GeriPal - Geriatrics and Palliative Care Blog

If you are interested in the intersection between aging and innovation, these certainly are intriguing times.

Last Thursday I attended the kickoff event for Aging 2.0's brand new GENerator program. This is "a new founders program that supports the most promising entrepreneurs working to enhance the lives of older adults and improve long-term care." (Which I think means this is a business accelerator, but after only a year blogging about digital health innovations, I can't promise to have mastered all the business lingo.) 
Despite the whopping size of the boomer market (see this terrific Bloomberg article on how business has so far struggled to tap it), this seems to be the first accelerator focused on serving the 50+ demographic.
I found myself impressed both by the growth of Aging 2.0 -- an organization co-founded by a gerontologist only 18 months ago -- and by the offerings of the eleven companies chosen. It's encouraging to see the power of innovation and tec…

Every time I listen or talk to Diane Meier I get inspired.  Today was no different.  She inspired me to do a quick search looking for how closely wikipedia articles on serious illnesses align with the current CAPC definition of palliative care.  I thought this may be tough, as I was trying to figure out how to judge different definitions of palliative care.    I was wrong.  Dead wrong.  It was shockingly easy as most articles on the ten life threatening illness that I looked up NEVER even mentioned palliative care.  The ones that did were mostly talking about palliative chemotherapy or radiation therapy.

10 Serious Illnesses and the Number of Times "Palliative" or "Palliative Care" Was Mentioned in Wikipedia

1. Breast Cancer: No mention of the word palliative (really, zero.  Check for yourself)

2. Prostate Cancer: the word palliative used twice, both times talking about how treatments would be "palliative and not curative”. No other mention of palliative care…

by: Alex Smith, @alexsmithMD

Journal of Palliative Medicine recently published a nice exploratory open label study of daily oral ketamine for depression and anxiety in hospice patients.  We discussed this paper in our last palliative care fellow's journal club, with the esteemed fellow Dr. Virginia Dzul-Church presiding.

I won't regurgitate the whole article - although Eric Widera just pointed out that one of the take home points of discussing this article is the importance of actually reading the article.  In brief, the wonderful Dr. Scott Irwin recruited 14 hospice patients with depression and anxiety and treated them with 0.5mg/kg of ketamine by mouth daily.  He found a significant reduction in both anxiety (starting at day 3) and depressive symptoms (starting at day 14) with few adverse side effects.

Sounds great, right?

Some points to consider:

No placebo.  Without a placebo we can't tell how well this drug would have performed above and beyond the placebo effect.  S…

In April, the Food and Drug Administration (FDA) approved florbetapir F-18 (Amyvid) PET scans to identify areas of accumulation of amyloid plaques.  Centers for Medicare and Medicaid Services (CMS) though has yet to allow reimbursement for amyloid PET scans for the evaluation of dementia outside of clinical studies, citing insufficient evidence that it improves health outcomes for Medicare beneficiaries.

The CMS decision is strongly opposed by Eli Lilly and its subsidiary Avid Radiopharmaceuticals, the makers of Amyvid. The Alzheimer's Association also was "disappointed" by the CMS decision, stating that there was “clear, scientific consensus recommendations by the Association and the Society for Nuclear Medicine and Molecular Imaging (SNMMI) regarding appropriate, limited coverage, only in specific populations."

So who is right? CMS? The Alzheimers Association? The Association and the Society for Nuclear Medicine and Molecular Imaging (SNMMI)?  Eli Lilly? …

"The current 'care system' provides disjointed specialty services, ignores the challenges of living with disabilities, tolerates routine errors in medications and transitions, disdains individual preferences, and provides little support for paid or volunteer caregivers."

This quote is from an amazing and brilliant viewpoint by Dr. Joanne Lynn on how the US health system and Medicare are failing to meet the needs of frail and disabled elders.  As Dr.  Lynn notes, this is an issue that that is virtually ignored in the media, political discourse, and professional education.  The vast majority of persons who live into their 80's and 90's will live with a prolonged period of disability in which they will need help because of physical and cognitive problems.

Older people and their families facing the problems of late life disabilty are faced with a Medicare system that offers unlimited resources to spend on disjointed disease-focused medical care.  But older pers…

Is it important to provide high quality palliative and supportive care in patients with serious illness?  Does it matter if we treat pain in patients with metastatic cancer?  Does it matter if we listen to patients and provide care consistent with their goals?

I'm sure most health system leaders would answer an emphatic yes! to these questions.  But do they really mean it?  Will their actions match their words?  Unfortunately, the answer to that question will usually be no.  If you are serious about improving a care process, you need to measure that process, and use those measurements to improve.   Performance measurement has led to many process improvements in health care such as increasing the use of Beta Blockers after MI and the use of screening eye exams to prevent vision loss from diabetic retinopathy.  Shouldn't we also be using performance measurement to improve the quality of palliative and supportive care in the seriously ill?

This is what makes a study recently pub…

Advance care planning is a process; a seemingly hard to do, hard to document process that we just aren’t very good at doing. No wonder, as to do it right involves multiple different steps like choosing a surrogate decision maker, identifying what is most important in life, and communicating these wishes to loved ones and other clinicians. Making it harder is the finding from Terri Fried and others that older individuals are in different phases of readiness to engage in these different aspects of advance care planning.

So how do we get individuals to engage in the advance care planning process? A new and potentially game changing way is to use technology to move individuals along the different stages of behavior change (i.e. from pre-contemplation to higher stages such as contemplation, preparation, and action) for each component of advance care planning. A new publication in the Journal of Pain and Symptom Management suggests that the PREPARE website, designed by Dr. Rebecca Su…