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Showing posts from September, 2017

Palliative Wound Care: A New Frontier

By Jeffrey M. Levine MD, AGSF, CWS-P I recently completed the revised chapter on pressure injuries for the Geriatrics Review Syllabus (GRS-10) which will be coming out shortly.  Part of the content addressed the topic of palliative care for chronic wounds.  In my text I claimed that a palliative approach can reduce suffering, improve quality of life, and decrease health care costs by eliminating expensive and/or painful procedures and treatments, but found little corroborating evidence. In the process of revision I did an informal poll of colleagues from coast to coast, and found nobody addressing palliative care for wounds.  Research in this area thus presents a wide open career opportunity for a young palliative care specialist.   Those of us who care for patients with pressure ulcers know that some wounds will not heal, and cure is an unrealistic goal.  Pressure ulcers can also herald the terminal stage of illness.  As the number of people living with chronic illness soars, i

Songs that Inspire, Move, or Make Us Think about Geriatrics or Palliative Care

Back in 2009, Pallimed created one of my favorite podcast posts titled " Top 10 Contemporary Palliative Care Songs ".  In it, they made a list of "contemporary" songs from many different genres that have palliative themes.   For todays podcast , we aim to update this list with songs that inspire, move, or make us think about geriatrics or palliative care. As with the Pallimed post, this is all personal preference.   So we would love to hear from you.  What one song would you have included in this podcast if you were sitting in the studio?  Put it in the comments section of this post! Listen to GeriPal Podcasts on: iTunes  Google Play Music Soundcloud Stitcher by: Eric Widera ( @ewidera ) ------------------------------------------------------------------------ We don't have a transcript for the podcast today, but here is the list of songs picked by our studio audience: Alex Smith: Dennis Kamakahi - Wahine 'Ilikea Jen Olenik :

Long Term Aspirin and the Risk of Bleeding Complications in Older Adults

by: Allen Tong MD As a geriatrician, removing unneeded or inappropriate medications from a patient’s drug list is something that brings me a lot of professional satisfaction.  Reducing drug burden, adverse drug effects or drug-drug interactions, is an important aspect of providing high quality care.  Proton pump inhibitors (PPIs), often prescribed for “stomach protection” is a common target for me to consider de-prescribing.  They are often continued indefinitely when a 4-8 week course is more appropriate.  But a recent study published in the Lancet  (1), puts a new twist into the risk-benefit analysis of long term PPI therapy, specifically as it relates to preventing upper gastrointestinal bleeds in patients on anti-platelet blood thinners such as aspirin or clopidogrel (brand name Plavix). Background: Anti-platelet therapies are commonly prescribed for primary and secondary prevention of vascular disease (heart attack, stroke, peripheral arterial disease).  But the long term

Sarah Hooper on Medical Legal Practice Clinics for Seniors

On this weeks podcast , we have Sarah Hooper, J.D., the Executive Director of the UCSF/UC Hastings Consortium on Law, Science and Health Policy, an interprofessional partnerships in education, research, and clinical training and service.   We talk with Sarah about her work creating the Medical-Legal Partnership for Seniors Clinic (MLPS) in which law students and faculty provide free legal assistance to low-income older patients at the UCSF Medical Center and at the San Francisco VA. Here is a short excerpt of the podcast in which Sarah talks about the state of affairs for MLPS in the realm of geriatrics and palliative care: "There are almost 400 medical legal partnerships around the country now, at least one in almost every state. The vast majority of them are focused on kids and families, which is incredibly, incredibly important; but I think that because of the demographic need and just the nature of the complex needs that people have in geriatrics and palliative care

Geripal Podcast: Zara Cooper on Trauma Surgery and Geripal

If you were talking to a geriatric trauma surgeon, wouldn't you think you'd be talking about surgery in older adults who experience trauma?  Fascinating, therefore, to talk with our GeriPal Podcast guest Dr. Zara Cooper, a palliative medicine and trauma surgeon, and critical care doctor at the Brigham and Women's Hospital and Harvard Medical School. Turns out most geriatric trauma patients don't have surgery.  The major focus of the geriatric trauma service is improving quality of life.  This is an area that is squarely at that surgery/geriatrics/palliative medicine interface. Trauma is so different from other forms of "serious" illness in older adults, because it comes on so suddenly.  You don't have any of those 4 classic archetypal trajectories (sudden death is the closest).  You have sudden advanced illness .  Implications are profound, from differences in the approach to advance care planning, to estimating prognosis, to the families emotiona