223 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.

GeriPal Alex Smith, Eric Widera

    • Health & Fitness
    • 4.8 • 209 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.

    How to discuss stopping screening: Mara Schonberg

    How to discuss stopping screening: Mara Schonberg

    Cancer screening is designed to detect slow growing cancers that on average take 10 years to cause harm.  The benefits of mammography breast cancer screening rise with age, peak when women are in their 60s, and decline thereafter. That is why the American College of Physicians recommendation regarding mammography for women over age 75 is: 
    In average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer.
    Today we talk with Mara Schonberg, who has been tackling this issue from a variety of angles: building an index to estimate prognosis for older adults, writing about how to talk with older adults about stopping screening, a randomized trial of her decision aid, and how to talk to older adults about their long term prognosis.  In the podcast she gives very practical advice with language to use, and references her decision aid, which is available on ePrognosis here.
    Mara keeps working at it, and the more she works, the closer we are to fine.
    -@AlexSmithMD

    • 43 min
    Managing Urinary Symptoms and UTI’s in Older Adults: A Podcast with Christine Kistler and Scott Bauer

    Managing Urinary Symptoms and UTI’s in Older Adults: A Podcast with Christine Kistler and Scott Bauer

    There are a lot of old myths out there about managing urinary tract symptoms and UTI’s in older adults.  For example, we once thought that the lower urinary tract was sterile, but we now know it has its own microbiome, which may even provide protection against infections. So giving antibiotics for a positive urine culture or unclear symptoms may actually cause more harm than good.
     
    On today’s podcast, we are gonna bust some of those myths.  We’ve invited some very special guests to talk about the lower urinary tract - Christine Kistler and Scott Bauer.  
    First, we talk with Christine, a researcher and geriatrician from the University of North Carolina, who recently published a JAGS article titled Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline.  We discuss with her how we should work-up and manage “urinary tract infections” (I’ve added air quotes to “UTI” in honor of Tom Finucane’s JAGS article titled “Urinary Tract Infection”—Requiem for a Heavyweight in which he advocated to put air quotes around the term UTI due to the ambiguity of the diagnosis.)
    Then we chat with Scott Bauer, internist and researcher at UCSF, about how to assess and manage lower urinary tract symptoms in men.  We also discuss Scott’s recently published paper in JAGS that showed that older men with lower urinary tract symptoms have increased risk of developing mobility and activities of daily living (ADL) limitations, perhaps due to greater frailty phenotype.  
     

    • 48 min
    Who should get Palliative Care? Kate Courtright

    Who should get Palliative Care? Kate Courtright

    In the US, geriatrics “grew up” as an academic profession with a heavy research base.  This was in part due to the tremendous support of the National Institute on Aging.  Clinical growth of geriatrics programs has lagged academic research, despite the rapid aging of the population.  Palliative care, in contrast, saw explosive growth in US hospitals.  In contrast to geriatrics, the evidence base for palliative care lagged clinical growth, in part because palliative care has no centralized “home” at the National Institutes of Health.  The National Palliative Care Research Center (NPCRC)and Palliative Care Research Cooperative (PCRC)were founded in part to meet this need.
    Today we interview Kate Courtright, a critical care and palliative care physician-researcher who conducts trials of palliative care.  Kate’s journey is in a way emblematic of the lack of centralized funding for palliative care: she’s received funding from three separate NIH institutes, the NPCRC, and been involved in the PCRC.
    We talk with Kate about how despite how far we’ve come in palliative care research, we still don’t have answers to some fundamental questions, such as:
    Who should get specialized palliative care?  Should eligibility and access be determined by clinician referral? By diagnosis?  By prognosis?  By need? If we move away from clinician referrals as the means by which people get access, how do we keep the clinicians engaged, and not enraged?  Can nudges help?  (see our prior podcast on Nudges with Jenny Blumenthal-Barby and Scott Halpern) When should people get palliative care?  What does “early” really mean?  We can’t possibly meet the needs of all people with newly diagnosed serious illness How do we move from efficacy (works in highly controlled settings) from effectiveness (works in real world settings?  What’s the role of implementation science? What is a pragmatic trial? What outcomes should we measure? We cover a lot of ground!  Working on a mystery.  Going wherever it leads.  Runnin down a dream…
    -@AlexSmithMD

    • 45 min
    What We Now Know About COVID Prevention and Treatment: A Podcast with Monica Gandhi

    What We Now Know About COVID Prevention and Treatment: A Podcast with Monica Gandhi

    We are two and a half years into the COVID pandemic.  We’ve lived through lockdowns, toilet paper shortages, mask mandates, hospital surges where ICU’s overflowed, a million COVID deaths, prolonged school closures, development and roll out of novel vaccines, an explosion of social isolation and loneliness, and the invention of the “zoom meeting.” 
    But what have we really learned over this seemingly endless pandemic other than how to make a quarantini?  Well, on today’s podcast we invite Monica Gandhi to sum up the evidence to date about how best to prevent getting COVID (or at least the severe outcomes of the disease) and how to treat it, including the role of Paxlovid in symptomatic disease.
    Monica Gandhi is a professor of medicine and associate division chief of HIV, Infectious Diseases, and Global Medicine at UCSF & San Francisco General Hospital.  In addition to her research publications, she is a prolific writer both on social media and on media outlets like the Atlantic and the Washington Post.  Some call her an optimist or maybe a pragmatist, but I’d call her someone who inherently understands the value in harm reduction when it’s clear harm elimination just ain’t gonna happen.
    So take a listen and if you want a deeper dive into some of the references we discuss on the podcast, here is a list:
    Medscape article on how “COVID-19 Vaccines Work Better and for Longer Than Expected Across Populations, Including Immunocompromised Individuals” Stat news article about variants/COVID becoming more predictable A good twitter criticism of the CDC 1 in 5 COVID survivors have long COVID study NIH study about long COVID published the day before in Annals of Internal Medicine Evusheld and how it works against BA4 and BA5 Our World in Data COVID graphs

    • 51 min
    Should we prioritize the unvaccincated for treatment? Govind Persad and Emily Largent

    Should we prioritize the unvaccincated for treatment? Govind Persad and Emily Largent

    It’s been a while since we’ve done a Covid/bioethics podcast (see prior ethics podcasts here, here, here, and here).  But Covid is not over and this pandemic keeps raising challenging issues that force us to consider competing ethical considerations.   This week, we discuss an article by bioethicists Govind Persad and Emily Largent arguing that the NIH guidance for allocation of Paxlovid during conditions of scarcity.  They argue that the current guidelines, which prioritize immunocompromised people and unvaccinated older people on the same level, should be re-done to prioritize the immunocompromised first, and additionally move up older vaccinated individuals or vaccinated persons with comorbidities.  The basis of their argument is the ethical notion of “reciprocity” - people who are vaccinated have done something to protect the public health, and we owe them something for taking that action.  Eric and I attempt to poke holes in their arguments, resulting in a spirited discussion.
    To be sure, Paxlovid is no longer as scarce as it was a few months back.  But the argument is important because, as we’ve seen, new treatments are almost always scarce at the start.  Evusheld is the latest case in point. 
    Sometimes, you can’t always get what you want…
    -@AlexSmithMD

    • 46 min
    Rethinking Opioid Conversions: Mary Lynn McPherson and Drew Rosielle

    Rethinking Opioid Conversions: Mary Lynn McPherson and Drew Rosielle

    A patient is on morphine and you want to convert it to another opioid like hydromorphone (dilaudid).   How do you do that?  Do you do what I do, pull out a handy-dandy opioid equianalgesic table to give you a guide on how much to convert to? 
    Well on today’s podcast we invited Drew Rosielle on our podcast who published this Pallimed post about why opioid equianalgesic tables are broken and why we shouldn't use them, as well as what we need to move to instead.
    But wait, before you throw out that equianalgesic table, we also invited Dr. Mary Lynn McPherson, PharmD extraordinaire who published this amazing book, Demystifying Opioid Conversions, 2nd Ed., which advocates for an updated, wait for it… equianalgesic table! 
    Oh boy, what should we do?  Should we throw out the equianalgesic table like some are advocating we do with advance directives (see here), or should we just modernize it for the times with updated data?   Listen to this spicy podcast with these wonderful guests to make up your own minds (I’m sticking with the equianalgesic table for now).
    If you want to take a deeper dive into some of the references, here you go:
    Pallmed Post on why “Opioid Equianalgesic Tables are Broken” Pallimed post on “Simplifying Opioid Conversions” Dr. Akhila Reddy and colleagues study looking at converting hospitalized cancer patients from IV hydromorphone to PO morphine, PO hydromorphone, or PO oxycodone. Our previous podcast with Mary Lynn titled “All the Questions You Had About Opioids But Were Afraid To Ask”  

    • 50 min

Customer Reviews

4.8 out of 5
209 Ratings

209 Ratings

BRCMDLA ,

A must-listen for all physicians

Excellent podcast with practical and insightful information for me as a doctor and medical director.

mrh2276 ,

Best in the biz

Insightful questions and fantastic guests! This is how I stay up-to-date on advances (and controversy) in palliative care. Thanks guys!

MarySTwo ,

Every geriatric social worker should listen!

This podcast makes otherwise inaccessible (because it is published in journals most of us don’t subscribe to), but valuable information understandable, useful, and fun! I look forward to every new episode. Highly recommend for anyone working with older adults.

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