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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
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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

COVID Vaccine Hesitancy in Frontline Nursing Home Staff

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. On today's podcast we talk about vaccine hesitancy with Sarah Berry, Kimberly Johnson, and David Gifford and the lessons learned from their “town hall” intervention they did that was just published in the Journal of the American Geriatrics Society .   A couple of take-home messages for me in this study was that vaccine misinformation was rampant, many nursing staff had lingering questions they wanted answered before getting the shot, and that sharing stories and personal experiences is

Expelled from Hospice: Podcast with Elizabeth Luth and Lauren Hunt

null   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 patients in a large New York Hospice with dementia who either are discharged from hospice or live longer than 6 months.  Turns out this happens - brace yourselves - nearly 40% of the time! And we talk with Elizabeth and Lauren Hunt, who helps us contextualize these findings in the setting of larger issues around the fit of hospice for persons with dementia and hospice Medicare policy. (We will add the link to the editorial when it’s uploaded to the JAGS website). -@AlexSmithMD

Reframing Aging: A Podcast with Patricia D'Antonio

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 that it downplayed the pandemic because it mostly harms older adults. So on today's podcast we are going to talk about the initiative to “Reframe Aging” with Patricia D'Antonio.  Patricia is a geriatric pharmacist, and the Vice President of Professional Affairs at the Gerontological Society of America (GSA).   The Reframing Aging initiative is a national effort, led by GSA and supported by Archstone Foundation, uses an evidence-based approach to communicating more effectively about ol

So you want to be a hospice medical director? Podcast with Tommie Farrell and Kai Romero

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 podcast with Tommie Farrell, hospice physician in West Texas and Chair of the Hospice Medical Director Certification Board, and Kai Romero, Chief Medical Officer for Hospice By the Bay (that’s San Francisco Bay). And I get a re-do attempt at REM’s “Everybody Hurts!”   Apologies for the first attempt!   -@AlexSmithMD

It's Time We Started Talking Openly About Near-Death Experiences and After Death Communication

  by Scott Janssen "For months as I visited Joe as his hospice social worker, he had remained silent about World War II. Now he was bedbound and dependent on others for help with personal care. The hardest part though was “being stuck in bed with too much time to think.” When I asked what he thought about he started talking about friends killed during the war. These memories, it turned out, had recently begun intruding into his mind and stirring intense feelings of grief and guilt. Talking about combat or other psychologically traumatic events can overwhelm patients, potentially triggering defensive behaviors, intense physiological sensations, or distressing emotions. I was careful not to push too hard, letting Joe decide how much he wanted to unpack. At one point I asked if he had ever thought he was going to die amidst the war’s cataclysmic violence. “All the time,” he said. “Did you ever experience anything unusual? Anything you couldn’t explain?” He asked what I meant. I told