GeriPal

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

  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

  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 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

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

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 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

  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

  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 University of Pennsylvania Perelman School of Medicine. In addition to being a geriatrician extraordinaire, he is the author of the new book “The Problem of Alzheimer’s: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It.” In addition to talking about PET scans and new drugs like aducanumab, we discuss with Jason about the history of Alzheimers, the history of how we care for and fund caregivers, and where we go from here. So take a listen and che

Short notice, but yes, there will be a Pallimed/GeriPal virtual party this year. Have we planned a lot around this? No. Do we want to see friends and colleagues and meet new people? Yes. Can we do it with minimal expectations? We hope so! We are not sure what to expect, but when we did this in person there was never that much of a plan anyway, except where to go next, and even that was up for improvisation. So what might we do. Probably hang out in different Zoom rooms talking about different subjects, playing games, talking about palliative care things, or maybe not palliative care things. When : Wednesday, Feb 17, 2012 6-8pm PST/9-11pm EST Where : Zoom invite via email sent by email at 5p CT RSVP here so we know how many to expect.   Reserve time on your calendar now! Share this with your friends. Get them registered too.  Keep an eye out on the Twitter accounts of Pallimed and GeriPal just in case this thing goes big and we need to make alternative plans. -Alex, Eric, and friends at

  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 Panagiotou and Elizabeth White, the authors of a JAMA IM study that finds that physical and cognitive function are key predictors of mortality prediction for nursing home residents with COVID.  We also talk with Marlon Aliberti, who authored a commentary .   Physical and cognitive function are easy to assess measures that should be routinely captured for older adults, in nursing homes and elsewhere.  Study after study document the importance of function to risk prediction. We also have a brief debate