GeriPal - A Geriatrics and Palliative Medicine Podcast

Alex Smith, Eric Widera
  • 4.8 (297)
  • MEDICINE
  • UPDATED WEEKLY

A geriatrics and palliative medicine podcast for every health care professional. Two UCSF doctors, Eric Widera and Alex Smith, 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. CME and MOC credit available (AMA PRA Category 1 credits) at www.geripal.org

  1. 3D AGO

    400th Episode Celebration: Ask Us Anything, Hot Ones-style

    Lynn Flint and Anne Kelly join as hosts in a reprise of last year's ask us anything format.  Thank you for sending in your terrific questions!  Lynn and Anne condensed them to about 20, and we ran through them rather rapid fire.  Also on fire? Our mouths.  As with our 300th episode, we did this Hot Ones-style. Every few questions, we had to eat a chicken wing slathered in hot sauce.  The hot sauces got progressively hotter, though as we discovered, the ordering may have been a littttttle bit off.  Still, by the time we hit the really hot ones, our mouths were on fire, we were blowing our noses, gulping down milk, and terrified of what the next hot wing would bring… We covered so much in this podcast, including: Coffee or tea? What jokes do you make with patients? Where do we see ageism? Why are we still advocating for advance care planning? Concerns about expansion of medical aid in dying Should doctors reveal that they're using AI in clinical care (thanks for the question mom!) The future of geriatrics and palliative care What we'd do differently about the podcast if we could start over, or what we could do that is new going forward. Surprises in terms of who is listening, our audience. Ideas for others to build community as we do at GeriPal Influence of our own spirituality and religion on our clinical practice Lasting practice changes from prior podcasts, or from Covid experience Why PC in the ED hasn't taken off And more!   Looking back on 10 years and 400 podcasts, Eric and I are filled with gratitude for you, dear listeners.  You sustain us.  You keep us going.  Please stay involved, send us messages about show ideas, and introduce yourself to us at national meetings. Thank you! -Alex Smith

    1h 1m

  2. APR 9

    Rural Palliative Care: Karl Bezak, Jeanie Youngwerth, Adie Goldberg, and Gregg Vandekieft

    Rural populations in the United States face unique healthcare challenges. These communities tend to be older, have higher mortality rates, and experience higher rates of chronic conditions and physical disabilities compared to urban populations. Despite the increased need for palliative care in rural areas, access remains alarmingly limited. Even in hospital settings, where palliative care programs are more common in urban areas, only 35% of rural hospitals report having such programs, compared to 81% of urban hospitals. In this week's podcast, we explore the challenges and opportunities of delivering palliative care in rural communities with our esteemed guests Karl Bezak, Jeanie Youngwerth, Adie Goldberg, and Gregg Vandekieft. We begin by discussing what inspired each of them to focus on rural palliative care. From there, we dive into what rural palliative care looks like and examine how it differs from care provided in urban settings. Our guests also share insights into the challenges of delivering this care in resource-limited rural environments and explore innovative strategies to ensure patients and families receive the support they need (like providing remote fellowship training for docs living in rural areas!). We also tackle the role of telemedicine in rural palliative care, both the good part, connecting patients in remote areas with specialists who might otherwise be unavailable, and the bad part, the huge digital divide seen in rural areas.  Join us for what I thought were some valuable insights our guests brought on how we can better serve rural populations and create a more equitable system for palliative care delivery. And if you want to learn more, check out some of these resources: University of Colorado's Community Hospice and Palliative Medicine (CHPM) Fellowship, which allows mid-career providers to obtain training while continuing to live and work in their community supported through online and distance learning technology Master of Science in Palliative Care Program: Master of Science Degree The Rural Health Information Hub's Rural Hospice and Palliative Care Overview  Stratis Health's Rural Community-based Palliative Care resource center The Washington Rural Palliative Care Initiative website CAPC's Safety-Net and Rural Care website         The paper validating the AI Algorithm used to identify patient in rural ED for the TeleGOC Pause Model at UPMC (SafeNET)  A Google Site where Karl is hosting their most recent data related to the TeleGOC Pause Model

    48 min

  3. APR 2

    Pragmatic Trial to Increase Advance Care Planning: Anne Walling, Neil Wenger, & Rebecca Sudore

    Today we're delighted to talk with Anne Walling, Neil Wenger, and Rebecca Sudore about a pragmatic implementation trial aimed at increasing advance care planning for primary care patients with serious illness in University of California clinics, published in Annals of Internal Medicine. Seriously ill primary care patients were identified using structured data fields (meaning routinely captured without needing to read the chart or use natural language processing). This study focused on patients without a completed advance directive or POLST form. This was a 3 arm trial that tested a nudge in the patient portal and a mailed advanced directive vs. the nudge plus a link to PrepareForYourCare vs. the nudge plus PrepareForYourCare plus a navigator reminding patients to talk with their doctor and bring any completed advance directives or POLST forms to the PCP visit. In brief, the study found that at 2 years there were higher rates of advance directive or POLST in the electronic health record (about 20%) in the arm with the nudge plus PrepareForYourCare plus the navigator compared to the other 2 arms (around 13%). Rates of advance care planning discussions with primary care providers were similarly higher in the 3rd arm. Health care utilization, however, did not differ between arms.  Please see links to articles describing the intervention in detail and incorporation of stakeholder perspectives. I'm going to cut to the pushback to this article right up front:  The study's primary outcomes were advanced directives or completion of POLST forms - haven't we moved beyond thinking completion of forms should be the primary outcome of advance care planning research? There was no control condition. Observed increases in advance directive or POLST in the electronic health record may have occurred without any intervention.  People with serious illness get sicker with time and the sicker they are the more likely they are to engage in advance care planning, without any intervention. This is particularly true as the study occurred during the hight of the Covid pandemic, when there was a global effort to increase advance care planning. How much did these interventions contribute on top of that rise that might have occurred without intervention?  Observed documentation - 13-20% - was low.  Is it worth the effort of getting buy-in to automate these EHR nudges and spend FTE to hire a navigator? Particularly as health systems, who pushed for focusing on seriously ill patients because they are the most expensive/highest utilizers, did not get what they wanted, i.e. no difference in utilization of acute healthcare services between arms? Our guests provide a strong defense and additional context, which you can and should listen to on the podcast. And I have to point out, setting aside the advance care planning aspect, the method of identifying upstream primary care patients with serious illness is a major contribution to the field in and of itself.  Pioneers in the field, led by Amy Kelley, have been working to identify the seriously ill population for over a decade. And a fun fact about All You Need is Love - the verses are in 7/4 time! -Alex Smith

    50 min

  4. MAR 26

    CMS's Age-Friendly Hospital Measure: Julia Adler-Milstein, Stephanie Rogers, and Shari Ling

    In 2025, the Centers for Medicare and Medicaid Services (CMS) began requiring hospitals participating in the Hospital Inpatient Quality Reporting (IQR) program to report on a new "Age-Friendly Hospital Measure."  The hope is that, by attesting to this measure, hospitals will develop evidence-based processes to improve care for older adults in hospital settings. On this week's podcast, we explore this new measure with Sheri Ling, CMS's Deputy Chief Medical Officer serving in the Center for Clinical Standards and Quality (CCSQ). We've also invited some returning guests from our past Age Friendly Health Systems podcast, Julia Adler-Milstein and Stephanie Rogers, to discuss how they are thinking about this new measure and how we should operationalize it. We go over everything you will want to know about the new measure, including: How does this CMS measure differ from both Age-Friendly Health Systems and the 4Ms movement we've been hearing about for years (and that we did the podcast on in 2020 here) Why is CMS finally making "Age-Friendly" a formal, structural requirement for hospitals now? What is an attestation measure vs outcome measure, and why is this one an attestation measure? A deeper dive into the 5 domains to the measure (Eliciting Patient Goals, Medication Management, Frailty Screening, Social Determinants of Health, and Leadership/Governance. Lastly, here are some great resources if you want to help get this started at your hospital: A report by JAHF, Julia and others on how to think about different dimensions of measure performance Health Affairs Scholar paper on related the 4Ms to the 5 domains Two CMS resources with detailed information on how to meet and report on the five domains of this measure: Age-Friendly Hospital Specifications (July 2025) Age-Friendly Hospital Measure Attestation Guide

    46 min

  5. MAR 19

    De-intensify Anti-Hypertensives for Nursing Home Residents? Athanase Benetos and Mike Steinman

    A few weeks ago, I was skimming this NEJM paper for UCSF's Division of Geriatrics Journal club on de-prescribing anti-hypertensive medications for older adults in nursing homes. Seemed to make a world of sense. The study found no difference between the deprescribing arm and the usual care arm in mortality, the primary study outcome. I thought, great! So we can deprescribe anti-hypertensives without changing mortality, that must be what the authors concluded. I was shocked, therefore, to read in the first paragraph of the discussion that the deprescribing arm did not achieve the hypothesized 25% reduction in mortality.  What?!?  Why would deprescribing be associated with reduced mortality? That's not the main reason or even the first reason I think of for deprescribing.  Reducing side effects that impair quality of life, sure. Less pill burden, of course.  But prolonged life?  Seemed a stretch. Today we hear from the first author of this study, Athanase Benetos, an esteemed geriatrician-researcher from France.  For context, we also interviewed Mike Steinman, co-chair of the Beers criteria and co-lead of the US Deprescribing Research Network. We learned about: Why the hypothesis of reduced mortality in deprescribing was justified, based on natural decreases in blood pressure with aging, and the Partridge study, an observational study that found higher risks of mortality associated with using multiple anti-hypertensive and low blood pressure. Why mortality was chosen as the primary outcome. Is a negative superiority study the same as what they might have found in a non-inferiority study? (stay with us) Variation in outcome by frailty status How to place this study in context with other research, such as the Danton study mentioned on a recent podcast about deprescribing near the end of life. Dantos was a study of deprescribing for nursing home residents with dementia that was stopped early due to safety concerns. Other studies for context include Sprint, Optimize, and an observational study by Bocheng Jing (UCSF statistician in our group). At the end, we ask our guests to put it together. With all that we know at this point, what's a clinician to do? To deprescribe or not to deprescribe? And, zoot alors! I get to sing Hymne A L'amour in French! Athanase recounts the moving story of how Edith Piaf sang this song the night she learned the man she loved, Marcel Cerdan, died in a plane crash. -Alex Smith

    52 min

  6. MAR 12

    Alzheimer's Definitions, Biomarkers, and Antibodies: Halima Amjad, Barak Gaster, and Heather Whitson

    It's an era of breakthroughs in Alzheimer's research, yet for many clinicians, it's also a time of profound uncertainty. We are currently navigating competing definitions of the disease, multiple new biomarkers coming on market seemingly every week, and the clinical rollout of new amyloid antibodies. How do we translate this rapid-fire science into daily practice? On this week's GeriPal podcast, we sit down with dementia experts Halima Amjad, Barak Gaster, and Heather Whitson. We dive deep into: The evolving definitions of Alzheimer's disease.  Does someone have Alzheimer's disease if you have only an abnormal biomarker as defined by the Alzheimer's Association, or is amyloid pathology necessary but not sufficient to define Alzheimer's as per the International Working Group (IWG) recommendations? Where do blood-based biomarkers for Alzheimer's fit into the diagnostic workup, and should they be used at all in primary care?  FYI - here is my take on that question in a recent JAMA IM article titled "The Limited Role of Alzheimer's Disease Blood-Based Biomarkers in Primary Care." What's the role of amyloid antibodies in the care of individuals with Alzheimer's disease, including who to use them on? We covered a lot and discussed some of these resources that you can do a deeper dive on: Blood-based biomarker resources JAMA article on Blood-Based Biomarkers for Alzheimer's Disease: Preventing Unintended Consequences  Alzheimer's Dementia article on Blood-based biomarkers for detecting Alzheimer's disease pathology in cognitively impaired individuals within specialized care settings: A systematic review and meta-analysis JAMA IM article on The Limited Role of Alzheimer Disease Blood-Based Biomarkers in Primary Care Appropriate use recommendations for amyloid antibodies Donanemab: Appropriate use recommendations  Lecanemab: Appropriate Use Recommendations Primary Care Resources Cognition in Primary Care program A JAGS article on "Large Health System Quality Improvement Intervention Providing Training and Tools to Improve Detection of Cognitive Impairment in Primary Care" Other resources AGS's new online curriculum for Alzheimer's Disease By Eric Widera

    52 min

  7. MAR 5

    Leadership, Quality, and the Future of Hospice: Guests Chris Comeaux and Cordt Kassner

    Today we're doing something different. Today, dear listeners, you get two podcasts for the price of one! (OK, our podcasts are both free, but you get the idea). We're joined today by Chris Comeaux, host of TCN Talks, a podcast about leadership, strategy, innovation, and the future of serious illness care, and author of The Anatomy of Leadership. We are also joined by TCN Talks' frequent guest host Cordt Kassner, CEO of Hospice Analytics, which provides in depth data on hospice quality, utilization, and access, and publisher of Hospice and Palliative Care Today, a daily email about the hottest stories and news in the field. This is an "ask us anything" style podcast in which we get to ask each other questions.  Our discussions focus on concerning trends in hospice, Ira Byock's white paper, concerning trends in hospice, certificate of need, danger of losing a generation of junior researchers and hope in the form of ASCENT, various measures of hospice quality including Cordt's National Hospice Locator, which ranks all area hospice by quality, unlike CMS's Hospice Care Compare, which only has star ratings for about 30% of hospices. Hospice and palliative care are going through a tough growth period, and sometimes being real with your friends and colleagues in your field means tough love. Love hurts.  And no, I'm not attempting the Nazareth version! -Alex Smith

    51 min

  8. FEB 26

    Deprescribing at the End of Life: Jennifer Tjia, Jon Furuno, Simon Mooijaart

    Philippe Pinel remarked in 1800 that "It is an art of no little importance to administer medicines properly, but it is an art of much greater and more difficult acquisition to know when to suspend or altogether to omit them." This insight remains profoundly relevant today, especially in hospice care, where inappropriate prescribing is a common issue. Studies show that 20%–70% of hospice patients receive at least one unnecessary medication near the end of life, including drugs like antihypertensives, statins, and vitamins. In this episode of the GeriPal Podcast, we tackle the pressing topic of deprescribing at the end of life with expert guests Jennifer Tjia, Jon Furuno, and Simon Mooijaart. The conversation focuses on identifying medications that should almost always be discontinued—such as statins, osteoporosis meds, finasteride, and vitamins, which offer minimal benefit for patients with limited life expectancy. We also delve into more nuanced cases, such as antithrombotics, which present complex decisions that challenge clinicians, particularly when prognosis spans the many weeks to months range. Finally, we explore practical strategies for engaging patients and families in deprescribing conversations. Our guests highlight tools such as the FRAME mnemonic (Focus on the goals of care, Review current medications, Assess each medication's risk/benefit, Minimize the medication burden, and Evaluate regularly) and the Goal Concurrent Prescribing tool, which helps ensure medication decisions align with patients' values and end-of-life priorities. By: Eric Widera Other resources discussed in the podcast Prevalence and Factors Associated With Receiving a Prescription for Antithrombotic Therapy on Hospice Admission," JAGS. 2025 Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease. 2025 Effects of the discontinuation of antihypertensive treatment on neuropsychiatric symptoms and quality of life in nursing home residents with dementia (DANTON): a multicentre, open-label, blinded-outcome, randomised controlled trial. 2024 Perspectives on deprescribing in palliative care. Expert Review of Clinical Pharmacology. 2023 Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Results of a European Delphi study. Thrombosis Research. 2025 Human-Centered Design Development and Acceptability Testing of a Goal Concordant Prescribing Program in Hospice. JPM 2025 Reduction of Antihypertensive Treatment in Nursing Home Residents. NEJM 2025

    48 min
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4.8
out of 5
297 Ratings

About

A geriatrics and palliative medicine podcast for every health care professional. Two UCSF doctors, Eric Widera and Alex Smith, 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. CME and MOC credit available (AMA PRA Category 1 credits) at www.geripal.org

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