On June 7th, 2021 FDA approved the amyloid beta-directed antibody aducanumab (Aduhelm) for the Treatment of Alzheimers. This approval of aducanumab was not without controversy. Actually, let me restate that. The approval of aducanumab was a hot mess, inside a dumpster fire, inside a train wreck. After the approval, three members of the FDA advisory panel, which unanimously was not in favor of the approval of aduhelm, quit. One of them, Aaron Kesselheim (who we have on our podcast today) describe...
Jul 29, 2021•44 min•Ep. 182
Cannabis use by older adults has increased substantially over the last decade, a trend that has paralleled the legalization of its use for medical and recreational purposes. In that same time, there has been a decreased perceived risk associated with cannabis use in older adults as noted in a recent study published in JAGS . On today’s podcast we talk with Drs. Bree Johnston and Ben Han about what the health care providers role is in cannabinoid prescribing and advising when caring for older adu...
Jul 22, 2021•45 min•Ep. 181
In 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 lif...
Jul 15, 2021•42 min•Ep. 180
Older adults often turn to institutional settings like nursing homes when they need more help than they can get at home. However, since the 1970s, there has been a program that allows older adults to receive nursing home-level care outside of nursing homes. That model of care is known as the Program of All-inclusive Care for the Elderly, or PACE. On today’s podcast, we discuss PACE with two leaders in the PACE community, Dan Drake and Jay Luxenberg. Dan is the President and CEO of Trinity Health...
Jul 08, 2021•46 min•Ep. 179
We have made remarkable progress in reducing the use of feeding tubes for patients with advanced dementia. This has been due to the leadership of people like Susan Mitchell and Joan Teno, among others. One might hope that this reduction in use of feeding tubes has been in part due to advance care planning discussions that helped align care and treatment with patients goals. How then, do we explain the concerning findings in a pair of recent papers demonstrating high rates of mechanical ventilati...
Jul 01, 2021•47 min•Ep. 178
While palliative care most traditionally grew up with a strong association with cancer care and end-of-life care, more and more evidence is coming out about how to integrate palliative care into a variety of serious illnesses from heart failure to chronic lung conditions. Another emerging field is the integration of neurology and palliative care, something that has been coined as “neuropalliative care.” We had Benzi on a previous GeriPal podcast to talk about palliative care in Parkinson's disea...
Jun 24, 2021•43 min•Ep. 177
What if there was a tool that could break down a neighborhood’s socioeconomic measures, like income, education, employment and housing quality, to give us a sense of how those factors influence overall health, and maybe even inform where to target health resources and social interventions. On today’s podcast we talk with Dr. Amy Kind from the University of Wisconsin School of Medicine and Public Health, who developed that tool, the Neighborhood Atlas. The Neighborhood Atlas uses the “Area Depriv...
Jun 17, 2021•43 min•Ep. 176
Harm reduction, as so clearly described by our guest Monica Gandhi on this podcast, began as a public health approach that guided management of HIV. Harm reduction represented an alternative to an abstinence-only approach, which clearly did not work. In the harm reduction model, you acknowledge that people will take some risks, and that the goal is to decrease risk, not eliminate it. And yet, here we are with a fear-not-facts approach to the COVID-19 pandemic. Some are advocating for the use of ...
Jun 10, 2021•40 min•Ep. 175
In your clinical experience, you may have cared for patients receiving palliative chemotherapy and wondered, hmmm, why is that called “palliative” chemotherapy? We’ve written about this issue previously here at GeriPal (“a term that should be laid to rest”) as has Pallimed (“an oxymoron”). Well, now we have “palliative” inotropes for people with heart failure. And we have to ask, is this a fitting term? And the answer is...complex...more so than you might think. Recall that in one of our earlies...
Jun 03, 2021•46 min•Ep. 174
What is a care manager? In this week’s podcast we talk with Chanee Fabius , who after a personal experience caring for a family member with dementia, became a care manager. Chanee explains in clear terms what a care manager is, what training is required, and what training is required. In essence, a care manager is a “glue person” who hold things together. After observing major race/ethnic disparities in caregiving, Chanee was inspired to obtain a doctoral degree in gerontology, and her research ...
May 27, 2021•42 min•Ep. 173
A September 2000 New York Times article titled, “Sometimes Saving the Heart Can Mean Losing the Memory” describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. The syndrome was termed “pump head.” A doctor is quoted in the article as stating that older patients he might have previously considered CABG for he would try to manage medically, with a stent. Data on the impact of CABG on cognitive func...
May 20, 2021•45 min
Frailty. What the heck is it? Why does it matter? How do we recognize it and if we do recognize it, is there anything we can do about it? On today’s podcast we talk to Linda Fried, Dean of Columbia University's Mailman School of Public Health and world renown frailty researcher about all things frailty. We talk to Dr. Fried about how she first got interested in frailty, how we define it including the difference between phenotypic frailty and a “deficit accumulation model’ frailty index”, and how...
May 13, 2021•39 min•Ep. 171
Though origins of the term “moral injury” can be traced back to religious bioethics, most modern usage comes from a recognition of a syndrome of guilt, shame, and sense of betrayal experienced by soldiers returning from war. One feels like they crossed a line with respect to their moral beliefs. The spectrum of acts that can lead to moral injury is broad, ranging from killing of an enemy combatant who is shooting at the soldier (seemingly acceptable under wartime ethics), to killing of civilians...
May 06, 2021•41 min•Ep. 170
During the winter peak in coronavirus cases, things got busy in my hospital, but nothing close to what happened in places like New York City last spring or Los Angeles this winter. Hospitals in these places went way past their capacity, but did this strain on the system lead to worse outcomes? Absolutely. On today’s podcast, we talk with Brian Block, lead author of a Journal of Hospital Medicine study that showed that patients with COVID-19 admitted to hospitals with larger COVID-19 patient surg...
Apr 29, 2021•42 min•Ep. 169
We know from study after study that most older adults would prefer to age in place, in their homes, with their families and embedded in their communities. But our health system is in many ways not particularly well set up to help people age in place. Medicare does not routinely require measurement or tracking of disability that leads many people to move out of their homes, and many interventions that support people to age in place are unfunded, underfunded, or funded by philanthropy rather than ...
Apr 22, 2021•39 min•Ep. 168
There are no currently approved disease modifying drugs for Alzheimer's disease, but in a couple months that may change. In July of 2021, the FDA will consider approval of a human monoclonal antibody called Aducanumab for the treatment of Alzheimer's disease. If approved, it will not only make this drug the defacto standard of care for Alzheimer's disease, but will create a monumental shift in the usage of other currently limited diagnostic tests, including Amyloid PET scans and other biomarkers...
Apr 15, 2021•53 min•Ep. 167
One of our earliest COVID podcasts with Jim Wright and David Grabowski a year ago addressed the early devastating impact of COVID on nursing homes. One year ago Mike Wasserman, geriatrician and immediate past president of the California Long Term Care Association , said we’d have a quarter million deaths in long term care. A quarter of a million deaths. No one would publish that quote - it seemed inconceivable to many at the time. And now, here we are, and the numbers are going to be close. In t...
Apr 08, 2021•43 min•Ep. 166
COVID has taken a devastated toll in nursing homes. Despite representing fewer than 5% of the total US events, at least 40% of COVID‐19–related deaths occurred in older individuals living in nursing homes. The good news is that with the introduction of COVID vaccines in nursing homes, numbers of infections and outbreaks have plummeted. However, only about 2/3rds of nursing home patients and only about ½ of nursing home staff have been vaccinated, largely due to hesitancy about taking the vaccine...
Mar 24, 2021•48 min•Ep. 165
Hospice may not be a great match for all of the care needs of people with dementia, but it sure does help. And, as often happens, when patients with dementia do not decline as expected, they are too frequently discharged from hospice, an experience that Lauren Hunt and Krista Harrison refer to in an editorial in the Journal of the American Geriatrics Society (JAGS) as feeling like being “expelled.” We talk on this week’s podcast with Elizabeth Luth, author of a study in JAGS about her study of p...
Mar 18, 2021•38 min•Ep. 164
The COVID pandemic brought to light many things, including how society views older adults. Louise Aronson wrote a piece in the NY Times titled “ ‘Covid-19 Kills Only Old People.’ Only? Why are we OK with old people dying? ”. The ageist viewpoint she was rallying against was also brought to light in a study of ageism in social media . When looking at those tweets that were related to older adults and covid, more than 1 in 10 tweets implied that either the life of older adults was less valuable or...
Mar 04, 2021•47 min•Ep. 163
So what exactly does a hospice medical director do? Why do some choose to become hospice physicians? What additional training is needed, if any, beyond Hospice and Palliative Medicine fellowship and boards? Who should take the new Hospice Medical Director Certification Board Examination ? A recent study in JAGS found high rates of hospice disenrollment (“live discharge”) for people with dementia - is that a good thing or a bad thing? Hmmm… We address these and other questions in this week’s podc...
Feb 25, 2021•45 min•Ep. 162
Where are we with Alzheimers? Are we about to see a revolution in how we diagnose and treat it with Amyloid PET scans and the amyloid antibody aducanumab (which is currently on FDA’s desk for approval)? Or are we still in the same place where there is no meaningfully effective treatment? Or is it somewhere in between, given the data that we have on comprehensive dementia care? We talk today with Jason Karlawish, a professor of medicine, medical ethics and health policy, and neurology at the Univ...
Feb 18, 2021•45 min•Ep. 161
Nursing home residents have been devastated by COVID. Somewhere around 40% of deaths from COVID have been among nursing home residents, though they make up just a sliver of the US population. Prognostication among nursing home residents who have COVID is important for a host of reasons - for counseling patients and families about what to expect, for making clinical decisions, and potentially for allocation of scarce resources such as treatments. In today’s podcast, we talk with Orestis Panagioto...
Feb 11, 2021•44 min•Ep. 160
Lesbian, gay, bisexual and transgender (LGBT) older adults have lived through a lifetime of discrimination, social stigma, prejudice, and marginalization. Is the care that we are giving them in later life changing any of that or are we pushing them back into the closet? This is what we talk about in this week's podcast with Carey Candrian from the University of Colorado School of Medicine, and Angela Primbas from Stanford University (and future geriatrics fellow at UCSF!). Carey has published a ...
Jan 29, 2021•38 min•Ep. 159
On the one hand, every year we are fortunate to have new medications that help older adults and people living with serious illness. New treatments for lung cancer with remarkable survival outcomes come to mind, for example. On the other hand, the tremendous growth in medications has led to an explosion of prescribing, polypharmacy, with attendant side effects and harms. In this week's podcast, we talk with Nagham Ailabouni, a pharmacist and researcher joining us from Australia (song choice: Down...
Jan 21, 2021•43 min•Ep. 158
Most of us know we are going to die. How often though do we actually let ourselves really internalize that understanding? To imagine it? To feel it? To try to accept it? On today’s podcast we invited BJ Miller back on our podcast to talk about death using as our guide his recent NY Times editorial What Is Death? How the pandemic is changing our understanding of mortality . In addition to being the author of this NY Times article, BJ is a Hospice and Palliative Care doc, and the founder of Mettle...
Jan 14, 2021•45 min•Ep. 157
Many of us in geriatrics and palliative care assume that we are the experts in health care when it comes to understanding the caregiver experience. Every once in a while, we are humbled and reminded of what we don’t know. Jessica Zitter had such an experience. Jessica, as many of you know, is an award winning author (link to our podcast about her book Extreme Measures) and was featured in an Academy Award winning film titled Extremis. She sought out to make another movie about the story of one o...
Jan 07, 2021•35 min•Ep. 156
Surrogate decision‐making around life-sustaining treatments in the hospital even in the best of circumstances is hard. It’s maybe even harder when caring for those who are conserved or have a professional guardian. The conservator may not have known the patient prior to them losing capacity, they may not know their values or goals that can help guide decisions, and they may be restricted by state statutes on what decisions they can make without getting a judge's approval. The prevailing wisdom i...
Dec 17, 2020•47 min•Ep. 155
“Diagnose and adios.” That’s the sad phrase that I’ve heard quoted more than once, representing caregivers' sentiment of what it’s like to be told by a clinician that your loved one has dementia. This week we talked with Zaldy Tan, Geriatrician and Director of the Memory and Aging program at Cedars Sinai in Los Angeles. With David Reuben at UCLA and others working LA realized that current caregiver training programs were lacking. Caregivers for people with dementia are stressed, short on time, a...
Dec 10, 2020•39 min•Ep. 154
What does it mean to create a cultural shift to the end of life experience? Is it even possible? How do you even start something like that? On today's podcast, we talk to Shoshana Ungerleider about her experience making that change. Shoshana is one of those amazing advocates for palliative and end of life care. She started the Ungerleider Palliative Care Education Fund to support innovative programs that further palliative care education. She is Executive Producer of the Academy Award-nominated ...
Dec 03, 2020•42 min•Ep. 153
