GeriPal

The Bay Area Geriatrics Community recently lost one of our greatest friends, innovators, and pioneers with the passing of Dr. Larry Feigenbaum.   Decades before almost anyone else, Larry saw how how our health system was failing to meet the needs of older patients coping with frailty and disability.   So much of what is happening in San Francisco to improve the care of older persons can be traced to Larry's vision.

In 1978, Larry established the first fellowship in Geriatric Medicine in the western United States at Mount Zion Hospital in San Francisco, a premier community hospital and teaching affiliate of UCSF.  He was so far ahead of his time.  It would be another 20 years before UCSF even had a Division of Geriatric Division.   I wonder if our current fellows realize that the opportunity they have to learn Geriatric Medicine has its roots in Larry's vision.

Larry also saw the need to integrate social services with medical care.  He played a crucial role in the establishme…

Improving the health outcomes of older adults with multiple chronic morbidities has been my calling as a physician. During residency, my colleagues were interested in difficult, rare, or novel cases. In contrast, I was attracted to the lingering, multiple everyday conditions that older adults faced. I was also struck by the fact that providing all the recommended screening and treatments for each of their conditions often did more harm than good. It became immediately clear to me that my role as a clinician was to partner with my patients. In the end, it was the patient and her family that had to identify health and life goals, prioritize which of those goals were most important, and then work with clinicians to find treatments that best aligned with one’s goals and values. From this perspective, “non-adherence is a dysfunctional concept.” The quintessential signs of poor quality of care for multimorbid older adults, e.g., polypharmacy, overutilization, adverse events, often result f…

There is a revolution in palliative care.  No longer just for those with advanced and often-incurable illness, individuals receiving palliative care may have a prognosis of years if not decades.  We are starting to see this revolution occur all around us with the development of outpatient clinics that integrate palliative care at the time of a diagnosis of serious illness.

With any revolution though, things are never as easy as they first seem to be. One area that becomes increasingly more complicated is the question of how best to treat pain that also may persist for years, if not decades, in those who have a serious illness or who are survivors of that illness.  An excellent case example of this comes from a paper recently written by Jessica Merlin, Julie Childers and Robert Arnold.
Ms L is a 52-year-old woman with a history of a malignant glioma and bipolar disorder. She underwent resection, adjuvant chemotherapy, and radiation therapy for her tumor 6 months ago. She had a complet…