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Showing posts from September, 2020

It's Time for Comprehensive Dementia Care: Podcast with Lee Jennings and Chris Callahan

Chris Callahan (of Indiana University) and Lee Jennings (University of Oklahoma) have some righteous anger.   Why do we have comprehensive cancer care centers and not comprehensive dementia care centers?   We have a body of evidence dating back 30 years to support people with dementia and their caregivers with Comprehensive Dementia Care. Lee Jennings added to this robust body of work with a study published in the Journal of the American Geriatrics Society demonstrating that a comprehensive dementia care program based out of UCLA reduced ED visits, hospital length of stay, increased hospice enrollment, and delayed time to admission to long term care.   As Chris Callahan notes in his accompanying editorial in JAGS , a fundamental problem with our healthcare system is that savings from Comprehensive Dementia Care accrues not to the dementia care program, but to the hospital and Medicare (ED visits, hospital length of stay) or Medicaid (long term care admission).  Our fragmented healthca

Reducing serious fall-related injuries: an interview with NEJM STRIDE Study author Tom Gill

Every year, about a third of older adults fall.  About one in five of those falls result in moderate to severe injury.  What can we do to help not only prevent those falls but also the complications of them? On todays podcast, we talk to Tom Gill, one of the authors of the recent Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study published in the NEJM.   The STRIDE study was huge, 5,451 patients in 86 primary care clinics from 10 different health care systems.   Individuals assigned to the interventions worked with a “falls care manager” whose goal was to help identify and make plans about risk factors for falls and fall-related injuries.  What did it show?   Well, the conclusion of the NEJM abstract states that this multifactorial intervention "did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care."   We talk to Tom about whether that is the right take home from this pragmatic study and ho

Virtual Resources for Older Adults during the COVID19 Pandemic

  by: Kahli Zietlow, Serena P Wong , and Mitchell Heflin In a recent telehealth visit, a patient presented alongside her husband, who was concerned that she had become a “shell of herself.” She previously enjoyed reading, spending time with family, and attending a water aerobics class at her local YMCA. Since the pandemic began, she has suffered from isolation; her aerobic classes were suspended, and their children had stopped visiting in an effort to protect them from contracting COVID19. She hadn’t left the house in months, stopped reading books, and seemed disengaged when her family called. He observed that she spends her days watching television and sleeping, and he was concerned that her memory had dramatically worsened in the past four months.  Social engagement and intellectual stimulation are critical to one’s wellbeing, memory, and mood. Numerous observational studies demonstrate that social engagement and cognitive stimulation can delay or prevent onset of dementia. Even be

Family Meetings for Patients with Serious Illness: Podcast with Eric Widera

No dear listeners and readers, that is not a typo.  Eric Widera is indeed our guest today to discuss his first author publication in the New England Journal of Medicine, Family Meetings on Behalf of Patients with Serious Illness .  Our other guests include other authors James Frank, Wendy Anderson, Lekshmi Santhosh, me and actress and frequent GeriPal guest-host Anne Kelly. There's a story behind this one folks. One day, Ken Covinsky walked into our office and said, "You know how the NEJM has this Videos in Clinical Medicine series?  With videos like, 'How to insert a central venous catheter?'  You should send them a video of your palliative care 'intervention' - how to conduct a family meeting."  Brilliant idea.  Well...that was 2014...a funny thing happened on the way to the theater. After several iterations, videos, reviews, a rejection, and lessons in persistence, we finally published. We were helped by an outstanding cast who role played the fa

The Perfect Storm of COVID‐19 in Nursing Homes: A Podcast with Joe Ouslander

COVID-19 has created a perfect storm in nursing homes.  As noted in a recent Journal of the American Geriatrics Society (JAGS) article by Joe Ouslander and David Grabowski, the storm is created by the confluence risks, including a vulnerable population that develop atypical presentations of COVID-19, staffing shortages due to viral infection, inadequate resources including testing and personal protective equipment (PPE), and lack of effective treatments.   The result?  Nearly half of COVID-19-related deaths in the US occur in people cared for in nursing homes and assisted living facilities, and about a quarter of all facilities have had at least one COVID case. On this weeks podcast, we talk to Dr. Ouslander about his JAGS article on this perfect storm , as well as strategies that one can take from a clinical, public health, and policy interventions to help calm the storm.  In particular Joe summarizes a lot of research published in JAGS lately on COVID-19, including some of these st