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Showing posts from January, 2018

Helping Patients Plan for the 4th Quarter of Life: An Interview with Lee Lindquist

This week we have Lee Lindquist with us on the GeriPal podcast to talk about planning for the "4th quarter" of life.   Dr. Lindquist is a geriatrician and chief of geriatrics at Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine in Chicago.

Dr. Lindquist developed a free to use website called PlanYourLifespan.org to help older adults create strategies for dealing with health crises, such as hospitalization, a serious fall, and dementia.   No this is not just end-of-life issues.   Using the website, older adults can think about what services they may need in the last 10 or 15 years of their lives, what choices they can make now, and how to access these services when needed.

So give it a listen and comment below on what you think should be addressed in the last quarter of life.  Below is also the link to her randomized control study showing increased understanding of posthospitalization and home services compared to the control group.

Lind…

Advance Care Planning in the Hospital: Are Palliative Care Doctors Doing Enough?

We have a great podcast this week exploring the advance care planning needs for hospitalized adults and what palliative care teams are doing (and not doing) to meet these needs.   We've invited Kara Bischoff, a palliative care doctor and Assistant Professor at UCSF in the Department of Hospital Medicine, who published a paper in JAMA Internal Medicine on this very topic.

Why was this JAMA IM paper so important for those who work in our field?  This was a real world study, looking at over 73,000 consultations from the Palliative Care Quality Network (PCQN).   They found palliative care teams consistently identified surrogates for patients, often addressed their preferences regarding life sustaining treatments, including code status, and frequently found a preference regarding life sustaining treatments that was different than what was previously documented before the consult.   But they rarely completed advance directives (only 3.2% of patients seen by palliative care teams) or Ph…

“It’s not that great to be rich, but it really sucks to be poor” Podcast with Lena Makaroun and Sei Lee on Wealth Disparities in the US and England

Our guests this week are Lena Makaroun, MD, a research fellow at the VA Pudget Sound, and Sei Lee, MD, Associate Professor of Medicine at UCSF and frequent co-host on this podcast.  They recently wrote a paper in JAMA Internal Medicine on wealth disparities in the US and England, and implications for mortality and disability.

Major take home points from the podcast:

“It’s not that great to be rich, but it really sucks to be poor.”  Those in the bottom quintile of wealth had the greatest difference in disability and mortality (ie worse).  Differences between those in the highest quintile of wealth and the next highest were relatively minor in comparison.“Rather than saying universal healthcare doesn't help, I would just say it's not enough.” Worse disability and mortality with lower wealth were observed in the US and England, both before and after age 65.  Does this mean National Health Service isn’t working?  The authors expected to find less difference in England where unive…