Stay ConnectedA 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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In this weeks podcast we talked with David Wang about how palliative care can join forces with the emergency department to improve care for the serious ill. This conversation was motivated in part by a recent expert consensus statement on key knowledge and skills standards about hospice and palliative medicine for emergency medicine providers. What should the core training be? How do emergency providers feel about palliative care? How can palliative care services that are typically available bankers hours work with the emergency department, open 24-7?
On todays podcast, we will be talking with Brooke Namboodri and we have Tim Platts-Mills from the University of North Carolina at Chapel Hill about their new article in the Journal of American Geriatric Society (JAGS) on "Elder abuse identification in the prehospital setting, an examination of state EMS protocols." We talk with Brooke and Tim about the state of EMS protocols in the US and how often the mention elder abuse in them (spoiler alert: not very often), how this compares to mentions of child abuse, the role EMS should play in elder abuse identification and management, and the role of potential screening tools for elder abuse.
In this weeks GeriPal/JAGS Podcast we talked witk Kei Ouchi, an emergency medicine physician, internist, and researcher at the Brigham and Women's Hospital and Harvard Medical School in Boston. We recorded this podcast in the hallways of the annual meeting. We talked about outcomes following intubation in the emergency department. Kei published a paper in JAGS that is notable for several things, but perhaps most of all for the innovative use of color imagery to convey a message. The image in the @AGSJournal tweet above is from Dr. Ouchi's article - this tweet went viral by the way - and notice what it does: (1) convey the main message that outcomes are worse with advancing age, and are not good in general overall; (2) grab your attention and make you want to learn more. Kei is very thoughtful about how these data should be used - not on the spot in the ED, when a patient is gasping for air, and you pull up the color figure on your iphone Twitter app - no, not then. Better to use this information in advance, when things are calm, outside the ED, for people at risk of going to the ED in extremis. This is the first in a series of GeriPal podcasts on the GeriPal - ED interface. ED stands for Emergency Department by the way. Enjoy! -By @AlexSmithMD
On this week's podcast, we talk with the authors of a Journal of the American Geriatrics Society (JAGS) article titled Should We Bury "The Good Death"? As luck may have it, one of the authors is co-host Alex Smith, and the other is a leader in geriatrics and palliative care, VJ Periyakoil. Alex and VJ's critique of the 'good death' was published alongside a paired commentary from Age and Ageing from the British Geriatrics Society.
For this week's GeriPal podcast we are honored to be joined by Tim Quill, palliative care physician and bioethicist from the University of Rochester, New York. Dr. Quill has pushed our nation to seriously grapple with the issue of physician aid in dying with a remarkably thoughtful and measured approach. We talk with Dr. Quill on this podcast about voluntary stopping eating and drinking, and a paper on this topic he recently published in JAMA Internal Medicine. As noted in the podcast, I am deeply ambivalent about physician aid in dying. I find voluntary stopping eating and drinking (VSED) to be far more acceptable. Some of this has to do with the acceptability of positive and negative acts (positive act - giving a patient a prescription for lethal medication; negative act - not inserting a feeding tube in a patient who refuses to eat and drink). Some of this just has to do with the time course: patients who stop eating and drinking must have the resolve and dedication over time. And they can change their minds. We address many aspects of this issue on the podcast, including: Who is VSED appropriate for? What can patients expect? How does VSED compare to other "options of last resort?" What is the role of palliative care? Should hospice's deem a patient eligible if they would not have a less than six month prognosis if they continued to eat and drink? When should a psychiatrist be involved? What if the suffering is not physician, but social or psychological? Is VSED legal? Should clinicians routinely offer VSED to all patients with serious illness as an option? How do you feel about this topic? Feel free to respond in the comments, or on Twitter!
For this weeks podcast, we talk with Laura Petrillo, lead author of a recent paper published in JAMA IM titled "Hypoglycemia in Hospice Patients With Type 2 Diabetes in a National Sample of Nursing Homes". Laura is a palliative care physician and researcher at Massachusetts General Hospital and Harvard Medical School. Laura's finding should serve as a wakeup call for anyone caring for individuals on hospice living in nursing homes. They found that 1 in 9 nursing home patients with type 2 diabetes experienced hypoglycemia. So take a listen an tell us what you think in the comment section on this GeriPal post.
Many in palliative care (including us) have argued that the default care model in nursing homes should be a palliative approach. Revealing indeed, therefore, to talk with nurse researcher Caroline Stephens about her publication in JAGS where she studied palliative care-eligibility and POLST completion for nearly 200 residents of 3 San Francisco area nursing homes, finding: 70% of nursing home residents were palliative care-eligible, but other than 2 patients on hospice, none were receiving consultative palliative care 99% of residents had completed a POLST, but almost no one remembered filling it out Listen to the podcast for more, including answer to questions: What does palliative-care eligible mean? How could they fill out a POLST but not remember it, did they all have dementia? What is Campbell's law, and does it have anything to do with his soup? We're joined on this podcast by Sei Lee, MD, regular guest host and as it happens senior author on the nursing home study, and Lynn Flint, MD, palliative care physician with extensive experience working in nursing home settings. Enjoy!
Proton pump inhibitors are one of the most widely used medications. As I note in the podcast below, I was in my local drug store the other day, and an entire shelf segment, top to bottom, was filled with medications for "heartburn," and most of them were proton pump inhibitors. And those are just the over the counter variety. So wouldn't it be a public health disaster if proton pump inhibitors, or PPIs, increased a persons risk for dementia? Even if the increase in dementia risk is only slight, on a population level, given the vast number of people using PPIs, the consequences would be disastrous. A major study in JAMA showed just such a linkage, raising serious alarm about this issue. So with this urgent question in mind, we talk with two authors about their more recent studies in JAGS suggesting that there is no such linkage. We talked with Shelly Gray, from the School of Pharmacy and the University of Washington, and Felicia Goldstein from Emory University, about their studies, the current evidence as a whole, and what an individual on PPI's should think at this time about his or her risk of dementia. Here is the bottom line, for those who can't wait. In response to Eric asking what advice they would give their 75 year old neighbor who is taking PPI's, Dr. Gray said: I would tell her that the information is conflicting, but some really high quality studies have been done and have not found an association, and if this medication is necessary to manage her condition, that she should continue taking it. However, I will say that we do know that these medications are overused, and so I still believe in the tenet of geriatric medicine that we try to deprescribe when possible, so I would try to reassure her and let her know that it's not a done deal and that the high quality studies do indicate that there doesn't seem to be an association.
Today we have Lee Lindquist with us on the GeriPal podcast to talk about planning for the "4th quarter" of life. Dr. Lindquist is a geriatrician and chief of geriatrics at Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine in Chicago. Dr. Lindquist developed a website called PlanYourLifespan.org to help older adults create strategies for dealing with health crises, such as hospitalization, a serious fall, and dementia. Using the website, older adults can think about what services they may need in the last 10 or 15 years of their lives, what choices they can make now, and how to access these services when needed. Her work was also recently published in a a Journal of Hospital Medicine paper showing that the website helped older adults plan for posthospital discharge needs before a hospitalization occurs. So give it a listen and comment below on what you think should be address in the last quarter of life.
We have a great podcast this week exploring the advance care planning needs for hospitalized adults and what palliative care teams are doing (and not doing) to meet these needs. We've invited Kara Bischoff, a palliative care doctor and Assistant Professor at UCSF in the Department of Hospital Medicine, who published a paper in JAMA Internal Medicine on this very topic. Why was this JAMA IM paper so important for those who work in our field? This was a real world study, looking at over 73,000 consultations from the Palliative Care Quality Network (PCQN). They found palliative care teams consistently identified surrogates for patients, often addressed their preferences regarding life sustaining treatments, including code status, and frequently found a preference regarding life sustaining treatments that was different than what was previously documented before the consult. But rarely completed advance directives (only 3.2% of patients seen by palliative care teams) or Physicians Orders for Life-Sustaining Treatment (POLST) forms (12.3% of patients seen by palliative care teams).
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