GeriPal - A Geriatrics and Palliative Care Podcast

In this week's podcast we talked with Dr. Bernard Lo (Bernie as he is known). Dr. Lo is President of the Greenwall Foundation, a foundation dedicated to improving Bioethics research nationally. Prior to Greenwall, Dr. Lo was Professor of Medicine at UCSF and head of the Bioethics Program. He still maintains a primary care practice at UCSF. We talked with Bernie about several dilemmas in the area of physician aid in dying, with conversation jump started by his recent NEJM perspective on this topic

For today's GeriPal Podcast we talk with Drs. Nathan Brummel and Lauren Ferrante, both critical care physician-researchers, about integrating geriatrics principles in intensive care units.

Tramadol. Is it just a misunderstood opioid that is finally seeing its well deserved day in the sun, or is it as our podcast guest David Jurrlink would say, what would happen if "codeine and Prozac had a baby, and that baby grew into a sullen, unpredictable teenager who wore only black and sometimes kicked puppies and set fires."

On today's episode we talk to Larry Allen and Dan Matlock about decision making around destination therapy. No this has nothing to do with your summer vacation plans. Rather, we talk about how individuals with heart failure decide about whether or not to pursue "destination therapy" with an Left Ventricular Device, or LVAD.

In this weeks GeriPal podcast, we interview Dr. Barak Gaster, Professor of Medicine and General Internist at the University of Washington in Seattle. Dr. Gaster felt like there was hole in the advance directives landscape around future planning for people with dementia. People with dementia experience a fairly common set of complications and decisions around feeding, loss of independence, and loss of ability to make complex decisions. His dementia specific advance directive has specific sections for care preferences for persons who progress through stages of dementia, including descriptions of mild, moderate, or severe dementia.

Can routine initiation of goals of care discussions by a palliative care social worker improve prognostic understanding, elicit advanced care preferences, and influence care plans for high-risk patients discharged after a heart failure hospitalization? That is the question we attempt to answer with this weeks podcast guest, Arden E. O’Donnell. kbez8pby

This week's guest is Doug White, Professor of Critical Care Medicine at the University of Pittsburgh and lead author of a randomized controlled study of a nurse-led intervention to provide emotional support to families of seriously ill patients in the ICU and improve the quality of communication, published in the NEJM.

How do patients come to the decision regarding whether or not to initiate dialysis? Well, that is the question that we talk about with Keren Ladin on this week's podcast. Keren is a social science researcher, bioethicist, and assistant professor in the department of Occupational Therapy at Tufts. What becomes clear when you look at Keren's research is the for many patients, there isn't a decision that is made.

This week, Eric and I talked with Melissa Wachterman, a physician researcher from the Dana Farber Cancer Institute and Harvard Medical School. Melissa used a national dataset of people receiving hemodialysis linked to Medicare claims for older adults who died.

In this week's GeriPal podcast we talk with Cynthia Boyd, Professor of Medicine and Geriatrician at Johns Hopkins University School of Medicine about how physicians communicate with home health agencies. Home health plays a critical role in caring for persons residing at home, and in the best of circumstances extend a seamless network of care from the primary care physician's office to the home. Sadly, reality is not so rosy. The major form of communication between physicians and home health nurses is, well, a form. CMS Form 485 to be specific. In a recent study published in Annals of Internal Medicine, Dr. Boyd revealed that most primary clinicians barely read what the home health nurses write on the form, don't find the form useful, and rarely does it change management. It's the 21st century people. Can we move beyond lame forms and communicate with each other, perhaps using some modern technology? Or even 20th century technology, such as phones, if not 21st Century technology, such as video chats? Listen or read more to learn more. Enjoy!

There is a lot of discussion about the right to die. Although most of these have to do with Physician Assisted Death (PAD). What about in those who are not dying but express a dire to end their lives in the absence of a diagnosable mental illness? Do they have the same right? Well, on today's podcast we are going to step into this tricky topic with our guest, Dr. Meera Balasubramaniam, a Geriatric Psychiatrist from NYU. Meera wrote a paper for JAGS titled "Rational Suicide in Elderly Adults: A Clinician's Perspective". We talk with Meera about her article, including how she would define rational suicide, how can we help best explore these thoughts that patients consider rational, and how society and baby boomers are changing the way we think about this. We also dive into some other interesting topics include agism. I really love this quote from Meera, so I'll post it here, but for the full transcript read below or listen to the podcast: Ageism is a very interesting and distinct concept. It's fear of growing old or fear of being in that state. It's so distinct from something like racism or sexism. If a person is racist about a certain other race, it's less likely that they are going to be part of the other race that they are having negative connotations about. Similarly, if you are sexist, it's less likely less likely that you are going to belong to the other gender. When it comes to age, it's quite fascinating that most of us are actually going to get to that stage that we're being ageist about. What it is about growing old and about being down in the future that scares most of us has been sort of the crux of part of my work from a society perspective.

In this weeks podcast we talked with David Wang about how palliative care can join forces with the emergency department to improve care for the serious ill. This conversation was motivated in part by a recent expert consensus statement on key knowledge and skills standards about hospice and palliative medicine for emergency medicine providers. What should the core training be? How do emergency providers feel about palliative care? How can palliative care services that are typically available bankers hours work with the emergency department, open 24-7?

On todays podcast, we will be talking with Brooke Namboodri and we have Tim Platts-Mills from the University of North Carolina at Chapel Hill about their new article in the Journal of American Geriatric Society (JAGS) on "Elder abuse identification in the prehospital setting, an examination of state EMS protocols." We talk with Brooke and Tim about the state of EMS protocols in the US and how often the mention elder abuse in them (spoiler alert: not very often), how this compares to mentions of child abuse, the role EMS should play in elder abuse identification and management, and the role of potential screening tools for elder abuse.

In this weeks GeriPal/JAGS Podcast we talked witk Kei Ouchi, an emergency medicine physician, internist, and researcher at the Brigham and Women's Hospital and Harvard Medical School in Boston. We recorded this podcast in the hallways of the annual meeting. We talked about outcomes following intubation in the emergency department. Kei published a paper in JAGS that is notable for several things, but perhaps most of all for the innovative use of color imagery to convey a message. The image in the @AGSJournal tweet above is from Dr. Ouchi's article - this tweet went viral by the way - and notice what it does: (1) convey the main message that outcomes are worse with advancing age, and are not good in general overall; (2) grab your attention and make you want to learn more. Kei is very thoughtful about how these data should be used - not on the spot in the ED, when a patient is gasping for air, and you pull up the color figure on your iphone Twitter app - no, not then. Better to use this information in advance, when things are calm, outside the ED, for people at risk of going to the ED in extremis. This is the first in a series of GeriPal podcasts on the GeriPal - ED interface. ED stands for Emergency Department by the way. Enjoy! -By @AlexSmithMD

On this week's podcast, we talk with the authors of a Journal of the American Geriatrics Society (JAGS) article titled Should We Bury “The Good Death"? As luck may have it, one of the authors is co-host Alex Smith, and the other is a leader in geriatrics and palliative care, VJ Periyakoil. Alex and VJ's critique of the ‘good death’ was published alongside a paired commentary from Age and Ageing from the British Geriatrics Society.