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Showing posts from October, 2019

Allowing for Chemotherapy in Hospice: A Podcast About Concurrent Care With Vince Mor

A recent study by Vince Mor published in JAMA Oncology found that veterans with advanced lung cancer treated in Veterans Affairs (VA) Medical Centers with high hospice use were more likely to receive concurrent cancer care and also less likely to receive aggressive care. On top of that, veterans treated at facilities with high levels of hospice use also incurred lower costs of care.   This is a strong case for the concept of concurrent care in which individuals can avoid the "terrible choice" between hospice and life prolonging therapies.   On this weeks podcast, we interview the lead author, Vince Mor, about this study and whether concurrent care is ready for prime time outside of a integrated health care system like the VA. We also put a plug in the end for the  NIA Imbedded Pragmatic AD/ADRD Clinical Trials (IMPACT) Collaboratory that Vince is helping to lead.   If you want to learn more about the collaborators, click here . by: Eric Widera

Health Navigators Improve Dementia Care: Podcast with Kate Possin and Sarah Dulaney

Do you remember the scene from the movie The Graduate where Ben's dad says, "One word: Plastics"? Well, I write this blog post from the National Palliative Care Research Center's annual Foley retreat, a who's who of palliative care researchers. The words on everyone's lips: "Lay Health Navigators." This is not to draw equivalency between environmentally destructive materials and people who help those with serious illness and caregivers navigate our complex health care system.  Rather, it's to point out that revolutions occur in palliative care research just as they do in business. In this week's podcast, we talk with Kate Possin, PhD and Sarah Dulaney, RN CNS of UCSF about the Care Ecosystem project.  In this remarkable study, published in JAMA Internal Medicine , lay health workers helped caregivers of persons with dementia navigate the health care system by providing support, education, and care coordination with dementia specia

Architecture and Medicine: Podcast with Diana Anderson and Emi Kyota

Before we get into this week's topic, would you please take 1 MINUTE to complete this GeriPal survey !  It will really help us out.  We swear, only 1 minute!  Click here to complete!  Thank you!  Now on to this week's topic. Alex : What do you get when you mix a doctor and an architect? Eric : An Archidoc? Alex : No a Dochitect.  What do you get when you mix a gerontologist with an architect? Eric : A gerontolitect? Alex : No an environmental gerontologist. OK, so we didn't have that EXACT conversation on this podcast, but something close to it.  There is a growing recognition that many of the settings where older adults receive healthcare are not designed to meet the needs of older adults.  The early part of this movement resulted in the Americans with Disabilities Act, which mandated such things as accessibility for persons with wheelchairs.  But it so much more than that.  The architecture of health care buildings can actually impair the health of older

Opening the Black Box of LTACs: Podcast with Anil Makam

What happens in Long Term Acute Care Hospitals, or LTACs (pronounced L-tacs)?  I've never been in one.  I've sent patients to them - usually patients with long ICU stays, chronically critically ill, with a gastric feeding tube and a trach for ventilator support.  For those patients, the goals (usually as articulated by the family) are based on a hope for recovery of function and a return home. And yet we learn some surprising things from Anil Makam, Assistant Professor of Medicine at UCSF.  In his JAGS study of about 14,000 patients admitted to LTACHs , the average patient spent two thirds of his or her remaining life in an institutional settings (including hospitals, LTACs and skilled nursing facilities).  One third died in an LTAC, never returning home. So you would think with this population of older people with serious illness and a shorter prognosis than many cancers, we would have robust geriatrics and palliative care in LTACs?  Right? Wrong. 3% were seen by a g

Geroscience and it's Impact on the Human Healthspan: A podcast with John Newman

Ok, I'll admit it. When I hear the phrase "the biology of aging" I'm mentally preparing myself to only understand about 5% of what the presenter is going to talk about (that's on a good day).  While I have words like telomeres, sirtuins, or senolytics memorized for the boards, I've never been able to see how this applies to my clinical practice as it always feels so theoretical.  Well, today that changed for me thanks to our podcast interview with John Newman, a "geroscientist" and geriatrician here at UCSF and at the Buck Institute for Research on Aging. In this podcast, John breaks down what geroscience is and how it impacts how we think about many age-related conditions and diseases. For example, rather than thinking about multimorbidity as the random collection of multiple different clinical problems, we can see it as an expression of the fundamental mechanisms of aging. This means, that rather than treating individuals diseases, target