GeriPal

In 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, and the full report here.

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 these needs (such as keeping on oral medications), to larger health policy issues including the need to integrate health and social policy.

This was a fun podcast, as you'll hear.  This is a topic that lends itself well to discussion.  Eric really pushes this issue: to what extent are meeting the our patient's needs for housing, transportation, and food a health issue?  Are these issues that a doctor should care about, and why?

And ou…

On 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 as seen in the chart below for both dementia and CHF:  


One can think of these numbers as so small of a difference that there really isn't a difference.   With that said, my favorite part of this interview is Julie's take on this difference, which is that while the difference is small, there is a difference ("There is a signal!").  This means "I know it can be different, because it is different." 

by: E…

We have had some amazing guests on our Podcast.  True luminaries in geriatrics and palliative care. This week we are fortunate to be joined by none other than Mary Tinetti, MD, to talk about her recent JAMA Internal Medicine trial of Patient Priorities Care.

In this study of older adults with multiple chronic conditions, patients are guided through a process of identifying their health priorities and objectives, and this information is communicated to their primary care physicians.  The trail resulted in more medications discontinued, fewer self-managment and diagnostic tests, and less report of treatment burden.  This podcast builds on our prior podcast on this topic with Aanand Naik (awesome song choice, Lumineers' Gun Song).

We talk with Mary Tinetti about what exactly Patient Priorities Care is, how it differs from geriatrics and palliative care (or does it?), and how to disseminate this program widely (hint: start by going to their amazing website).

And...ah...Mary made me s…

On 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 have two very special thank you's.  First is to Archstone foundation, who just became GeriPal's first sponsor!   It's really is an honor to be backed by such a wonderful organization with a mission so aligned with our podcast.  We also want to thank all of our listeners for your support and encouragement.  It is really touching every time we hear some feedback about our shows and we lo…

Nursing 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 a multicomponent intervention to integrate basic nonspecialist palliative care in in 78 nursing homes located in 7 different European countries.  Just take a moment to grasp the size of this study - 7 counties, 78 nursing homes.  I struggle with just trying to improve palliative care in one site!

We discuss with Lieve the results of the study, her take on why they got…

If you're like me, then you can't get enough of these exciting meetings with high concentrations of hospice and palliative care researchers: the National Palliative Care Research Center's Annual Foley Retreat, the Palliative Care Research Cooperative Group meetings, the Beeson meeting, and more.  All of these meetings have high concentrations of engaged palliative care researchers. 

Similarly, the annual palliative care assembly sponsored by AAHPM and HPNA has a considerable amount of research programming. 

So, you might ask, why would one attend the brand-new-first-ever-of-it's-kind State of the Science in Hospice and Palliative Care Meeting? This new meeting, which will overlap with the end of the annual assembly and continue through Sunday in San Diego (March 20-22).

How is this meeting different from the regular assembly meeting?  I put the question to the meeting's co-chair Nick Dionne-Odom, who replied:
The Annual Assembly Meeting has primarily centered on clinic…

A 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, about this study and whether concurrent care is ready for prime time outside of a integrated health care system like the VA.

We also put a plug in the end for the NIA Imbedded Pragmatic AD/ADRD Clinical Trials (IMPACT) Collaboratory that Vince is helping to lead.   If you want to learn more about the collaborators, click here.

by: Eric Widera

Do you remember the scene from the movie The Graduate where Ben's dad says, "One word: Plastics"?

Well, I write this blog post from the National Palliative Care Research Center's annual Foley retreat, a who's who of palliative care researchers.

The words on everyone's lips: "Lay Health Navigators."

This is not to draw equivalency between environmentally destructive materials and people who help those with serious illness and caregivers navigate our complex health care system.  Rather, it's to point out that revolutions occur in palliative care research just as they do in business.

In this week's podcast, we talk with Kate Possin, PhD and Sarah Dulaney, RN CNS of UCSF about the Care Ecosystem project.  In this remarkable study, published in JAMA Internal Medicine, lay health workers helped caregivers of persons with dementia navigate the health care system by providing support, education, and care coordination with dementia specialists.  The…

Before 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 here to complete!  Thank you!  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 environmental gerontologist.

OK, so we didn't have that EXACT conversation on this podcast, but something close to it.  There is a growing recognition that many of the settings where older adults receive healthcare are not designed to meet the needs of older adults.  The early part of this movement resulted in the Americans with Disabilities Act, which mandated such things as accessibility for persons with wheelchairs.  But it so much more than that.  The architecture of health care buildings can actually impair the health of older adults or people living wit…

What 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 LTACHs, the average patient spent two thirds of his or her remaining life in an institutional settings (including hospitals, LTACs and skilled nursing facilities).  One third died in an LTAC, never returning home.

So you would think with this population of older people with serious illness and a shorter prognosis than many cancers, we would have robust geriatrics and palliative care in LTACs?  Right? Wrong.

3% were seen by a geriatrici…

Ok, 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, John breaks down what geroscience is and how it impacts how we think about many age-related conditions and diseases. For example, rather than thinking about multimorbidity as the random collection of multiple different clinical problems, we can see it as an expression of the fundamental mechanisms of aging. This means, that rather than treating individuals diseases, targeting …