You may have heard of Area Agencies on Aging, but do you really know what they do or how they do it? What about State Departments of Aging or state master plans for aging? Do you know how these agencies fit in with programs like Meals-on-Wheels or other nutritional support programs? Is your brain hurting yet with all these questions? No? Ok, what about Aging and Disability Resource Connection (ADRC) services? Well, if you are like me, you’ve probably heard of these programs but are at a loss to ...
Jul 06, 2023•49 min•Ep. 272
I don't know 'bout religion I only know what I see And in the end when I hold their hand It's both of us set free These are the ending lyrics to Bonnie Raitt’s song “Down the Hall”, an ode to the Pastoral Care Workers who care for their fellow inmates in the hospice unit at the California Medical Facility in Vacaville, California. On last week’s podcast we interviewed the medical director and the chaplain of the prison’s hospice unit ( Hospice in Prison Part 1 ). This week we turn our attention ...
Jun 29, 2023•47 min•Ep. 271
In the early 1990’s, California Medical Facility (CMF) created one of the nation’s first licensed hospice units inside a prison. This 17-bed unit serves inmates from all over the state who are approaching the end of their lives. A few are let out early on compassionate release. Many are there until they die. Today’s podcast is part one of a two-part podcast where we spend a day at CMF, a medium security prison located about halfway between San Francisco and Sacramento, and the hospice unit house...
Jun 22, 2023•53 min•Ep. 270
Artificial Intelligence, or AI, has tremendous potential. We talk on this podcast about potential uses of AI in geriatrics and palliative care with natural language processing guru Charlotta Lindvall from DFCI, bioethicists and internist Matt DeCamp from University of Colorado, and prognosis wizard Sei Lee from UCSF. Social companions to address the epidemic of loneliness among older adults Augmenting ability of clinicians by taking notes Searching the electronic health record for data Predictin...
Jun 15, 2023•50 min•Ep. 269
Diabetes is common. When I’m on nursing home call, the most common page I receive is for a blood sugar value. When I’m on palliative care consults and attending in our hospice unit we have to counsel patients about deprescribing and de-intensifying diabetes medications. Given how frequent monitoring and prescribing issues arise in the care of patients with diabetes in late life, including the end of life, Eric and I were excited when Tamryn Gray emailed us requesting a follow up podcast on this ...
Jun 08, 2023•46 min•Ep. 268
Our guests today present an important rejoinder to the argument that we should refocus away from advance care planning (ACP). Sarah Nouri, Hillary Lum, and LJ Van Scoy argue that diverse communities are asking for ACP. Sarah Nouri gives an example from her work in the LGBTQ+ community of a trans woman who was buried as a man because existing laws/rules did not protect her wishes. Others cited the call from communities to meet them where they are - be they senior centers, Black-owned businesses, ...
May 25, 2023•48 min•Ep. 267
Hot off the press is a brand spanking new updated 2023 AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults . The Beers Criteria is one of the most frequently cited reference tools in geriatrics, detailing potentially inappropriate medications to prescribe to older people. We’ve invited two members who helped update the criteria including Todd Semla and Mike Steinman. We discuss a little history of the Beers criteria, including the original Beers Criteria that was publ...
May 18, 2023•46 min•Ep. 266
We’ve had multiple GeriPal episodes about treatments for dementia, including aducanumab ( here , here , and here ) and lecanemab ( here ). As today’s guest, Kristine Yaffe notes, part of the reason for that emphasis is that in the US we prioritize treatment, whereas other countries are ahead of us in prioritizing prevention. Deb Barnes and Kristine Yaffe published a landmark paper in Lancet Neurology finding that up to half of dementia risk is due to modifiable factors. If we focused on preventi...
May 11, 2023•46 min•Ep. 265
I haven’t worked with many adolescents and young adults (AYA, roughly teens to twenties). But when I have, I find that they’re often some of the hardest patients to care for. Why? We talk about why it’s so hard with Abby Rosenberg (chief of PC at DFCI and Boston Childrens), Nick Purol (clinical social worker at DFCI and Boston Childrens), Daniel Eison (pediatric PC doc and co-host of PediPal). We are grateful to Andrea Thach (PC doc at Sutter East Bay) for bringing this topic to our attention an...
May 04, 2023•49 min•Ep. 264
We have a special extra podcast this week. During the last AAHPM - HPNA meeting in Montréal, we went around asking attendees what one thing that they are most worried about and one thing they are most hopeful for when thinking about the future of our field. We couldn’t fit everyone’s responses in but came up with the big themes for questions and edited them into this weeks podcast / YouTube video. Eric and Alex DISCLAIMER While we filmed in Montreal during the Annual Assembly, all opinions expre...
Apr 27, 2023•11 min•Ep. 263
In 1990 11% of homeless persons were older than 50. Today half are over age 50. Today we talk with Margot Kushel about how we got here, including: That sense of powerlessness as a clinician when you “fix up” a patient in the hospital, only to discharge them to the street knowing things will fall apart. Chronic vs acute homelessness What is the major driver of homelessness in general? What is the major driver of the increase in older homeless persons? Why do we say “over 50” is “older” for homele...
Apr 20, 2023•54 min•Ep. 262
Social connections impact our health in profound ways, whether it is the support we receive from family and friends in navigating serious illness, the joy from shared social activities, or connecting with our community. Experiencing social isolation , the objective lack of contact with friends, family, or the community, or loneliness , the subjective feeling of lacking companionship or feeling left out, may be signs that our overall social life is struggling. But, should we as clinicians care ab...
Apr 13, 2023•43 min
Do 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 ch...
Apr 06, 2023•49 min•Ep. 260
Two weeks ago on the GeriPal podcast we talked about why and how to write for the general public . This week we’ve invited three guests to share their stories about storytelling that’s written for healthcare providers. The first guest is Liz Salmi. Liz wrote a fabulous perspectives piece in the NEJM titled “ Deciding on My Dimples ” which talks about her experience as a patient doing shared decision making during neurosurgery for resection of an astrocytoma. In addition to this being a fascinati...
Mar 30, 2023•50 min•Ep. 258
In November of 2022, Ava Kofman published a piece in the New Yorker titled “How Hospice Became a For-Profit Hustle.” Some viewed this piece as an affront to the amazing work hospice does for those approaching the end of their lives by cherry picking stories of a few bad actors to paint hospice is a bad light. For others, this piece, while painful to read, gave voice to what they have been feeling over the last decade - hospice has in some ways lost its way in a quest of promoting profit over car...
Mar 24, 2023•52 min•Ep. 258
So you want to write a book. So you want to write a book! So…you want to write a book?!? Today we talk with two geriatricians: Rosanne Leipzig , author of Honest Aging: An Insider's Guide to the Second Half of Life; and Louise Aronson , author of Elderhood: Redefining Aging, Transforming Medicine, and Reimagining Life. (You can hear our prior podcast on Louise’s book here ). We talk with them about writing for the lay public, including: Why write a book for the lay public? Why write about aging?...
Mar 16, 2023•47 min•Ep. 257
Psychedelics are having a moment. Enthusiasm is brimming. Legalization is moving forward in several states , following the lead of Oregon and Colorado. FDA is considering approval, shifting away from Schedule I restrictions, paving the way for use in clinical practice. Potential use in palliative care , chronic pain , and for mood disorders is tantalizing. Early data on efficacy in patients with anxiety and demoralization are promising. Research is exploding. Two of our guests today, Stacy Fisch...
Mar 09, 2023•48 min•Ep. 256
Gabapentin is the 10th most prescribed drug in the United States and use is increasing. In 2002, 1% of adults were taking gabapentinoids (gabapentin and or pregabalin). By 2015 that number increased to 4% of US adults. There are a lot of reasons that may explain the massive increase in use of these drugs. One thing is clear, it is not because people are using it for FDA approved indications. The FDA-approved indications for gabapentin are only for treating patients with partial seizures or posth...
Mar 02, 2023•48 min
You know when you walk out of a patient's room and have that sense, “This isn’t going to go well.” The patient is sick and getting sicker, and refuses to let you talk with family or other members of her inner circle. Should you stop at “no?” Today we talk with Anne Rohlfing, Lynn Flint, and Anne Kelly, authors of a JGIM article on the reasons we shouldn’t stop at “no.” We owe it to the patient to explore the reasons behind the “no,” commonly not wanting to be a burden to their family. In such ca...
Feb 23, 2023•46 min•Ep. 254
Think about the last time a patient yelled at you in anger. How did you react? The last time this happened to me I immediately went on the defensive despite years of training in serious illness communication skills. Afterwards, I thought there must be a better way. Well on today’s podcast we invite two of our favorite palliative care psychiatrists, Dani Chammas and Keri Brenner, to teach us about going beyond simple communication skills like naming the emotion when interacting with the angry pat...
Feb 16, 2023•56 min•Ep. 253
Amber Barnato is an expert in simulation studies. A health services researcher and palliative care physician, Amber lauds the ability of simulation studies to isolate one variable in a study. For example, we spend the first half talking about a RCT simulation study of clinician verbal and non-verbal communication with a seriously ill patient with cancer. In one room the physician under study interacts with a white patient-actor, and in another room interacts with a Black patient-actor. They foun...
Feb 09, 2023•49 min•Ep. 252
Sometimes 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 h...
Feb 02, 2023•50 min•Ep. 251
The 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 t...
Jan 26, 2023•46 min
In April 2022, the National Academies of Sciences, Engineering and Medicine (NASEM) issued a report on how the United States delivers, regulates, finances, and measures the quality of nursing home care. It’s massive with over 600 pages detailing everything from the history of nursing home care in the United States to the latest issues that nursing homes have had to face with COVID-19. On today's podcast we invited Jasmine Travers, Alice Bonner, Isaac Longobardi, and Mike Wasserman to talk about ...
Jan 20, 2023•48 min•Ep. 249
Acute Care for Elders (ACE Units) have been around for over a quarter of a century. Randomized trials of ACE units date back to 1996 when Seth Landefeld and colleagues published a study in NEJM showing that they improve basic activities of daily living at discharge and can reduce the frequency of discharge to long-term care institutions. But if ACE units are so great, why do so few hospitals have them? On today's podcast we talk about ACE units with geriatricians Kellie Flood and Stephanie Roger...
Jan 12, 2023•48 min•Ep. 248
Today’s podcast may be a stretch for our listeners. Please stick with us. No matter what your position on medical aid in dying (I’m ambivalent) or abortion (I’m pro-choice), this is a bioethics podcast, and I hope that we can all agree that the ethical issues at stake deserve a critical re-think. All three of today’s guests are well established bioethicists. Let me start by quote/paraphrasing one of today’s guests, Mara Buchbinder, who puts her finger on the issue we talk about today: “Typically...
Jan 05, 2023•48 min•Ep. 247
From discussing “taking away the keys to the car” for a cognitively impaired older adult to decisions to limit life sustaining treatments at the end of life, conflict and disagreement permeate everything that we do in medicine. How well though are we taught to handle conflict and disagreement? I’d say not well as I don’t think I’ve ever received a formal talk on the issue. On today’s podcast we take a deep dive into the topic of Negotiation and Dispute Resolution training with Lee Lindquist and ...
Dec 29, 2022•50 min•Ep. 246
We’ve talked at length on prior podcasts about the failures of aducnumab, Biogen, and the FDA’s decision to approve it. But wait, there’s a shiny new anti-amyloid drug, lecanemab! (No it’s not just the French version of Aducanumab). In an article in the NEJM (a published article this time, wonder of wonders!) lecanemab was shown to slow the rate of cognitive decline by 0.45 points on an 18 point cognitive scale compared to placebo. Wow! Wow? Wait, what ? On today’s podcast we talk with Jason Kar...
Dec 15, 2022•50 min•Ep. 245
Eric 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 as...
Dec 08, 2022•47 min•Ep. 244
What would it take to transform dementia care? While a lot of hope and money is being put into new monoclonal amyloid antibodies like lecanemab, the evidence is that while they are great in reducing amyloid in the brain for those with early Alzheimer’s disease, the effects are at best modest in slowing down the decline in cognition and function (more to be said on that in an upcoming podcast). In order to truly transform dementia care we need to think much broader than the amyloid hypothesis. So...
Dec 02, 2022•53 min•Ep. 243
