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Reducing serious fall-related injuries: an interview with NEJM STRIDE Study author Tom Gill

Every year, about a third of older adults fall.  About one in five of those falls result in moderate to severe injury.  What can we do to help not only prevent those falls but also the complications of them?
On todays podcast, we talk to Tom Gill, one of the authors of the recent Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study published in the NEJM.   The STRIDE study was huge, 5,451 patients in 86 primary care clinics from 10 different health care systems.   Individuals assigned to the interventions worked with a “falls care manager” whose goal was to help identify and make plans about risk factors for falls and fall-related injuries. 
What did it show?   Well, the conclusion of the NEJM abstract states that this multifactorial intervention "did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care."   We talk to Tom about whether that is the right take home from this pragmatic study and how …
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Virtual Resources for Older Adults during the COVID19 Pandemic

by: Kahli Zietlow,Serena P Wong, and Mitchell Heflin In a recent telehealth visit, a patient presented alongside her husband, who was concerned that she had become a “shell of herself.” She previously enjoyed reading, spending time with family, and attending a water aerobics class at her local YMCA. Since the pandemic began, she has suffered from isolation; her aerobic classes were suspended, and their children had stopped visiting in an effort to protect them from contracting COVID19. She hadn’t left the house in months, stopped reading books, and seemed disengaged when her family called. He observed that she spends her days watching television and sleeping, and he was concerned that her memory had dramatically worsened in the past four months.  Social engagement and intellectual stimulation are critical to one’s wellbeing, memory, and mood. Numerous observational studies demonstrate that social engagement and cognitive stimulation can delay or prevent onset of dementia. Even before t…

Family Meetings for Patients with Serious Illness: Podcast with Eric Widera

No dear listeners and readers, that is not a typo.  Eric Widera is indeed our guest today to discuss his first author publication in the New England Journal of Medicine, Family Meetings on Behalf of Patients with Serious Illness.  Our other guests include other authors James Frank, Wendy Anderson, Lekshmi Santhosh, me and actress and frequent GeriPal guest-host Anne Kelly.
There's a story behind this one folks.
One day, Ken Covinsky walked into our office and said, "You know how the NEJM has this Videos in Clinical Medicine series?  With videos like, 'How to insert a central venous catheter?'  You should send them a video of your palliative care 'intervention' - how to conduct a family meeting."  Brilliant idea. 
Well...that was 2014...a funny thing happened on the way to the theater.
After several iterations, videos, reviews, a rejection, and lessons in persistence, we finally published. We were helped by an outstanding cast who role played the family m…

The Perfect Storm of COVID‐19 in Nursing Homes: A Podcast with Joe Ouslander

COVID-19 has created a perfect storm in nursing homes.  As noted in a recent Journal of the American Geriatrics Society (JAGS) article by Joe Ouslander and David Grabowski, the storm is created by the confluence risks, including a vulnerable population that develop atypical presentations of COVID-19, staffing shortages due to viral infection, inadequate resources including testing and personal protective equipment (PPE), and lack of effective treatments.   The result?  Nearly half of COVID-19-related deaths in the US occur in people cared for in nursing homes and assisted living facilities, and about a quarter of all facilities have had at least one COVID case.On this weeks podcast, we talk to Dr. Ouslander about his JAGS article on this perfect storm, as well as strategies that one can take from a clinical, public health, and policy interventions to help calm the storm.  In particular Joe summarizes a lot of research published in JAGS lately on COVID-19, including some of these studi…

Advance Care Planning is Wrong: Podcast with Sean Morrison

Sean Morrison dropped a bomb.  It's a perspective I've heard before from outside of palliative care, most clearly by bioethicists Angie Fagerlin and Carl Schnieder in their landmark article Enough: The Failure of the Living Will.  But Sean Morrison, Director of the National Palliative Care Research Center and Chair of the Department of Geriatrics and Palliative Medicine at Mt. Sinai, former President of the American Academy of Hospice and Palliative Medicine, is about as inside palliative care as one can get.  Sean argues in his Journal of Palliative Medicine piece that we should stop putting resources into making advance care planning and advance directives work.  For decades, we have tried and tried, pouring $300 million dollars into research, untold intellectual capitol, at the expense of those resources going toward other areas of need such as disparities in access and outcomes for people with serious illness.  And what do we have to show for it?  1660 studies and 80 syste…

Ageism in the Time of COVID: Podcast with Louise Aronson

In this week's GeriPal podcast we talk with Louise Aronson, author of the Pulitzer prize finalist Elderhood (listen/read our podcast with Louise on her book here).

Louise has been one of the (sadly) few voices beating a loud and urgent drum in the medical and lay press about the insidious ageism taking place in the time of COVID.  In a prior podcast we discussed the ways in which structural racism contributed to vast disparities in COVID, and similarly in this podcast we talk about the ways in which COVID exposes existing ageist assumptions, attitudes, and systematic forms of discrimination.  
To give a sense about how prolific Louise Aronson has been writing about ageism, here are links to just a sampling of her articles in the NEJM, New York Times 1 and 2, VOX, Forbes, and the Atlantic.  She also mentions this terrific piece by Nathan Stall and Samir Sinha during the podcast.
And wow - love the song choice - It's the End of the World As We Know It by REM.  Sure seems like i…

Advance Care Planning should be revisited proactively during the COVID-19 Pandemic

Jennifer L. Giddings, DNP, CRNP, FNP-BC 
Erik K. Fromme, MD, MCR, FAAHPM 

   I had just started my first job in long term care at a 150-bed skilled nursing facility in a densely populated city on the East Coast. During my third month on the job, COVID-19 cases skyrocket from 120,000 to over 1 million. My organization reacted immediately, restricting visitors, minimizing patient interaction, and implementing every possible protocol to prevent the virus from entering and overtaking the facility. Despite all these efforts, COVID-19 took over our building, infecting many patients, staff, and providers. Knowing that we’re working with the highest risk population for mortality with COVID-19, I began calling family members to notify them of the outbreak but also to discuss advance care plans if their loved one becomes gravely ill. Faced with this impossible task as a new provider to the facility I was speaking to many of our patient’s family members for the first time. Met with an array of q…

Communication Skills in a time of Crises: A Podcast with VitalTalk Faculty Drs. Back and Anderson

Despite being in the field over 15 years, I've never felt so far outside my comfort zone as as palliative care provider as I have felt in the last four months.  A worldwide pandemic of a novel virus had me questioning how I communicate prognostic information when uncertainty was one of the few things I was certain about.  It also pushed me to have these conversations via telemedicine, something I was previously more than happy to leave as a tool for only outpatient providers.  The pandemic and the murder of George Floyd brought to the forefront the systemic racism that permeates our society and my own inadequacies in discussing the trauma that these killings and mistreatment have on black Americans. 

We grow though when we are pushed outside of our comfort zones.  I'm pretty sure Tony Back, the co-founder of VitalTalk, would probably say that I have found my "learning edge".  Lucky for me, we have Tony, along with another VitalTalk guru, Wendy Anderson, on today…

Elder Mistreatment: Podcast with Laura Mosqueda

If you looked at the academic literature, you would think that elder abuse and neglect, collectively called elder mistreatment, did not exist before the 1990s.  Of course that's not true at all, it was hidden, covered, and not a major subject of research.  Several pioneers have placed elder mistreatment firmly on the map, including XinQi Dong, Mark Lachs, and today's GeriPal podcast guest, Dean Laura Mosqueda (@MosquedaMD) of the Keck School of Medicine at the University of Southern California and Director of the National Center of Elder AbuseArchstone Foundation, who funds our podcast, was a critical early investor in efforts to raise awareness, study, and intervene to prevent elder mistreatment.

Today we learn about what a long term care Ombudsman is, about the impact of Covid19 on elder mistreatment, and ethical issues at the core of elder mistreatment (autonomy vs. safety and public health).  
One major take home point that I'd like to emphasize here are three ques…

Outsized Impact of COVID19 on Minority Communities: Podcast with Monica Peek and Alicia Fernandez

This was a remarkable podcast during this moment in which our country is hurting in so many ways.  
Today's topic is the impact of COVID19 on minority communities, but we start with a check in about George Floyd's murder and subsequent protests across the country.  Our guest Monica Peek, Associate Professor of Medicine and Director of Research at the MacLean Center of Clinical Medical Ethics at the University of Chicago, notes right off the bat: COVID19 and the reaction to Floyd are related.  The covid epidemic has created an economic crisis, a heightened level of worry, and a disproportionate number of deaths among the African American community.  When we add COVID on top of the long history of police brutality that has been heightened over the last several years that has been ignored by the federal government - in that context, it's not surprising that we're seeing protesters put their lives on the line to stand up for what they believe in.  These protesters are put…

Rationing of Scarce COVID-19 Drug Treatments: A Podcast with Drs. DeJong, Chen, and White

The question of who should get limited supplies of drugs that treat COVID-19 is not a theoretical question, like what seems to have happened with ventilators in the US.  This is happening now.  Hospitals right now have limited courses of remdesivir.  For example the University of Pittsburgh hospital system has about 50 courses of remdsivir.  They expect it to last to mid-June, enough for about 30% of patients who will present in the next 3 weeks.   Who do you give it to?   The first that present to the hospital (give it all away in the first week)?   Random lottery?  Or something else that also accounts for the greater impact of COVID-19 has on disadvantaged communities ?

On today's Podcast we talk with Colette DeJong, 3rd year medicine resident at UCSF, and Alice Hm Chen, Deputy Secretary for Policy and Planning at the California Health and Human Services Agency, who were two of the authors of a recently published JAMA article titled "An Ethical Framework for Allocatin…

Immune Checkpoint Inhibitors: Podcast with Laura Petrillo

Immune Checkpoint Inhibitors.   They are revolutionary and transforming cancer care.  They shrink tumors and extend lives.  Plus they have a better side effect profile than traditional therapies for conditions like metastatic lung cancer, so when those with really poor performance status can't tolerate traditional chemotherapy, immune checkpoint inhibitors are an attractive option.  But should they be?

We talk on today's podcast with Laura Petrillo, a palliative medicine clinician and investigator at Massachusetts General Hospital and Harvard Medical School.  Laura was the first author of a paper published in Cancer titled "Performance Status and End-Of-Life Care Among Adults With Non-Small Cell Lung Cancer Receiving Immune Checkpoint Inhibitors."

In this study, Laura looked at 237 patients with advanced non-small cell lung cancer who initiated immune checkpoint inhibitors from 2015 to 2017.  She found that those with impaired performance status had significantly s…