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.
So you want to be a hospice medical director? Podcast with Tommie Farrell and Kai Romero
So what exactly does a hospice medical director do? Why do some choose to become hospice physicians? What additional training is needed, if any, beyond Hospice and Palliative Medicine fellowship and boards? Who should take the new Hospice Medical Director Certification Board Examination? A recent study in JAGS found high rates of hospice disenrollment (“live discharge”) for people with dementia - is that a good thing or a bad thing? Hmmm…
We address these and other questions in this week’s podcast with Tommie Farrell, hospice physician in West Texas and Chair of the Hospice Medical Director Certification Board, and Kai Romero, Chief Medical Officer for Hospice By the Bay (that’s San Francisco Bay).
And I get a re-do attempt at REM’s “Everybody Hurts!”. Apologies for the first attempt!
The Problem of Alzheimer's: A Podcast with Jason Karlawish
Where are we with Alzheimers? Are we about to see a revolution in how we diagnose and treat it with Amyloid PET scans and the amyloid antibody aducanumab (which is currently on FDA’s desk for approval)? Or are we still in the same place where there is no meaningfully effective treatment? Or is it somewhere in between, given the data that we have on comprehensive dementia care?
We talk today with Jason Karlawish, a professor of medicine, medical ethics and health policy, and neurology at the University of Pennsylvania Perelman School of Medicine. In addition to being a geriatrician extraordinaire, he is the author of the new book “The Problem of Alzheimer’s: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It.”
In addition to talking about PET scans and new drugs like aducanumab, we discuss with Jason about the history of Alzheimers, the history of how we care for a fund caregivers, and where we go from here.
So take a listen and check out Jason’s book!
Importance of Function in COVID Prognosis: Podcast with Orestis Panagiotou, Elizabeth White, and Marlon Aliberti
Nursing home residents have been devastated by COVID. Somewhere around 40% of deaths from COVID have been among nursing home residents, though they make up just a sliver of the US population.
Prognostication among nursing home residents who have COVID is important for a host of reasons - for counseling patients and families about what to expect, for making clinical decisions, and potentially for allocation of scarce resources such as treatments.
In today’s podcast, we talk with Orestis Panagiotou and Elizabeth White, the authors of a JAMA IM study that finds that physical and cognitive function are key predictors of mortality prediction for nursing home residents with COVID. We also talk with Marlon Aliberti, who authored a commentary.
Physical and cognitive function are easy to assess measures that should be routinely captured for older adults, in nursing homes and elsewhere. Study after study document the importance of function to risk prediction.
We also have a brief debate about how vaccinations should be allocated - according to a “one size fits all” age criteria, or a prognostic model that individualizes risk. Though I’m an advocate for prognostic models (see eprognosis.org) I’m actually on the age criteria alone side of the debate, with generous distribution among hardest hit minority communities.
And sing along to This Little Light of Mine!
LGBT Care for Older Adults and Serious Illness: Podcast with Carey Candrian and Angela Primbas
Lesbian, gay, bisexual and transgender (LGBT) older adults have lived through a lifetime of discrimination, social stigma, prejudice, and marginalization. Is the care that we are giving them in later life changing any of that or are we pushing them back into the closet?
This is what we talk about in this week's podcast with Carey Candrian from the University of Colorado School of Medicine, and Angela Primbas from Stanford University (and future geriatrics fellow at UCSF!).
Carey has published a wonderful article in the Gerontologist titled “She’s Dying and I Can’t Say We’re Married?”: End-of-Life Care for LGBT Older Adults, in which she describes how older LGBT adults may be at higher risk for having their health care wishes ignored or disregarded, their families of choice are less likely to be included in their decision making, and they may experience increased isolation, bullying, mistreatment, or abuse, which ultimately contribute to receipt of poor-quality health care.
We talk about the scripts that we use in medicine that may hamper open discussions about sexual orientation and gender identity (SOGI) including the term “family meeting”, the need to revise our intake forms to incorporate SOGI questions, and the need for education. We also get a chance to hear Alex Sing “The Story” whose lyrics very much speak to the subject at hand:
“All of these lines across my face
Tell you the story of who I am
So many stories of where I've been
And how I got to where I am
But these stories don't mean anything
When you've got no one to tell them to…”
If you want to learn more, please check out these wonderful resources:
LGBT Resource Center https://www.lgbtagingcenter.org LGBTQ Resource List from GLAAD: https://www.glaad.org/resourcelist National Resource Center on LGBT Aging: https://www.lgbtagingcenter.org/ Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE): https://www.sageusa.org/
Medications Safety/Quality Update: Podcast with Nagham Ailabouni
On the one hand, every year we are fortunate to have new medications that help older adults and people living with serious illness. New treatments for lung cancer with remarkable survival outcomes come to mind, for example.
On the other hand, the tremendous growth in medications has led to an explosion of prescribing, polypharmacy, with attendant side effects and harms.
In this week's podcast, we talk with Nagham Ailabouni, a pharmacist and researcher joining us from Australia (song choice: Down Under!) about her review of major articles on medication safety and quality for older adults. Dr. Ailabouni summarized the top four hardest hitting in a recent publication in the Journal of the American Geriatrics Society, or JAGS. The four articles are:
Older Medicare Beneficiaries Frequently Continue Medications with Limited Benefit Following Hospice Admission Prescribing of oral anticoagulants in the emergency department and subsequent long-term use by older adults with atrial fibrillation Effect of an Electronic Medication Reconciliation Intervention on Adverse Drug Events: A Cluster Randomized Trial Intensification of older adults' outpatient blood pressure treatment at hospital discharge: national retrospective cohort study Dr. Ailabouni’s pet peeve medication she sees prescribed to hospice patients? High dose metformin. Listen to the podcast for more!
Living with Death: A Podcast with BJ Miller
Most of us know we are going to die. How often though do we actually let ourselves really internalize that understanding? To imagine it? To feel it? To try to accept it?
On today’s podcast we invited BJ Miller back on our podcast to talk about death using as our guide his recent NY Times editorial What Is Death? How the pandemic is changing our understanding of mortality. In addition to being the author of this NY Times article, BJ is a Hospice and Palliative Care doc, and the founder of Mettle Health which aims to provide personalized, holistic consultations for any patient, caregiver or clinician who need help navigating the practical, emotional and existential issues that come with serious illness and disability.
We start off with BJ appropriately picking the song "Ebony Eyes" as our intro song, which is a good analogy to talking about death, as it was initially banned by the BBC from airplay as its lyrics were considered too upsetting to play on the radio. We then go into his thoughts on how we picture our deaths and dealing with those emotions we feel when we do, how we “live with death”, and...
Also check out BJ’s article that is geared towards kids/students - https://www.nytimes.com/2021/01/06/learning/how-do-you-view-death.html. As BJ put it in an email to us: “It’s fascinating to me how they’re taking care to reach out to younger minds, further proof that the idea that no one wants to think or talk about death - especially youngsters - is bunk.
Customer ReviewsSee All
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.