GeriPal

Lesbian, gay, bisexual and transgender (LGBT) older adults have lived through a lifetime of discrimination, social stigma, prejudice, and marginalization. Is the care that we are giving them in later life changing any of that or are we pushing them back into the closet? This is what we talk about in this week's podcast with Carey Candrian from the University of Colorado School of Medicine, and Angela Primbas from Stanford University (and future geriatrics fellow at UCSF!).   Carey has published a wonderful article in the Gerontologist titled “She’s Dying and I Can’t Say We’re Married?”: End-of-Life Care for LGBT Older Adults , in which she describes how older LGBT adults may be at higher risk for having their health care wishes ignored or disregarded, their families of choice are less likely to be included in their decision making, and they may experience increased isolation, bullying, mistreatment, or abuse, which ultimately contribute to receipt of poor-quality health care.  We t

by: Abigail Nathanson, Bridget Sumser, Shirley Otis-Green, and BJ Miller These are survival times. The pandemic, the drawn-out election, the climate crisis, the parading of white supremacy - the last year has changed how many of us see ourselves, care for ourselves, and engage in the world. Our sense of impact and control are ever changing, rapidly redefined by external forces and perhaps some internal ones too. Without our familiar sense of control, death feels more salient, more real, and not as far away as we are used to. Our ICU’s are full. We have countless videos of Black people being killed by police with little to no accountability. The Capital stormed. Wildfires, hurricanes, earthquakes. We refresh our news feeds hoping for a different story; we don’t get it. Our usual ways of coping aren’t cutting it - many of us feel unsure how to forge a meaningful path forward. From this uncertainty comes the invitation to explore a new path, one that involves a more personal r

On the one hand, every year we are fortunate to have new medications that help older adults and people living with serious illness.  New treatments for lung cancer with remarkable survival outcomes come to mind, for example.   On the other hand, the tremendous growth in medications has led to an explosion of prescribing, polypharmacy, with attendant side effects and harms.   In this week's podcast, we talk with Nagham Ailabouni, a pharmacist and researcher joining us from Australia (song choice: Down Under!) about her review of major articles on medication safety and quality for older adults.  Dr. Ailabouni summarized the top four hardest hitting in a recent publication in the Journal of the American Geriatrics Society, or JAGS.  The four articles are: Older Medicare Beneficiaries Frequently Continue Medications with Limited Benefit Following Hospice Admission Prescribing of oral anticoagulants in the emergency department and subsequent long-term use by older adults with atrial f

Most of us know we are going to die.  How often though do we actually let ourselves really internalize that understanding?   To imagine it?  To feel it?  To try to accept it? On today’s podcast we invited BJ Miller back on our podcast to talk about death using as our guide his recent NY Times editorial What Is Death?  How the pandemic is changing our understanding of mortality . In addition to being the author of this NY Times article, BJ is a Hospice and Palliative Care doc, and the founder of Mettle Health which aims to provide personalized, holistic consultations for any patient, caregiver or clinician who need help navigating the practical, emotional and existential issues that come with serious illness and disability. We start off with BJ appropriately picking the song "Ebony Eyes" as our intro song, which is a good analogy to talking about death, as it was initially banned by the BBC from airplay as its lyrics were considered too upsetting to play on the radio.  We t

  “In the beginner's mind there are many possibilities, but in the expert's there are few” - Zen Master Shunryu Suzuki Many of us in geriatrics and palliative care assume that we are the experts in health care when it comes to understanding the caregiver experience.  Every once in a while, we are humbled and reminded of what we don’t know. Jessica Zitter had such an experience.  Jessica, as many of you know, is an award winning author (link to our podcast about her book Extreme Measures) and was featured in an Academy Award winning film titled Extremis.  She sought out to make another movie about the story of one of her patients who enrolled in hospice. The idea was it would be a film about all of the support that hospice provides and how it’s a transformative experience.  What she realized, however, is that the real story in this film is about the caregiver in the film, who is overworked, overburdened, and has few options for supportive to care for his wife’s daily needs.   Th