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Showing posts from November, 2017

Tom Gill on Distressing Symptoms, Disability, and Hospice

by:Alex Smith @AlexSmithMD

In this week's GeriPal Podcast, sponsored also by the Journal of the American Geriatrics Society, we talk with Tom Gill, MD, Professor of Medicine at Yale.

With guest co-host Dan Matlock, MD, from the University of Colorado, we talk with Tom about his recent JAGS publication on the relationship between distressing symptoms, disability, and hospice enrollment.  Tom conducted this study in a long running cohort of older adults that has made a number of outstanding contributions to the GeriPal literature (see links).

Major points:

Restricting symptoms start 6 months before death, but most folks didn't enroll in hospice until 2 weeks before deathDisability increased markedly over the last months of life, and precipitated hospice use, but most hospice and palliative care programs are not set up to help with a persons daily needs.  There's a mismatch between the need for daily assistance and the hospice and palliative care services offered.
Tom's s…

What a Gatorade Bottle Taught Me About Functional Assessment

by: Leah B. Rorvig, MD, MS (@GeriPowerMD)

On the third day after my arthroscopic shoulder surgery, I was finally alone at home. My nausea had receded. And I wanted Gatorade. I went to the fridge, pulled out the bottle, and lodged it between my knees. I twisted and twisted with my left hand. I held the lid with a towel. No dice. It wouldn’t budge. Defeated, and still thirsty, I put the bottle back in the fridge. It is still there.

My ADL disability is temporary. I’m in a right arm sling 24 hours a day for the next 6 weeks, during which time I can’t drive or hold anything heavier than a cup of coffee in my right hand. But by next May (6 months from now) my surgeon says I’ll be back to surfing two or three times a week and, best of all, it is very unlikely that I will ever dislocate my right shoulder again (despite my love of sports like surfing and rock climbing). But as a clinical fellow in geriatrics, having a temporary ADL disability has profoundly impacted my perspective on my pati…

Global Palliative Care Takes the Stage

by: Jessi Humphreys, MD (@jessi_humphreys)

Across the world, millions of individuals, largely from developing regions, suffer and die in pain, with no access to palliative care services or pain relief. This includes 2.5 million children dying annually with serious health-related suffering. This is inexcusable. We must intervene on this well-demonstrated inequality. Moreover, fixing this problem would be surprisingly cheap.

In the past, global health initiatives have had many key priorities: maternal and fetal mortality, immunizations and infectious diseases among them. The importance of these areas cannot be overstated (remember the damage that polio and small pox caused!). Global palliative care is one of the newest priorities. With increasing energy dedicated to chronic and life-limiting illness including oncologic disease, health care providers discovered that globally we lack the supportive care and pain relief to enable quality treatment of these diseases. In 2014, the WHO pub…