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Architecture and Medicine: Podcast with Diana Anderson and Emi Kyota

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…
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Opening the Black Box of LTACs: Podcast with Anil Makam

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…