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Showing posts from March, 2010

Does Having a Sense of Purpose Prevent Alzheimer Disease?

At our most recent UCSF Division of Geriatrics journal club, we had a very lively discussion about an article examining whether older persons with a sense of "purpose in life" were less likely to develop Alzheimer Disease. This excellent article, by Dr. Patricia Boyle, is in the March issue of the Archives of General Psychiatry. It is the latest report from the ground breaking Rush Memory and Aging Project.

A lot of research on Alzheimer disease examines more "biologic" risk factors, sucn as markers found in blood or findings on brain MRI scans. This work is very important, but there is also compelling evidence that psychosocial risk factors may be profoundly important determinants of Alzheimer Disease. There is much less research support focused on psychosocial mediators, and that makes this study a welcome addition.

The investigators followed a group of over 900 elderly Chicagoans (average age of 80) for an average of 4 years and compared rates of Alzheimer Dise…

Explaining Palliative Care: Matching Treatment to Patient Goals

I was consulted recently about an elderly woman who refused surgery for a large bowel obstruction from a colonic mass (likely cancer).  The inpatient team asked me to help with the transition to hospice and to help make her comfortable.

I went to see her.  She had a nasogastric tube sucking up brown material from her stomach.  Her abdomen was swollen and uncomfortable. Her primary goal was to return to walking about with her walker, and she had grossly overestimated the risks of surgery.  I recommended surgery.  I persuaded her that surgery would meet her goals better than no sugery.  After considerable discussion, she agreed. 

What a shock to the primary team!  They called a palliative care consult to assist with the transition to hospice, and here I'd gone and persuaded the patient to have surgery.

In her lecture at AAHPM/HPNA this year, Diane Meier said, "palliative care is about matching treatment to patient goals."  She said it over and over and over.  And she'…

Q&A with Jeff Gordon - Author of "A Death Prolonged"

Many terminal patients linger through their final months with a miserable quality of life and too often with extreme levels of suffering. Today’s high-tech medical care can sustain technical life – the beating heart – but utterly fails to restore real quality of life for many. The result: Death Prolonged. This is the introduction from Dr. Jeff Gordon’s new book, A Death Prolonged.  Dr. Gordon's agenda is pretty clear in this book - to get people to talk about end-of-life prefereneces. He uses a fictional account of a young physician who learns that high cost end-of-life care may not be synonymous with high quality care.  She also learns that in a system with limited resoureces, high cost interventions in terminally ill patients are likely to shift resources away from cheaper preventive care. 

After reading this book I thought it would be a good idea to ask Dr. Gordon a couple questions about how he decided to approach this subject in his novel.  Here are four of the answers he gav…

Jennie Chin Hansen: New CEO of the American Geriatrics Society

The American Geriatrics Society (AGS) gave us good reason to be optimistic about the future of our organization when it announced that Jennie Chin Hansen has been named as its new CEO. Ms. Hansen is currently president of the AARP, but in San Francisco she has iconic status for her many years of leadership and innovation at On Lok Senior Health Services, including a decade as CEO.


On Lok is a visionary program that provides complete medical and social care to frail nursing home eligible elders who wish to stay in the community. Ms. Hansen was part of a group of innovators who grew On Lok and developed it as a viable long term care model. She played an instrumental role in implementing the On Lok model nationally, giving rise to the Program of All-Inclusive Care For the Elderly (PACE). The over 70 national PACE sites now serve thousands of frail elders. Many view PACE as the single most innovative development in long term care over the past generation. With the selection of Ms. Hansen, …

Social Workers Are Awesome

In 1927, Francis Peabody remarked that "The secret of the care of the patient is in caring for the patient." Medicine has made much progress since those days, but some might argue that some of the humanitarian cornerstones of caring that concerned Peabody have been lost. Of course, there are many health professionals that still embody this caring ethic. And in todays era, perhaps the group that best personfies this central caring ethic of medicine are medical social workers.

I know we should avoid generalizations, but isn't it the case that all social workers are nice? Perhaps it is this niceness, combined with their knowledge and skills that makes them so indispensable. It is often the social worker on the team that understands what is really going on with the patient and identifies the key details that make it possible to effectively care for them. It is because they know what to ask, and patients and families are comfortable confiding in them.

Geriatrics practice wou…

Talking Palliative Care and Death: Get Up, Stand Up, Grow Up

Finally. This debate has been waiting to happen ever since NHO added the “PC” to its name back in the last century. How ironic that dying has suddenly become so un-PC. Even to us.

What is our problem? On the surface, it’s simple: we have matured as a field, to the point that we now have to contend with how we look, and more importantly how we speak and act, in the real world of health care. This is good news, but to make it work, some soul searching is in order.

Why has dying become “radioactive?” Because Sarah Palin, PR master, made it that way with her Death Panel comment on Facebook. With one (more) semi-conscious crazy-ass remark she made “fear of death” the brand for all end-of-life considerations. And because optics is everything in our surface-obsessed culture, the world bought it. Are we following the world on this one? Uh-oh – I smell fear in the room. In fact a subtle scent of fear pervaded many of the meeting rooms in the Hyde Center last week. Did you notice?

Be careful, …

Maintaining Relationships: Stop Using the Words ‘Terminal’, ‘Dying’, ‘Hospice’, ‘Advance Directives’ and ‘Bereavement’ that Push Others Away

The best learning experiences for me have been times when I come away questioning core assumptions about the work I/we do. As palliative care folks, we try to help people understand where they are in relation to their disease and what their hopes and goals are for care. We offer treatments and resources to match those needs through, in part, supportive communication. What if, in our kind, well-meaning communication, we actually hurt or push away the very people we purport to serve? We may then feel misunderstood, even angry. (Sound like a relationship you’ve had?)

Diane Meier, MD gave an update on March 4th at the HPNA/AAHPM annual meeting entitled “Update on National Palliative Care News: How the Big Picture Affects You.” It was an enlightening, exciting, distressing update and call to action for the palliative care community. She made too many important points to discuss here, so let me pick one.

The new (to me) hot word in the political arena is “optics”. It’s all about how you see…

GeriPal at HPNA/AAHPM in Boston!

The annual HPNA/AAHPM conference starts tomorrow and many of us will be in Boston (me, Eric Widera, Patrice Villars, Rebecca Sudore, Bob Arnold, VJ Periyakoil, among others).  We decided to take a cue from big pharma (facetiously) and advertise GeriPal with pens - look for them!
Two GeriPal related events you should know about:
Social Media in Palliative Care Communities: Developing and maintaining your online presence.  Presentation by Eric Widera, Christian Sinclair, and Alex Smith.  Friday March 5th 7-8:15am.  Set your alarm!Party!  We are cohosting a gathering with Pallimed Friday night March 5th at 8pm at Lir Irish Restaurant and Pub, 903 Boylston (1/2 a block from the convention center). Appetizers on us!Looking forward to seeing you in Boston!