GeriPal - Geriatrics and Palliative Care Blog

A dominant focus of research in Geriatric Medicine has been on the prevention of the types of disability that are common in older persons. This research is important, because if it is successful it will lead to more years of independent living in which seniors do not need the help of caregivers or care in nursing homes.
But in our zeal to prevent disability in older persons, we sometimes paint an overly bleak picture of disability. Preventing and delaying disability is a very good thing. But there are no interventions or lifestyle changes that fully prevent late life disability. Rather, effective interventions slow down the process. The vast majority of persons who live to old age will experience a period of disability, and this period will often be prolonged. Our research on prevention of disability needs to complemented by studies that teach us how to help frail and disabled elders have an excellent quality of life.
Is it really possible for a senior to be significantly dis…

For the most part in geriatrics and palliative care we like to point the finger at other medical providers and say, "STOP."  Stop giving so much chemotherapy.  Stop giving so many medications.  Stop scanning.

But now it's time to take a long hard look in the mirror.

Medical specialty organizations are being asked to come up with a list of 5 tests or treatments that are over-utilized or may actually be harmful.  This effort, called the Choosing Wisely Initiative, is being spearheaded by the American Board of Internal Medicine (ABIM) Foundation.  ABIM President and renowned geriatrician Christine Cassel was quoted in today's New York Times saying:
“In fact, rationing is not necessary if you just don’t do the things that don’t help.” This same article notes that as much as 1/3 of health care costs are wasted on unnecessary hospitalizations, tests, and treatments.

So far 9 specialty boards have come up with their lists - the boards and there list are here - but Geriatri…

Have you ever read something that made you very sad? I did at the end of last week. It was an earlier post on this blog – Being Accused of Murder – that Dan Matlock had written. It’s frustrating, as I know all too well, this system of ours when it comes to letting – or not letting -- someone die.

The story below is the tale of a death when there isn’t a champion like Dan who is inside an institution and who stands up to speak for a patient. It’s the tail end of a story that began when a family caregiver was rescued from an endless round of diagnostic appointments by a geriatrician who said “here’s what we’re going to do” and laid out a practical course of action that covered the medical and social needs of the patient in question. It’s a tale of a death in a nursing home where hospice beds were very new and the culture change had been slow to follow. It’s been over a decade now and the story still makes me mad. It’s the story of my aunt, the story of how she died.

I wanted to …

Bill Thomas is a very busy man. He is the founder of the Eden Alternative that has been on the forefront of transforming nursing homes into elder-centered communities.  He developed the Green House Project, which focuses on replacing institutional nursing homes with smaller, 10-12 person homes.  He has given talks on the need to change the culture of aging (see the TEDx video below).  And now, he has released his latest book, the Tribes of Eden, a novel inspired by his "life’s work as a self-proclaimed nursing home abolitionist seeking to change the way society views aging."






I was given the opportunity to interview Bill Thomas about the experience of being a writer and how the Tribes of Eden book can impact the way we care for our aging population.  Here is the transcript:

Widera: So what is the connection between the Eden alternative and your new book Tribes of Eden?

Thomas: For the past twenty years the Eden Alternative has been working to make long-term care environments …