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Showing posts from September, 2019

Becoming an Advocate for Older Adults: A Podcast with Joanne Lynn

Geriatricians in the 2030s may be able to prescribe very costly medications for older Medicare beneficiaries who cannot get supper. Most older Americans who live with disabilities will not be able to pay for adequate housing, food, medicine, and personal care. All who serve older adults must shoulder the responsibility to help avert this oncoming suffering and social disruption. The window of opportunity for effective change is already narrow; procrastinating for a decade will be too late. These are the words of Joanne Lynn, a geriatrician and palliative care physician, who leads Altarum’s work on eldercare. She wrote a recent JAGS editorial titled The “ Fierce Urgency of Now”: Geriatrics Professionals Speaking up for Older Adult Care in the United States ” which is very much a call to action for those who care for older adults.  We talk with Joanne about this article and some meaningful things clinicians in both geriatrics and palliative care can do to be advocates for a growin

Hiding Behind High Value Care: A Podcast with Vinny Arora and Chris Moriates

You're the attending physician on a teaching service.  Your resident says we shouldn't order a CT because CT's are over-used for this condition, and represent overuse, waste, and low-value care.  In this case, however, you suspect that's not the resident's real reason.  The real reason behind the resident's decision is that they are serial minimizers - residents who make little of potentially important findings.  You feel they might be hiding their minimizing behind the sexy, trendy notion of providing "high value care." Does this sound familiar to you?  It did to me.  I've been in the awkward situation of being the consulting palliative care physician saying to the primary team, I know they have cancer and that's the most likely explanation for this abdominal pain.  I also worry that this pain is out of proportion and different from other pain I've seen, and I think it should be evaluated with further testing.  Kind of strange to sa

The Life of Individuals with Moderate Dementia: A Podcast with Krista Harrison

On this weeks podcast, we talk with Krista Harrison about the life of individuals living with moderate dementia, as well as what we know about their caregivers.  Krista is is an Assistant Professor in the Division of Geriatrics at UCSF, a social scientist, and something that we learned in this podcast, someone who knows a thing or two about singing opera. Krista recently published a JAGS paper titled " Care Settings and Clinical Characteristics of Older Adults with Moderately Severe Dementia ."   In this paper, which we discuss in the podcast, she gives us a snapshot of older adults in the United States who have experienced the onset of moderately severe dementia within the past year.  We learn that 2/3'rds of these individuals are living in the community.  Interestingly, older adults living at home were 2 to 5 times more likely to be members of disadvantaged populations and had more medical needs.  In the podcast we discuss some potential reasons why this may be t