GeriPal - A Geriatrics and Palliative Care Podcast

Geriatrics teaches us that older adults with infections often present with non-specific symptoms rather than typical localizing symptoms of infection present in younger adults. Sometimes they present with fever, delirium, malaise, or fatigue. In today's GeriPal/JAGS joint podcast, Jeff Caterino challenges this common teaching by examining the extent to which non-specific symptoms are predictive of infection for older adults presenting to the emergency department. Turns out - they're not so predictive as you might think!

May Hua's study addresses the still unanswered question - do specialized palliative care consults in the ICU do anything? She looked a number of outcomes comparing ICU patients in hospitals with and without palliative care consults. While most outcomes were similar, rates of hospice use were higher in hospitals with palliative care teams.

On todays Podcast we talk with Marian (Emmy) Betz about firearm safety, including how to counsel individuals with dementia about guns. Emmy is an Associate Professor in the Department of Emergency Medicine at the University of Colorado School of Medicine, and has written some pretty amazing papers on the subject of firearm safety.

In this week's GeriPal podcast we talk with Tim Girard, Plumonary Critical Care physician-researcher at the University of Pittsburgh about his study NEJM study of Haloperidol vs. Ziprasidone vs. Placebo for ICU delirium in critically ill patients.

On this weeks podcast we are talking with Aanand Naik about his recent JAGS article titled "Development of a Clinically Feasible Process for Identifying Individual Health Priorities".

We thought it would be an excellent time to talk about substance use in older adults as many of us gather around the Thanksgiving dinner table with our extended families. We invited Ben Han, a geriatrician and Assistant Professor of Medicine in Geriatrics at NYU, to talk about the research that he has done in this area. In particular, we talked with Ben about the recent increase in substance use in older adults with the rising baby boomer generation, including use of alcohol, marijuana, heroin and prescription opiate misuse, and other drugs.

In this week's GeriPal podcast we interview Randy Curtis, Professor of Medicine and Pulmonary Critical Care and Director of the Palliative Care Center of Excellence at the University of Washington. We address the question: how do we get more patients with chronic and serious illness to engage in goals of care conversations with their doctors.

On this weeks podcast, we invited Rebecca Sudore to talk about the results of her PREPARE randomized trial that was published in JAMA Internal Medicine this week. The trial enrolled nearly 1,000 English and Spanish speaking older adults being cared for in a public hospital. The headline results showed that after reviewing the PREPARE For Your Care online program and the easy-to-read advance directive, 98% of older adults reported increased engagement in advance care planning (ACP) and 43% had new ACP documentation in their medical record. Even more good news, PREPARE worked equally well among English and Spanish-speakers and across health literacy levels.

In this week's GeriPal podcast we talk with Guy Micco, MD, a longtime bioethicists, internist, hospice physician, teacher in the UC Berkeley and UCSF Joint Medical Program, mentor, and friend. Guy and I wrote an article recently for the journal Perspectives in Biology and Medicine about the intersection and issues between the fields of geriatrics, palliative care, and bioethics. The main thrust of the paper is that we need a workforce that is trained in the principles of all three fields to take the best care of the very sick, the very frail, and the very old. And for those of you who listen, Guy sings a great rendition of Hello in There, by John Prine: sweet, sad, and sentimental. Chorus: You know that old trees just grow stronger And old rivers grow wilder every day Old people just grow lonesome Waiting for someone to say, "Hello in there, Hello." Enjoy!

All the Questions You Had About Opioids But Were Afraid To Ask: A Podcast with Mary Lynn McPherson by Alex Smith and Eric Widera

How do you teach communication in serious illness? Can you? Do you teach it the same way to doctors and nurses in training? What level trainee do you target - medical students, interns, residents? How do we know our teaching is working? We discuss these and other bread and butter communication issues with Dr. Wendy Anderson, a palliative care physician at UCSF, director of the Bay Area Hub for Vitaltalk, and leader of IMPACT-ICU, a project to train ICU nurses in communication. Enjoy! -@AlexSmithMD

In this week's podcast we talk with Helen Kales, Professor of Psychiatry at the University of Michigan the VA Center for Clinical Management and Research. We've spent a great deal of effort in Geriatrics describing what we shouldn't do to address behavioral symptoms in dementia: physical restraints, antipsychotics, sedating antidepressants. Helen Kales was lecturing around the country about all of these things we shouldn't do a few years back, and people would raise their hands and ask, "Well, what should we do?" She realized she needed to give caregivers tools to help. Dr. Kales went on to develop the DICE approach to managing behavioral and psychiatric symptoms in dementia. Listen or read the full podcast to learn more! You'd be "crazy" not to! (hint: song choice).

On this weeks podcast, we interview Dr. Joan Teno about her recently published study in JAMA titled "Site of Death, Place of Care, and Health Care Transitions Among US Medicare Beneficiaries, 2000-2015." In 2013, Dr. Teno published a study that showed how good our health care system in the US promotes patient churn. Despite positive signs of more hospice use and decreased deaths in the hospital, Dr. Teno found the from 2000 to 2009 we "churned" patients through more ICU visits, more hospitalizations, and more late transitions that are burdensome to dying persons in their family. Dr. Teno's latest study shows us how we are doing now, extending that work to 2015 and now including Medicare Advantage (MA) plans. So what did she find? Well here is a summary quote from Dr. Teno of the good news: "So, we see a continued decline in people dying in acute care hospital. Increase gross of hospice to nearly half the decedents. And what got me excited about these findings was we saw burdensome patterns of care decreasing. So, people who spent less than three days of hospice decreased from 14.2% in 2009 to 10.8%. People having three or more hospitalizations the last 90 days in life decreased from 11.5 to 7.1. The other thing is transitions between a nursing home and hospital and hospital nursing home nearly had a 50% reduction." And here is the bad news (depending on how you look at it): "So if you just take a look at that, it looks like we're heading in the right direction. One thing that we didn't see a budge in was, the use of ICU in the last 30 days of life. Now, is the glass half empty or is the glass half full? I have to admit I was pretty excited that ICUs wasn't going up." But there is so much more to summarize, including the difference between traditional Medicare fee-for-service and Medicare Advantage plans that you should just listen to the whole podcast as Dr. Teno is always someone I learn a ton from. Also, for more on this subject, check out our past podcast with Shi-Yi Wang, Assistant Professor in the School of Public Health at Yale, on her JAGS paper: "End-of-Life Transition Patterns of Medicare Beneficiaries."

This week we talk with Charlie Wray, MD, Assistant Professor of Medicine at UCSF, about why clinicians should use social media in their professional lives. Charlie is a hospitalist and the Associate Social Media Editor for the Journal of Hospital Medicine. His arguments for using social media are germane to all clinicians, however. "Number Needed to Tweet" is the title of his recent grand rounds on this subject.

In this week's GeriPal podcast we talked with Dr. John Nelson, who has been Medical Director of Hospice of Humboldt for 17 years.