GeriPal - Geriatrics and Palliative Care Blog

I had good reason to miss the 2012 AGS meeting as the dates overlapped with Victory Day in Moscow. Victory Day is the Russian national holiday commemorating surrender of the German army on May 9, 1945. The country fought for 6 bloody years and lost millions of civilians and soldiers, and throughout Russia and much of the former Soviet Union there is an outpouring of patriotism. My goal for the trip was to photograph elderly WWII veterans who come to display their uniforms and medals. What I found was an amazing and touching public tradition of honoring the older generation.
Victory Day in 2012 was two days after Vladimir Putin's inauguration and there was a heavy military presence. In the days leading up to the event I watched as demonstrators were hustled away by police in riot gear and taken away in crowded vans. On Victory Day central Moscow was locked down and many streets and subway stations around Red Square were closed. I was able to get to Tverskaya Street, a wide bouleva…

by: Amy Getter, a hospice nurse who blogs regularly at hospicediary.com

My all-too-frequent experience going from house to house visiting the ill, aging population is this: many and perhaps most people being served in our communities are sadly lacking in actual advocacy. I often feel like I only apply “Band-Aids”. (Recent case in point; explaining the treatment choice to an 84 year old patient who didn’t realize the doctor’s intervention was permanent, something for him to manage at home. He asks me, “You mean I have to live like this?”) In every medical setting the average lay person while preparing to go home from their latest hospitalization needs an interpreter to understand what the hospitalist who just left their room was saying. Discharge instructions seem to fall on overwhelmed ears. And having worked in the circus of admissions and discharges of chronically ill patients in the hospital setting, I know the nurse/social worker/discharge planner/palliative care team must…

by: Patrice Villars

We all want the best possible end of life care for patients, our families, ourselves. Most of us don’t have a clue that Not All Hospices are Alike.

Here is one story (patient identity and characteristics have been changed to preserve anonymity):

Brianna, a 61-year-old woman with metastatic esophageal cancer and renal insufficiency, had been served by our outpatient palliative care clinic for over two years, alongside our oncology team. She had been previously referred to a home health agency by her primary care provider’s RN for assistance with medication management, physical and occupational therapy. So when the time came to transition to hospice care at home, the RN referred Brianna to the home health agency’s ‘sister’ organization, Hospice X. Easy peasy.

Not long after she was admitted, I started to receive phone calls from her partner (I’ll call him Mr. Brianna) re. unsatisfactory pain management and requests for opioid medications refills the hospice agen…

Our society is faced with the dilemma of aging prisoners, and some predict this will become one of the most important factors in managing the criminal justice system. Elderly inmates represent the fastest growing segment of federal and state prisons, a trend which is expected to continue. Hospice programs are growing in American correctional facilities, with access to health care professionals and efforts to provide a dignified death. In 2010 I took a road trip to photograph aging prisoners in one of America’s most notorious prisons, Louisiana State Penitentiary, also known as Angola Prison. 


I heard about the penitentiary’s special programs for the elderly including a treatment center and hospice, and received permission from Warden Burl Cain to tour the facility with my camera. It was a 150 mile drive from New Orleans through Mississippi Delta wetlands to get to the place that was surrounded by razor-topped chain link fences and sentry towers. Before passing through the gates, …

By: Paul Tatum  @doctatum

This year the Obama administration will convene the 2015 White House Conference on Aging (WHCOA).  The WHCOA has historically been viewed as a catalyst for improving policy on aging. This year's conference includes one laudable goal of improving "Healthy Aging."  This month's WHCOA blog makes the case as follows: "Older Americans are calling for a shift in the way we think and talk about aging. Rather than focusing on the limitations of aging, older adults across the nation want to focus instead on the opportunities of aging. Older adults are seeking ways to maximize their physical, mental, and social well-being to remain independent and active as they age."

The WHCOA has focused on important areas to improve aging and has highlighted key areas:  Promoting Health and Prevening Disease and Injury, Optimizing Cognitive Health, Optimizing Behavioral Health, Maximizing Independence at Home, and Promoting Community and Civic Engagement.

…

The recently published statin-discontinuation trial has been celebrated in the palliative care community.  It’s message is clear – go ahead and stop statins in patients nearing the end of life. 
Or is it?
I’ll offer a contrarian viewpoint: the trial does not reliably prove that people are helped by stopping statins in the final year or so of life. 
Why this “downer” message?  It’s because the study had insufficient power to assess if there are clinically meaningful differences between people who were randomized to stop their statin and those who were randomized to continue.  This is no fault of the investigators; the study was carefully planned and thoughtfully designed.   However, participants lived three times longer than expected (an average of 9 months, compared with a projected average of 3 months).  As a result, the original sample size projections and outcome analysis were jettisoned.  In consultation with the trial’s data safety and monitoring board, a new outcome of 60-day…

by: Alex Smith, @alexsmithMD

This is the 8th installment in my occasional post-being-on-service-digestion-of-what-just-happened-via-blogging potpourri from clinical work series.
TVs.  Our palliative care consult service spends it days turning off TVs.  In rooms of patients with advanced dementia and the TV is on and loud and right in front of their face.  Who turned it on?  In the ICU rooms of patients with delirium, blaring over the other beeps and noise.  Asking the sitter/CNA to turn it off please.  I think TVs are a hazard to the mental health of hospitalized patients, particularly those who have cognitive impairment, delirium, or are seriously ill.  Why are they always on?  We are the turn-off-the-TV palliative care service.Tissues.  In palliative care we generally teach: "When the patient or family member starts crying don't reach right away for the tissues.  It sends the wrong message.  It sends the message that you can't deal with the sadness of this moment and wa…

Dear GeriPal community,

We write today with a different sort of post.

We realize direct solicitations are not the intended purpose of GeriPal but this time we appeal directly to you as our peers and readers to help a national service at risk of being shut down. To each of you who has experienced or laid witness to depression, loneliness, grief, and isolation among older adults, we ask that you consider a contribution to help support the Friendship Line.

The Friendship Line is the nation's only toll-free, accredited, 24-hour suicide prevention hotline and warm-line for seniors and disabled adults. The Friendship Line makes and receives more than 100,000 calls every year, providing a lifeline for thousands of lonely, isolated older adults, who are 2-3 times more likely than teens to commit suicide. For many of these clients, the Friendship Line is the only human connection they can count on.

Unfortunately, this vital program is facing a significant challenge. The Friendship Line r…

It’s a welcome sign of spring in Manhattan when the Easter Parade comes to Fifth Avenue. This parade is not one of marching bands and drummers, but rather it’s made up of locals and tourists strolling and smiling, many sporting hats made especially for the occasion. The vehicular traffic that normally clogs the street is blocked off for the joyful celebration that lasts most of the day. 

Now that I’ve been invited to post on the GeriPal blog, I went there to photograph men and women of a certain age looking to show off their finest millinery in celebration of the holiday and the season. Despite what you see in this selection, it was actually an event for all ages. Not only was there a diversity of humans, but also of canines and some other species as well. Looking at the faces takes me back to the reasons I went into geriatrics many years ago, I hope you feel the same.






Happy Spring everyone! Jeffrey M. Levine MD
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Dr. Jeff Levine’s photography exhibit entit…