeriPal - A Geriatrics and Palliative Care PodcastAid in Dying: A Podcast with Lewis CohenIn 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 disability rights activists and challenges leaders of the aid in dying movement. His book is filled with stories of the people and family, doctors and activist who have...2019-09-0547 min
GeriPal - A Geriatrics and Palliative Care PodcastImproving Advance Care Planning for Latinos with Cancer: A Podcast with Fischer and FinkIn 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? - What do lay health navigators offer that specialized palliative care doesn't? Are they replacing us? - What makes the health navigator intervention particularly appropriate for Latinos and rural individuals? For advance care...2019-08-0634 min
GeriPal - A Geriatrics and Palliative Care PodcastDoes Intensive Blood Pressure Lowering Prevent Dementia? A Podcast with Jeff WilliamsonAs Eric notes in the introduction, this recent study in JAMA by Jeff Williamson and colleagues led to some very contradictory headlines. Some headlines proclaimed that lowering blood pressure prevents dementia, and others stated the opposite, that lowering blood pressure does not prevent dementia. So what exactly did the study show? Do these results apply to patients we commonly see in Geriatrics? What should we make of the fact that after the trial was stopped early the blood pressures in the lower blood pressure target group rose - does this mean you can't achieve intensive blood pressure lowering "in the...2019-03-0834 min
GeriPal - A Geriatrics and Palliative Care PodcastRehabbed to Death NEJM Perspective: Podcast with Lynn FlintThree reasons you should listen to this podcast: The issue of patients cycling back and forth between the hospital and skilled nursing facilities near the end of life is common, will ring true to those of you who are clinicians, and has largely been ignored in the literature. It's about a hot off the press article published today in the NEJM. Lynn Flint, Palliative care doc at UCSF in the Division of Geriatrics, first author, and our guest, makes me sing "Hit Me Baby One More Time" by Brittany Spears. This moment is either a new high or a new...2019-01-3133 min
GeriPal - A Geriatrics and Palliative Care PodcastAll the Questions You Had About Opioids But Were Afraid To Ask: A Podcast with Mary Lynn McPhersonAll the Questions You Had About Opioids But Were Afraid To Ask: A Podcast with Mary Lynn McPherson by Alex Smith and Eric Widera2018-10-0546 min
GeriPal - A Geriatrics and Palliative Care PodcastMelissa Wachterman Podcast: Dialysis and HospiceThis week, Eric and I talked with Melissa Wachterman, a physician researcher from the Dana Farber Cancer Institute and Harvard Medical School. Melissa used a national dataset of people receiving hemodialysis linked to Medicare claims for older adults who died.2018-05-1632 min
GeriPal - A Geriatrics and Palliative Care PodcastShould Concept of the "The Good Death" Be Buried? A Podcast with VJ PeriyakoilOn this week's podcast, we talk with the authors of a Journal of the American Geriatrics Society (JAGS) article titled Should We Bury “The Good Death"? As luck may have it, one of the authors is co-host Alex Smith, and the other is a leader in geriatrics and palliative care, VJ Periyakoil. Alex and VJ's critique of the ‘good death’ was published alongside a paired commentary from Age and Ageing from the British Geriatrics Society.2018-03-1333 min
GeriPal - A Geriatrics and Palliative Care PodcastDo proton pump inhibitors cause dementia?Proton pump inhibitors are one of the most widely used medications. As I note in the podcast below, I was in my local drug store the other day, and an entire shelf segment, top to bottom, was filled with medications for "heartburn," and most of them were proton pump inhibitors. And those are just the over the counter variety. So wouldn't it be a public health disaster if proton pump inhibitors, or PPIs, increased a persons risk for dementia? Even if the increase in dementia risk is only slight, on a population level, given the vast number of people using...2018-02-0223 min
GeriPal - A Geriatrics and Palliative Care PodcastZara Cooper the Need to Integrate Geriatrics and Palliative Care into Trauma SurgeryZara Cooper the Need to Integrate Geriatrics and Palliative Care into Trauma Surgery by Alex Smith and Eric Widera2017-09-0126 min
GeriPal - A Geriatrics and Palliative Care PodcastHow to have a code status conversation with Laura Petrillo and a live studio audienceHow to have a code status conversation with Laura Petrillo and a live studio audience by Alex Smith and Eric Widera2017-08-1736 min
GeriPal - A Geriatrics and Palliative Care PodcastVicki Jackson and David Ryan: Living with CancerVicki Jackson and David Ryan: Living with Cancer by Alex Smith and Eric Widera2017-08-0832 min