302 episodes

A geriatrics and palliative care podcast for every health care professional.

We invite the brightest minds in geriatrics, hospice, and palliative care to talk about the topics that you care most about, ranging from recently published research in the field to controversies that keep us up at night. You'll laugh, learn and maybe sing along. Hosted by Eric Widera and Alex Smith. CME available!

GeriPal - A Geriatrics and Palliative Care Podcast Alex Smith, Eric Widera

    • Health & Fitness
    • 4.9 • 253 Ratings

A geriatrics and palliative care podcast for every health care professional.

We invite the brightest minds in geriatrics, hospice, and palliative care to talk about the topics that you care most about, ranging from recently published research in the field to controversies that keep us up at night. You'll laugh, learn and maybe sing along. Hosted by Eric Widera and Alex Smith. CME available!

    Dysphagia Revisited: A Podcast with Raele Donetha Robison and Nicole Rogus-Pulia

    Dysphagia Revisited: A Podcast with Raele Donetha Robison and Nicole Rogus-Pulia

    Almost a decade ago, our hospice and palliative care team decided to do a “Thickened Liquid Challenge.”  This simple challenge was focused on putting ourselves in the shoes of our patients with dysphagia who are prescribed thickened liquids.  The rules of the challenge were simple: fluids must be thickened to “honey consistency” using a beverage thickener for a 12-hour contiguous period.
    All of us failed the challenge. We then decided to challenge others and asked them to post their videos online using the hashtag #thickenedliquidchallenge.  Here are some of the results of those videos: https://geripal.org/the-thickened-liquid-challenge/
    On today’s podcast, we revisit dysphagia and thickened liquids with two researchers and speech-language pathologists, Raele Donetha Robison and Nicole Rogus-Pulia.  We talk with them about the epidemiology, assessment, and management of dysphagia, including the role of modifying the consistency of food and liquids, feeding tubes, and the role of dysphagia rehabilitation like tongue and cough strengthening.  We also talk about the importance of a proactive approach to involving speech-language pathologists in the care of individuals early on with neurodegenerative diseases like dementia and ALS.
    If you want to take a deeper dive, take a look at these articles:
    A nice overview of swallowing disorders in the older adults published in JAGS
    A study in JAGS showing that 89% of feeding tubes inserted during hospitalization were in patients with no preexisting dysphagia
    Nicole’s article on shifting to a proactive approach of dysphagia management in neurodegenerative disease
     

    • 46 min
    End-of-Life Doulas: A Podcast with Jane Euler, Beth Klint, and John Loughnane

    End-of-Life Doulas: A Podcast with Jane Euler, Beth Klint, and John Loughnane

    In the last several years, I’ve seen more and more articles about end-of-life doulas (like this NY Times article from 2021). Despite this, in my 20-year career as a palliative care physician, I have yet to see a death doula in the wild. I’m unsure what they do, how often they’re used, and who pays for their work. So, on today’s podcast, we try to get to the bottom of what exactly is an end-of-life doula.
    We’ve invited two death doulas, Jane Euler and John Loughnane (who is also a family doc and palliative care physician), to talk about the role of a doula at the end of life.  We also invited Beth Klint to speak about the doula's role within a traditional hospice organization. Why Beth?  In addition to being a palliative and hospice RN, she is the Executive Director for Goodwin Hospice, a large non-profit hospice that added end-of-life doula care to their services in collaboration with Jane and John’s doula organization, Present for You.
    If you are interested in learning more about death doulas, check out the following links
    Goodwin Hospice’s article on the collaboration with Present for You
    A HospiceNews article talking about the value proposition of death doulas for hospices
    NHPCO’s End-of-Life Doula Council page that includes a lot of great links
     

    • 43 min
    GeriPal 300th Episode: Ask Me Anything Hot Ones Style

    GeriPal 300th Episode: Ask Me Anything Hot Ones Style

    Today we celebrate eight years, around 2 million listens, and 300 podcasts! 
     
    Eric and I take questions from you, our listeners, about: why we podcast, our most controversial podcast, which podcast changed our practice, favorite song request, should all nursing home residents complete the POLST, expanding access to durable medical equipment, palliative care in rural regions, do we have an advance directive, what we’d do to improve healthcare with 7 trillion dollars, treatment for poor appetite, and Eric on how to make a latte.  Thank you to Lynn Flint and Anne Kelly who serve as hosts for this episode, asking us the tough questions.
    We answer your questions hot ones style.  I borrowed some screaming hot sauces from my friends Jerome Kim and Tony Le, and added them to my small collection of extra mild sauces.  Every two questions we ate a chicken wing covered in hot sauce. The hot sauces progressed from mild to extreme (and I mean extreme) heat.
    Can I just say…it works?  Being asked a question with your mouth on fire, sweat streaming down your face, feeling the most awake and terrified you have ever been in your life, forces you to give an unadorned answer, straight from the heart.
    Don’t take my word for it, listen for yourself! Or better yet, watch the video of this one on YouTube. Some of the funniest parts are caught on video, in the background. We will be re-watching this one for years to come.
    Thank you, dear listeners, for sending us your questions, for your enthusiasm, and for your support. Enjoy!
    -@AlexSmithMD
     
     

    • 43 min
    Psychological Issues in Palliative Care: Elissa Kozlov and Des Azizoddin

    Psychological Issues in Palliative Care: Elissa Kozlov and Des Azizoddin

    In our podcast with palliative care pioneer Susan Block, she identified the psychological/psychiatric aspects of palliative care as the biggest are of need for improvement.  As she said, when you think about the hardest patients you’ve cared for, in nearly all cases there was some aspect of psychological illness involved.  That rings true to me.
    Today we talk with two psychologists who are deeply invested in addressing psychological aspects of care for people living with serious illness. Elissa Kozlov, a geropsychologist and director of a new population aging MPH at Rutgers, surveyed AAHPM members, and found that doctors reported major shortcomings in level of comfort and knowledge caring for patients with psychological illness. She conducted a systematic review and meta-analysis of 38 palliative care trials, finding that many excluded people with serious illness, and a lack of impact on psychological outcomes.  Analyzing the Health and Retirement Study, she found 60% of older adults screened positive for depression in the last year of life (related study here).
    Des Azizoddin is a psychologist at the University of Oklahoma primarily focused on pain for people with cancer. Des delivered a plenary at this year’s National Palliative Care Research Center’s Foley retreat. She began by asking, “Raise your hand if you think there is a psychological component to cancer pain.” All hands go up.  Then, “Keep your hand up if you frequently refer patients with cancer pain to a psychologist?” All hands go down.  Unfortunately, we lack the financial structures to reimburse psychologists that would incentivize widespread inclusion on palliative care teams.  Because we live in the world as it is, not as it should be, Des has helped develop an app (link to pilot trial hot off the press!) to help people with cancer pain engage in cognitive behavioral therapy in bite sized 3-4 minute sessions (there are other apps available now developed in the VA, who have been leaders in the psychology/palliative care space).  Des additionally studied stigma associated with opioid use among patients with cancer in the context of the opioid epidemic;  depression, pain catastrophizing, recent surgery and opioid use among people with cancer.
    And, we talk about these issues and more (with far more nuance than I can include in this post). 
    Kudos and credit to my son Renn, age 15, for the guitar on Heartbeats (hand still broken at time of recording).

    • 45 min
    EMS Intervention to Reduce Falls: Carmen Quatman and Katie Quatman-Yates

    EMS Intervention to Reduce Falls: Carmen Quatman and Katie Quatman-Yates

    We've talked about Falls a couple of times on this podcast, most recently with Tom Gill about the STRIDE study and before that with Sarah Szanton about the CAPABLE study.  A takeaway from those podcasts is that fresh innovative thinking in the falls prevention space is welcome.
    Today we talk with the twin sister power duo of Carmen Quatman and Katie Quatman-Yates about an intervention that is both brilliant and (in retrospect) should have been obvious.  The insight started when Carmen, an orthopedic surgeon-researcher, and Katie, a physical therapist- researcher participated in ride-alongs with EMS providers to patient’s homes.   They were stunned by the number of calls for lift assistance for older adults who had fallen. Going into patient's homes was eye opening. There were trip hazards, loose carpets, some people were hoarders. And yet, after assisting the older adult to their feet, the EMS providers would leave. Their job was done. It's not surprising that the number of repeat calls for falls is alarmingly high.  Addressing the root environmental causes of falls was not part of EMS providers' job description.  In addition to stigma, practical barriers to older adults addressing environmental issues themselves abound. For example, Carmen and Katie found thousands of grab bars on Amazon (overwhelming), and when they called installation companies (handypersons), received different quotes if the person calling was a man or a woman.
    So Carmen and Katie developed an EMS Community Partnership program.  EMS providers were trained to provide practical home modifications: installation of grab bars, removal of carpets, removal of other obstacles. They created a seamless link between this Community Partnership program and 911 calls for falls.  People who had grab bars installed through the program called their neighbors and say, hey you should get this too.  Word of mouth spread rapidly.  And the number of calls for falls dropped.
    Eric and I enjoyed talking with Carmen and Katie about this innovative and common sense approach to addressing falls in the community.
    In addition to the podcast, you can see more about this in Carmen's TEDx talk.
    Thanks to my wife Cindy Hsu for piano on Eye of the Tiger. Enjoy!
    -@alexsmithMD
     

    • 45 min
    The Nature of Suffering: BJ Miller and Naomi Saks

    The Nature of Suffering: BJ Miller and Naomi Saks

    In 1982 Eric Cassell published his landmark essay: On the Nature of Suffering and the Goals of Medicine.  Though his narrow definition of suffering as injured or threatened personhood has been critiqued, the central concept was a motivating force for many of us to enter the fields of geriatrics and palliative care, Eric and I included.
    Today we talk about suffering in the many forms we encounter in palliative care.  Our guests are BJ Miller, palliative care physician and c-founder of Mettle Health, and Naomi Saks, chaplain at UCSF. 
    We discuss:
    How to respond when a nurse or trainee says, “I think this patient is suffering,” but the family does not share that perception
    The trap in comparing one person’s suffering to another person’s suffering
    How to respond to suffering, from naming to rebirth
    Ways in which suffering can bring meaning and purpose, or at the very least co-exist alongside growth and transformation
    The extent to which elimination of suffering ought to be a goal of palliative medicine (with a nod to Tolstoy)
    A simple 2 sentence spiritual assessment
    Credit to my son Kai Smith on guitar on Everybody Hurts for those listening to audio only (hand still splinted at time of this recording)
    -@AlexSmithMD
     
    Additional links:
    Screening for suffering: https://pubmed.ncbi.nlm.nih.gov/27714532/ and https://pubmed.ncbi.nlm.nih.gov/35195465/ and https://pubmed.ncbi.nlm.nih.gov/31387655/
    Evans CB, Larimore LR, Grasmick VE. Hospital Chaplains, Spirituality, and Pain Management: A Qualitative Study. Pain Manag Nurs. 2023 Dec 20:S1524-9042(23)00202-3. doi: 10.1016/j.pmn.2023.11.004. Epub ahead of print. PMID: 38129210.
    Kleinman, A. (2020). The illness narratives suffering, healing, and the human condition. 
    Accepting This
    Poem by Mark Nepo
    https://marknepo.com/poems_accepting.php
    Saks, N., Wallace, C.L., Donesky, D., & Millic, M. (in preparation). “Profession-specific Roles in Palliative Care.” In Donesky, D., Wallace, C.L., Saks, N., Milic, M. & Head, B. (eds.), Textbook on Interprofessional Palliative Care. Oxford University Press.

    • 52 min

Customer Reviews

4.9 out of 5
253 Ratings

253 Ratings

The OGG ,

Great info, fun to listen

I love this podcast. Eric and Alex (and frequent guest cohosts) offer up-to-date and engaging information about hot topics in geriatrics and palliative care in a way that is fun to listen to. They have a really diverse group of guests and do a nice job with the interview. This is a great, easy way to stay informed! Definitely recommend.

indiaphile ,

Geripal

As a Geriatrician working in LTC I find Geripal a useful and enjoyable podcast. One of the best in the field.

sdpatel07 ,

Great Podcast!

I’ve learned so much!!

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