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Return to Normal Hesitancy: Podcast with Monica Gandhi and Ashwin Kotwal

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 masks in schools, hospitals, and nursing homes in perpetuity.  As in, forever.  Sounds eerily like an abstinence-only approach, right?  Science would dictate that now that we have vaccines, which Monica describes as “the solution,” we don’t need to engage in masking (with a few exceptions). Monica Gandhi, an infectious disease doctor at UCSF, has advocated strongly for a fact-based approach to school opening, early masking and now dropping masking, and global access to vaccinations (and tem
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"Palliative" Inotropes?!?: Podcast with Haider Warraich

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 earliest podcasts, we talked with Nate Goldstein who memorably proclaimed “the best palliative care for heart failure is treatment for heart failure.”   To unpack the issue of palliative inotropes, we welcome back Haider Warraich , a cardiologist with a strong interest in palliative care.  We are joined again by Anne Rohlfing, palliative care fellow at UCSF who spent last year as a hospitalist on the heart failure service.  Please tune in to hear more about the role of palliative care in inotrope

All Things Caregivers: Podcast with Chanee Fabius and Halima Amjad

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 is now directed toward reducing disparities in caregiving, particularly for patients with dementia.  See for example, her recent paper in the Gerontologist describing Black and White differences in caregiving . We are also joined by Halima Amjad , a geriatrician-researcher, who, like Halima, is at Hopkins.  Halima is very interested in improving care for people with dementia.  As she notes, when we talk about outcomes for older adults, we often talk about the characteristics of the patient as

Geriatric Cardiology and "Pump Head" Revisited: Podcast with Liz Whitlock and Mike Rich

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 function over the subsequent 20 years has been mixed .  The problem with these prior studies is they enrolled patients at the time of the CABG.  They didn’t have a sense of what the cognitive trajectory was before the procedure. In this context, enter Liz Whitlock’s study published this week in JAMA comparing cognitive trajectories before and after CABG versus stenting procedures .  Liz finds no difference in the decline in memory before or after CABG vs PCI - in other words - their memory conti

Frailty and Resilience: A Podcast with Linda Fried

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 we should think about assessing frailty and managing it. We also talk with Dr. Fried about how she thinks about resiliency and the analogy put forth by George A. Kuchel in a wonderful article published in the Journal of American Geriatrics Society (JAGS) that uses the Golden Gate Bridge to explain different definitions of frailty as shown below:

Moral Injury: Podcast with Shira Maguen

  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 or children (unacceptable). One need to witness the killing - dropping bombs or napalm can result in moral injury as well - nor need it be killing; harassment, hazing, and assault can result in moral injury, as can bearing witness to an event. While there is often overlap between moral injury and post-traumatic stress disorder (PTSD), they are not synonymous. Today we talk with Shira Maguen, psychologist and Professor at UCSF and the San Francisco VA.  One of the many fascinating parts of

Life, Death, and a Hospital Strained by COVID: a Podcast with Brian Block, Sunita Puri and Denise Barchas

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 surges had an increased odds of death.   We talk about the findings in his study, which also included some variation in the surge hospitals as well as potential reasons behind these outcomes. We’ve also invited two other guests, Denise Barchas and Sunita Puri , to describe their hospital experiences in a COVID surge.  Denise is a ICU nurse at UCSF who volunteered in New York during the spring surge of COVID cases.  Sunita is the Medical Director of Palliative Medicine at USC’s Keck Hospital &

GeriPal's Newsletter is Moving

Hey GeriPal readers and listeners, A very quick update.  The GeriPal podcast is changing our service provider that our newsletter uses.  If you are already signed up for the newsletter, you don't need to sign up again, but do us a quick favor and do one of the following to avoid the newsletter getting stuck in your junk folder: Add to your email's contact list ( Click here to download GeriPal's vCard ) Add the email to your safe sender list We have a new post coming out Thursday morning from our new email address (, so if you don't see it in your inbox by Friday, look in your junk or quarantine folders.  If you are not yet on the newsletter list, sign up below with your email address (if you are not sure, put it in again as we remove all duplicates).  We aim for once a week updates so we won't clog up your inbox. Subscribe Thanks,  Eric and Alex PS.  If all you want

Disability in the home: Podcast with Sarah Szanton and Kenny Lam

  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 the government. Today we talk with Sarah Szanton, who created the CAPABLE multi-disciplinary model to help older adults stay at home, and Kenny Lam, who used a national study to examine the need for home-modification devices .  And we preview another of the AGS songs for the literature update - this one to the tune of “My Get up and Go” by Pete Seeger. Enjoy! -@AlexSmithMD

Capturing Pandemic Lessons Learned for Local Health Departments and Long-Term Care Facilities

by Sara Levin, David Farrell, Terry Hill, and Nicole Howell As with much of our pre-pandemic reality, the relationship between local health departments and long-term care facilities appears in retrospect to have been tranquil and routine.   Each year, local health departments offered influenza vaccine supplies to long-term care facilities and provided support for reportable communicable disease investigations as needed.   That relationship was upended with the advent in March 2020 of an expanding COVID-19 pandemic that would soon bring suffering and death to long-term care facilities.   The prior supports for infection prevention and control from federal, state, and local entities were wholly inadequate to address the COVID-19 tsunami.   For local health departments, rapid resource reallocation and improvisation became imperative.   Outbreak investigation and support teams blossomed in every local health department; phone calls and emails were numberless in both directions.   The suppo

All things Amyloid, including Aducanumab and Amyloid PET scans with Gil Rabinovici

  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. On today's podcast, we talk about all things Amyloid, including Aducanumab and Amyloid PET scans with Gil Rabinovici .  Dr. Rabinovici is the Edward Fein and Pearl Landrith Endowed Professor in Memory & Aging at UCSF.    I could talk to Gil all day long, but we try to fit all of these topics in this jam-packed podcast: The heterogeneity of dementia and potentially Alzheimer's disease Where are we now with disease modifying treatments for Alzheimer’s disease The Role

Ageism + COVID19 = Elder Genocide: Podcast on nursing homes with Mike Wasserman

  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 this podcast we look back on where we’ve been over the last year, where we are now, and what’s ahead. One theme that runs through the podcast is that if this level of death, confinement, and fear occured to any other population, change would have been swift.  But nursing home residents, for the most part, don’t have a voice, they’re not able to speak up, they lack power to move politicians and policy.   Mike Wasserman is a provocateur.  He is a needed voice for the nursing home residents an