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.
Assisted Living Communities: Podcast with Sheryl Zimmerman, Kenny Lam, and Ken Covinsky
Assisted Living Communities (no longer preferable to call them Assisted Living Facilities, as we learned on the podcast) are…what, exactly? That’s the central question on today’s podcast. The problem is the tremendous heterogeneity in services offered and quality of care. If you’ve seen one Assisted Living Community you’ve seen one Assisted Living Community.
To address this question, we talk with Sheryl Zimmerman, author of a recent study in JAMA Network Open that used a Delphi process to ascertain what experts thought were the essential services an Assisted Living Community should offer to residents. The experts settled on a range of key services, from more palliative care focused (e.g. end of life care and advance care planning) to more geriatrics focused (e.g. toenail trimming) to things in between (e.g. staff training in person centered care). The problem, as Kenny Lam and Ken Covinsky, authors of an accompanying editorial, state on the podcast: there is an inherent tension between the motives of the corporations that own most Assisted Living Facilities (profit) and the ideal services offered in Assisted Living Facilities.
We additionally firmly establish that the song How to Save a Life by the Fray was a product of the aughts (2005, to be exact), not the 90’s ):
-@AlexSmithMD (still on Twitter at present)
Loss, Grief, and Wellness Debriefings: A Podcast with Matt Loscalzo, Vickie Leff, and Craig Blinderman
Health care professionals are human, and as humans we experience loss both in and out of work. You’d imagine though that our professional expertise and experiences in helping patients and families cope with loss and grief would be helpful in managing our own personal losses. Turns out, it’s maybe not.
That was the lesson I learned from reading a new book edited by Matt Loscalzo along with Marshall Forstein called “Loss and Grief: Personal Stories of Doctors and Other Healthcare Professionals”. It’s a collection of personal stories of a small number of health professionals, including Craig Blinderman and Susan Block, who have been struck by personal illness and loss.
On today’s podcast, we’ve invited Matt Loscalzo and Craig Blinderman to talk about their book and the process they used to create these stories, which all stood out for their openness in talking about things that we as healthcare professionals often keep so very private.
We also brought in Vickie Leff to talk about the work she does with Wellness Debriefings. These debriefings create a safe outlet for health care professionals to talk about the feelings resulting from their work. Vickie worked with CAPC to create tools, including a facilitator guide, to encourage clinicians and their organizations to adopt debriefings.
So take a listen and check out some of these resources for healthcare provider loss, grief, and wellness:
Loss and Grief: Personal Stories of Doctors and Other Healthcare Professionals Dates & registration info about debriefings offered by CAPC The CAPC Debrief Facilitator Training Manual we developed: PDF Download. Jared Rubensteins' "Token of Appreciation" video A great website for dealing with loss and grief: refugeingrief.com
This episode of the GeriPal Podcast is sponsored by UCSF’s Division of Palliative Medicine, an amazing group doing world class palliative care. They are looking for physician faculty to join them in the inpatient and outpatient setting. To learn more about job opportunities, please click here: https://palliativemedicine.ucsf.edu/job-openings
New Prognostic Models for Older Adults: Alex Lee, James Deardorff, Sei Lee
Dr. Faith Fitzgerald once quipped that prognostic modeling is the “punctilious quantification of the amorphous.” She has a point. Prognosis is inherently uncertain. As Alex Lee says on our podcast today, all prognostic models will be wrong (in some circumstances and for some patients); our job is to make prognostic models that are clinically useful. As Sei Lee notes, the argument for developing prognostic models has won the day, and we increasingly use prognostic scores in clinical decision making. What makes prognostic models for mortality different from models used for anticoagulation or risk of renal injury? James Deardorff replies that there is something inherently different about predicting mortality. Death is different. For some reason clinicians who might be perfectly comfortable using an anticoagulation risk calculator might be skeptical of a mortality risk calculator (see this recent terrific JAMA IM study from Nancy Shoenborn on this issue). And yet, the only thing that may be worse than a prognostic calculator is a clinician relying solely on their clinical intuition.
Today our guests Alex Lee, James Deardorff, and Sei Lee, talk to us about the uses, limitations, and clinical use cases for prognostic models. As a springboard for this conversation we discuss new prognostic models developed to predict (simultaneously) mortality, disability, and mobility impairment (Alex Lee first author, JAGS) and mortality for people with dementia residing in the community (James Deardorff first author, JAMA IM).
Both new models are now available and free to use on ePrognosis.
And Sei and Eric reminisce about slow dancing to “Forever Young” by Alphaville in their teenage years.
Demystifying the Role of HHS and ASPE in Guiding Federal Aging Policy and Priorities with Dr. Tisamarie Sherry
The Department of Health and Human Services helps to guide billions of dollars in investment and direction in research, policy, and health care. The Assistant Secretary for Planning and Evaluation (ASPE), within the HHS, is the principal advisor to the Secretary of HHS on health policy, ranging from legislation to strategic planning to research. How does this relate to aging policy and research? How does coordination occur between the federal, state and local level in aging health policies? And, who within ASPE guides aging policy and connects policy to every day health challenges experienced by patients and clinicians?
On today today’s podcast, we are joined by guest host and UCSF geriatrician Ashwin Kotwal as we welcome Dr. Tisamarie Sherry (Deputy Assistant Secretary for the Office of Behavioral Health, Disability, and Aging Policy (BHDAP), appointed by the Biden administration). This office is tasked with providing aging policy research and recommendations within ASPE, including long term care and the National Alzheimer’s Project Act. Dr. Sherry shares her expertise in aging health policy and helps us make sense of the role of her Office and how she coordinates with the multitude of federal agencies aligned around the goal of advancing aging research, policy, and health. For the policy buffs and policy newbies out there, we hope this podcast is an essential primer to government in action.
We talk about:
The structure of federal agencies and how they coordinate Priorities of the National Alzheimer’s Project Act, and the unique role of ASPE and BHDAP in guiding the agenda and long-term goals The recent focus on nursing facilities and long term supportive services during the pandemic, along with key gaps How HHS and ASPE solicit input from clinicians, community leaders, and older adults and how much it impacts policy decisions (spoiler alert: this involvement is CRUCIAL) How to make your voice heard and get involved We also touch briefly on topics discussed in prior podcasts such as loneliness and federal responses to the pandemic in relation to long-term care. Tune to hear Alex’s rendition of 'With a Little Help from My Friends'!
- Ashwin Kotwal, MD, MS
Updates in ID and Nephrology: Lona Mody, Rasheeda Hall, Devika Nair, Sonali Advani
When I’m on service these days there is inevitably a moment when a resident says “Patient so-and-so is on X” - and I have absolutely no idea what X is. Modern subspecialist practice advances at such a remarkably rapid pace, it can be hard to keep up.
In this context, we’re excited to hear from infectious disease experts and nephrologists about updates in the care of older adults. Sonali Advani and Lona Mody talk about their recent JAGS article highlighting three recent articles that every clinician caring for older adults should be aware of in the treatment of infectious diseases (hint: I’ve never finished a course of antibiotics, and maybe your patients don’t need that full course either). Devika Nair and Rasheeda Hall talk about their JAGS article highlighting updates from nephrology in the care of older adults, including a link to this new eGFR calculator that does NOT include race. We have a discussion about the decision to remove race, a social construct, from clinical risk calculators (though I’m not 100% sold that race should always be removed - if removal is likely to worsen disparities for example - at least until a superior race-blind calculator can be developed).
These articles are part of a new series called Clin-Star Corner, a new series in JAGS that reviews practice changing articles in the care of older adults.
And yeah, they made me sing a Miley Cyrus song…(but not this hilarious parody about UTIs).
Evidence-Based Messaging for Serious Illness Care: A Podcast with Tony Back and Marian Grant
Earlier this year palliative care was the correct response to the following clue on the game show Jeopardy:
From a Latin word for “to cloak”, it’s the type of care given to seriously ill patients to provide comfort without curing
What struck me most was not that palliative care was a question, nor that it made it seem that palliative care isn’t provided alongside care directed at curing, nor was it that hospice was the first buzzed in response, but it was that palliative care was the $2000 question in the Double Jeopardy round! The fact that palliative care was the hardest of questions told me that we have a massive messaging problem in our field.
So what do we do about it? Well, on today’s podcast we talk with Marian Grant and Tony Back, who with support form the John A Hartford Foundation and the Cambia Health Foundation, have done a deep dive into the research on layperson perceptions of palliative care, hospice, and advance care planning. The result is a new toolkit to help us fix our messaging & engage the public: seriousillnessmessaging.org
Questions we talk about include:
What do we know about the public’s perception of palliative care, hospice, and advance care planning? What’s wrong with the “pictures of hands clasping each other” as our palliative care meme? How can we bring in marketing strategies into our public messaging? Don't palliative care clinicians already know how to explain things with empathy? Why is this different from clinical communication skills? If we avoid talking about death, is it just contributing to the public death denial that is rampant in American culture?
Public Perceptions of Advance Care Planning, Palliative Care, and Hospice: A Scoping Review
Public Messaging for Serious Illness Care in the Age of Coronavirus Disease: Cutting through Misconceptions, Mixed Feelings, and Distrust
Effective Messaging Strategies: A Review of the Evidence. Communicating to Advance the Public's Health: Workshop Summary
Love you podcast! How about including one on interventional pain management?
Outstanding palliative care podcast
Geripal never fails to both inform and entertain. As a palliative care physician and researcher, I love the chance to hear from researchers about their own work. Interviewers are tough and respectful. Show notes consistently include helpful links. And the songs are not. to. be. missed. Geripal is a joyful reminder of everything that I love about our field.
A must-listen for all physicians
Excellent podcast with practical and insightful information for me as a doctor and medical director.