GeriPal - A Geriatrics and Palliative Care Podcast

In this week's GeriPal podcast we talk with Stacy Fischer, MD and Regina Fink, RN, PhD, both from the University of Colorado, about a lay health navigator intervention to improve advance care planning with Latinos with advanced cancer. The issue of lay health navigators raises several issues that we discuss, including: - What is a lay health navigator? - What do they do? How are they trained? - What do lay health navigators offer that specialized palliative care doesn't? Are they replacing us? - What makes the health navigator intervention particularly appropriate for Latinos and rural individuals? For advance care planning? Eric and I had fun singing in French (yes French, not Spanish, listen to the podcast to learn why). Enjoy! Alex Smith, MD

This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End." As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care. His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times. As we discuss on the Podcast, this has changed BJ's life, and he spends most of his working time engaged in public speaking, being the public "face" of the hospice and palliative care movement. The book he and Berger wrote is filled to the brim with practical advice. I mean, nuts and bolts practical advice. Things like: - How to clean out not only your emotional house but your physical house (turns out there are services for that!) - Posting about your illness on social media (should you post to Facebook) - What is the difference between a funeral home and mortuary - Can I afford to die? How much will it cost? We focus our discussion with BJ on his reasons for writing the book, sexuality and serious illness, and priming people to check the instincts of a medical system that favors aggressive/intensive/invasive care and crappy deaths. And BJ came up with some nice harmonies to "Tonight, You Belong to Me." Enjoy! AlexSmithMD

This weeks podcast is all about the intersection of geriatrics, palliative care, advanced care planning and surgery with our guest Dr. Vicky Tang. Vicky is an assistant professor and researcher here at UCSF. We talk about her local and national efforts focused on this intersection, including: * Her JAMA Surgery article that showed 3 out of 4 older adults undergoing high risk surgery had no advance care planning (ACP) documentation. * Prehab clinics and how ACP fits into these clinics * The Geriatric Surgery Verification Quality Improvement Program whose goal is to set the standards for geriatric surgical care including ACP discussions prior to surgery * How frailty fits in and how to assess it (including this paper from JAGS on the value of the chair raise test) So take a listen and enjoy this informative podcast. You can also check out associated links that can be found in this podcast on our website at: https://www.geripal.org/2019/06/advance-care-planning-before-major-surgery.html

There are few names more closely associated with palliative care than Diane Meier. She is an international leader of palliative care, a MacArthur "genius" awardee, and amongst many other leadership roles, the CEO of the Center to Advance Palliative Care (CAPC). We were lucky enough to snag Diane for our podcast to talk about everything we always wanted to ask her, including: * What keeps her up at night? * Does palliative care need a national strategy and if so why and what would it look like? * The history of CAPC and the leadership centers * Advice that she has for graduating fellows who want to continue to move palliative care forward as they start their new careers * What she imagines palliative care will look like in 10 or 15 years? * What is the biggest threat facing palliative care? We hope you join us for this great podcast!

In this week's podcast, we talk with Dr. Ira Byock, a leading palliative care physician, author, and public advocate for improving care through the end of life. Ira Byock wrote a provocative and compelling paper in the Journal of Pain and Symptom Management titled, "Taking Psychedelics Seriously." In this podcast we challenge Ira Byock about the use of psychedelics for patients with serious and life-limiting illness. Guest host Josh Biddle (UCSF Palliative care fellow) asks, "Should clinicians who prescribe psychedelics try them first to understand what their patient's are going through?" The answer is "yes" -- read or listen on for more!

In this week's podcast we talk with Louise Aronson MD, MFA, Professor of Geriatrics at UCSF about her new book Elderhood, available for purchase now for delivery on the release date June 11th. We are one of the first to interview Louise, as she has interviews scheduled with other lesser media outlets to follow (CBS This Morning and Fresh Air with Terry...somebody). This book is tremendously rich, covering a history of aging/geriatrics, Louise's own journey in medicine and as a geriatrician facing burnout, aging and death of family members, filled with stories of patients, etc. We focus therefore on the main things we think our listeners and readers will be interested in. First - why the word "Elder" and "Elderhood" when JAGS/AGS and others recently decided that the preferred terminology was "older adult"? Second - Robert Butler coined the term ageism in 1969 - where do we see ageism in contemporary writing/thinking? We focus on Louise's delectable takedown of Ezekiel Emanuel's Atlantic Article "Why I hope to Die at 75" Third- Louise's throws down the guantlet to the field of geriatrics. She argues that we have held too narrow a view of ourselves as clinicians for the oldest old and frailest frail. Instead, we should expand our vision of the field to include all older adults - including healthy 60/70 year olds & healthy aging - and become the default clinicians for all people entering life's last stage. Elderhood is a terrific read, and you are listeners/readers will all be inspired by the ideas, moved by the stories (you will identify with them), and challenged to re-imagine our clinical practice. (apologies - I had a cold so sort of struggle through the singing, far different from my usual perfect rendition!) Enjoy!

In this week's GeriPal podcast we discuss the research into delirium with a focus on prevention. We are joined by internationally acclaimed delirium researcher Sharon Inouye, MD, MPH. Dr Inouye is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center in the Institute for Aging Research at Hebrew SeniorLife.

Estimating prognosis is hard and clinicians get very little training on how to do it. Maybe that is one of the reasons that clinicians are more likely to be optimistic and tend to overestimate patient survival by a factor of between 3 and 5. The question is, aren't we better as palliative care clinicians than others in estimating prognosis? This is part of our training and we do it daily. We got to be better, right?

On today's podcast we talk with one of the national experts on multimorbidity, Melissa Wei. Dr. Wei is an Assistant Professor and physician researcher at the University of Michigan. In addition to destroying the lyrics to Bohemian rhapsody, we talk to Dr. Wei about how we should conceptualize multi morbidity, it's impact on older adults, and about her recent JAGS publication titled "Multimorbidity and Mental Health-Related Quality of Life and Risk of Completed Suicide."

In this weeks GeriPal podcast we take a deeper dive into this issue of language and medicine. We are joined by guests Anna DeForest, MD, MFA, a resident in Neurology at Yale, and Brian Block, MD, a pulmonary critical care fellow at UCSF.

Our first live podcast at the annual meeting for the American Academy of Hospice and Palliative Medicine! We invited Rachelle Bernacki and Jo Paladino to discuss their two papers published today on the the Serious Illness Care Program.

As Eric notes in the introduction, this recent study in JAMA by Jeff Williamson and colleagues led to some very contradictory headlines. Some headlines proclaimed that lowering blood pressure prevents dementia, and others stated the opposite, that lowering blood pressure does not prevent dementia. So what exactly did the study show? Do these results apply to patients we commonly see in Geriatrics? What should we make of the fact that after the trial was stopped early the blood pressures in the lower blood pressure target group rose - does this mean you can't achieve intensive blood pressure lowering "in the real world"?

In the 1990s, Susan Tolle helped create the POLST. Now she and Elizabeth Eckstrom want to change it. And personally, I think they're right.

On this week's podcast we have Bridget Sumser, a clinical palliative care social worker, board member for the Advanced Palliative Hospice Social Worker certification exam, and now co-author of a new book "Palliative Care: A Guide for Health Social Workers".

Three reasons you should listen to this podcast: The issue of patients cycling back and forth between the hospital and skilled nursing facilities near the end of life is common, will ring true to those of you who are clinicians, and has largely been ignored in the literature. It's about a hot off the press article published today in the NEJM. Lynn Flint, Palliative care doc at UCSF in the Division of Geriatrics, first author, and our guest, makes me sing "Hit Me Baby One More Time" by Brittany Spears. This moment is either a new high or a new low for the GeripPal podcast, I can't tell which. You really need to listen to the final seconds when Eric joins in singing, "still believe" in high falsetto.