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.
Moral Injury: Podcast with Shira Maguen
Though origins of the term “moral injury” can be traced back to religious bioethics, most modern usage comes from a recognition of a syndrome of guilt, shame, and sense of betrayal experienced by soldiers returning from war. One feels like they crossed a line with respect to their moral beliefs. The spectrum of acts that can lead to moral injury is broad, ranging from killing of an enemy combatant who is shooting at the soldier (seemingly acceptable under wartime ethics), to killing of civilians or children (unacceptable). One need to witness the killing - dropping bombs or napalm can result in moral injury as well - nor need it be killing; harassment, hazing, and assault can result in moral injury, as can bearing witness to an event. While there is often overlap between moral injury and post-traumatic stress disorder (PTSD), they are not synonymous.
Today we talk with Shira Maguen, psychologist and Professor at UCSF and the San Francisco VA. One of the many fascinating parts of our discussion is when we talk about the moral injury faced by healthcare workers during COVID. I encourage you to listen to the last podcast to hear what moral injury can sound like - being asked to care for patients under far less than ideal circumstances, care that is the best under the circumstances but is not standard of care, wondering if as a result patients may have been harmed or died.
One common feature of moral injury in combat is a feeling of betrayal by superior officers who order soldiers to act in a way that contravenes their self-conception of right and wrong. One might say we in healthcare experienced a similar betrayal of leadership that flouted the science of mask wearing, stated that doctors were billing for COVID excessively to turn a profit, and touted unproven and potentially harmful medications as miracle cures.
We also talk about treatment (and it’s more than “I wanna hold your hand,” song choice hint)
Moral Injury Fact Sheet: Moral Injury in Health Care Workers: Health and Human Services: Moral Injury for Healthcare Workers: Gender differences in Moral Injury Moral Injury in the Wake of Coronavirus: Attending to the Psychological Impact of the Pandemic on Healthcare Workers: Moral Injury
Life, Death, and a Hospital Strained by COVID: Podcast with Brian Block, Sunita Puri and Denise Barchas
During the winter peak in coronavirus cases, things got busy in my hospital, but nothing close to what happened in places like New York City last spring or Los Angeles this winter. Hospitals in these places went way past their capacity, but did this strain on the system lead to worse outcomes? Absolutely.
On today’s podcast, we talk with Brian Block, lead author of a Journal of Hospital Medicine study that showed that patients with COVID-19 admitted to hospitals with larger COVID-19 patient surges had an increased odds of death. We talk about the findings in his study, which also included some variation in the surge hospitals as well as potential reasons behind these outcomes.
We’ve also invited two other guests, Denies Bachas and Sunita Puri, to describe their hospital experiences in a COVID surge. Denise is a ICU nurse at UCSF who volunteered in New York during the spring surge of COVID cases. Sunita is the Medical Director of Palliative Medicine at USC’s Keck Hospital & Norris Cancer Center in Los Angeles. She is also the author of numerous books and essays, including “That Good Night: Life and Medicine in the Eleventh Hour” (if you haven't read it yet you should!)
Disability in the home: Podcast with Sarah Szanton and Kenny Lam
We know from study after study that most older adults would prefer to age in place, in their homes, with their families and embedded in their communities. But our health system is in many ways not particularly well set up to help people age in place. Medicare does not routinely require measurement or tracking of disability that leads many people to move out of their homes, and many interventions that support people to age in place are unfunded, underfunded, or funded by philanthropy rather than the government.
Today we talk with Sarah Szanton, who created the CAPABLE multi-disciplinary model to help older adults stay at home, and Kenny Lam, who used a national study to examine the need for home-modification devices. And we preview another of the AGS songs for the literature update - this one to the tune of “My Get up and Go” by Pete Seeger.
All things Amyloid, including Aducanumab and Amyloid PET scans with Gil Rabinovici
There are no currently approved disease modifying drugs for Alzheimer's disease, but in a couple months that may change. In July of 2021, the FDA will consider approval of a human monoclonal antibody called Aducanumab for the treatment of Alzheimer's disease. If approved, it will not only make this drug the defacto standard of care for Alzheimer's disease, but will create a monumental shift in the usage of other currently limited diagnostic tests, including Amyloid PET scans and other biomarkers.
On today's podcast, we talk about all things Amyloid, including Aducanumab and Amyloid PET scans with Gil Rabinovici. Dr. Rabinovici is the Edward Fein and Pearl Landrith Endowed Professor in Memory & Aging at UCSF.
I could talk to Gil all day long, but we try to fit all of these topics in this jam-packed podcast:
The heterogeneity of dementia and potentially Alzheimer's disease Where are we now with disease modifying treatments for Alzheimer’s disease The Role of Amyloid PET scans and other biomarkers both now and in the future The wild story Aducanumab and the controversy surrounding its pending FDA approval
Ageism + COVID19 = Elder Genocide: Podcast on nursing homes with Mike Wasserman
One of our earliest COVID podcasts with Jim Wright and David Grabowski a year ago addressed the early devastating impact of COVID on nursing homes.
One year ago Mike Wasserman, geriatrician and immediate past president of the California Long Term Care Association, said we’d have a quarter million deaths in long term care. A quarter of a million deaths. No one would publish that quote - it seemed inconceivable to many at the time. And now, here we are, and the numbers are going to be close.
In this podcast we look back on where we’ve been over the last year, where we are now, and what’s ahead.
One theme that runs through the podcast is that if this level of death, confinement, and fear occured to any other population, change would have been swift. But nursing home residents, for the most part, don’t have a voice, they’re not able to speak up, they lack power to move politicians and policy.
Mike Wasserman is a provocateur. He is a needed voice for the nursing home residents and the nursing home staff who often are not able to speak for themselves. He is regularly quoted in major news outlets, and was in the Washington Post about opening up nursing homes to visitation the day of our podcast. If you don’t follow him on Twitter @Wassdoc you should!
-Link to Wassmerm and Grabowski’s article in the Health Affairs blog on the need for financial transparency in nursing homes.
-Link to webinar about what to do about COVID in long term care from April 2020
COVID Vaccine Hesitancy in Frontline Nursing Home Staff
COVID has taken a devastated toll in nursing homes. Despite representing fewer than 5% of the total US events, at least 40% of COVID‐19–related deaths occurred in older individuals living in nursing homes. The good news is that with the introduction of COVID vaccines in nursing homes, numbers of infections and outbreaks have plummeted. However, only about 2/3rds of nursing home patients and only about ½ of nursing home staff have been vaccinated, largely due to hesitancy about taking the vaccine.
On today's podcast we talk about vaccine hesitancy with Sarah Berry, Kimberly Johnson, and David Gifford and the lessons learned from their “town hall” intervention they did that was just published in the Journal of the American Geriatrics Society.
A couple of take-home messages for me in this study was that vaccine misinformation was rampant, many nursing staff had lingering questions they wanted answered before getting the shot, and that sharing stories and personal experiences is an important way to overcome hesitancy.
In addition to listening to the podcast, we really encourage everyone to take a look at the JAGS article as it has two great tables for anyone willing to do similar town halls. The first is a summary of the concerns of healthcare staff. The second is sample responses to address some of these concerns.
I am a hospice nurse in New York State seeing patients in the community and skilled nursing facility settings. I love your podcast and find it very informative regarding current issues in hospice and palliative care as well as symptom management for the geriatric patient. The episodes on COVID-19 have been poignant and informative. Please consider a podcast focused on hospice care and COVID-19. We are seeing a rapid influx in COVID positive hospice patients as the disease spreads and hospitals discharge patients electing comfort care.
Where have you gone?
Haven’t seen an episode in over a month. I am an educated layperson, helping people write their advance directive, and your podcast often helps with its perspective. Please come back!
Efficient way to stay up to date
As a Geriatrics fellow, I love this podcast. Especially that there isn’t 10 minutes of filler at the beginning! The short song is the perfect intro.