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Summary Transcript Summary The comprehensive geriatric assessment is one of the cornerstones of geriatrics. But does the geriatric assessment do anything? Evidence has been mounting about the importance of the geriatric assessment for older adults with cancer, the subject of today’s podcast. Precision medicine?
To delve into these questions, we spoke with Hope Wechkin, medical director of EvergreenHealth home hospice, who authored an article describing a process of Minimal Comfort Feeding (MCF) for patients who have expressed an interest in not wanting to live with advanced dementia. Eric 01:13 Yeah, you got to jump in. Take it over.
Mariah 03:51 I like the SAMHSA definition as sort of a guiding definition for it, and I’m happy to read it. Well, being a pretty comprehensive definition. Kate 11:33 Yeah, I mean, definitely more indirect pathways than direct. Eric 04:19 Yeah. So there’s an event or a series of events. Everything may not be.
We talk with them about the epidemiology, assessment, and management of dysphagia, including the role of modifying the consistency of food and liquids, feeding tubes, and the role of dysphagia rehabilitation like tongue and cough strengthening. Raele: Yep, they definitely can be. Eric: And why is it more common in hospitalized adults?
On today’s podcast we dive into drivers of invasive procedures and hospitalizations in advanced dementia by talking to some pretty brilliant nursing and nurse practitioner researchers focused on dementia, geriatrics, and palliative care in nursing homes: Ruth Palan Lopez, Caroline Stephens, Joan Carpenter, and Lauren Hunt. Rehabbed to Death.
Our task is simple, we are going to be sampling each of these hot chicken wings while we ask Eric and Alex questions related to Palliative care and Geriatrics. Eric: Definitely MAID- Alex: Eric knows, MAID in Canada Eric: Medical Aid In Dying in Canada. They’ve all been laid out for you. Anne: Right. Alex: That one’s easy.
How definitions bind us, for example the division between chronic pain and palliative pain in much of the US. Somehow we were not very limited by definitions. Definitions can be shackles. Raj: We are not limited by definitions because we started our first non non-government organization. We create definitions.
Because, if anybody hasn’t seen it, you’ve got a great Twitter feed that gives tons of pearls on palliative care and a lot on communication. Yeah, I think we took a pretty broad definition in the article, but really it’s any failure to communicate clearly and adequately. What motivated you to dive into this?
This idea that for critically ill patients in the ICU, geriatric conditions like disability, frailty, multimorbidity, and dementia should be viewed through a wider lens of what patients are like before and after the ICU event was transformative for our two guests today. He, his Twitter feed though is brilliant. Eric: Yeah.
Nikki Davis: I’m a nurse practitioner and have been working in geriatrics and palliative care for about 21 years now. It is something that I have been involved with in a past life, but I was definitely not where I would consider myself a subject matter expert.
We talk on this podcast about potential uses of AI in geriatrics and palliative care with natural language processing guru Charlotta Lindvall from DFCI, bioethicists and internist Matt DeCamp from University of Colorado, and prognosis wizard Sei Lee from UCSF. Sei Lee is Professor of Medicine at UCSF in the division of geriatrics.
However if you want to take a deeper dive, check out his website “ The Ink Vessel ” or his amazing twitter feed which has a lot of his work in it. If you look back to some of my cartoons from late in residency, they showed just how dehumanized I felt and definitely give windows into how dehumanized I imagined my patients to be.
Eric 02:37 Feeding the beast, Matthew, feeding the beast [laughing] Alex 02:41 All right, here’s a little bit. And in fact, as Alex mentioned in the intro, probably more than 20 years ago, Muriel Gillig asked me to help out with the geriatric modules at the Brigham women’s hospital primary care medicine sort of sessions.
Julie: I definitely feel like that because unfortunately, now I’m… And this is what I’m working on now is it’s really hard not to get focused on numbers and views and if someone’s going to like it, and now I have a book that I’m trying to sell, which I hate that feeling- Eric: You’ve got a brand.
How do you talk to them about these terms and these definitions? Naomi 14:50 I definitely think, and I love Jane, how you keep coming back to the moment, because that’s all we have. There are stories that are stuck in here that need definitely. Naomi, I’m going to turn to you. Thoughts on kind of where we are.
And I learned, so you have this wonderful paper that just came out in JAGS, Journal of the American Geriatrics Society, titled Patients Living with Dementia Have Worse Outcomes When Undergoing High-Risk Procedures. So we followed Gretchen Schwarze’s definition, which was 1% or higher inpatient mortality was considered high-risk.
And I think part of the problem is for many people who are doctors, and I’m not talking to our palliative care geriatric audience, there is a sense of what it is to be a doctor is to fix things, is to save lives. Alex: A feeding tube. We’re giving some biologic information if they want it. Eric: Yeah. Alex: Thank you.
And I think … And to me, working well speaks to what you describe as the transdisciplinary definition. And you feed the medicine in. Eric: I got another question then, feeding on that, thoughts on how we can promote leadership in palliative care social work. Barbara: I definitely agree with you. Barbara: Exactly.
Alex Smith: And we’re delighted to welcome back Alex Lee, who’s an epidemiologist and assistant professor at UCSF in the division of geriatrics. Nadine: I think for our geriatric friends that listen to the podcast, there’s a lot of discussion about de-intensifying management as people age. Happy to be here.
Alex: We are delighted to welcome back to the GeriPal podcast, Katie Fitzgerald Jones, who’s a nurse scientist at the New England Geriatric Research Education and Clinical Center, and a palliative and addiction nurse practitioner at the VA in Boston. Who do we have with us today? Katie, welcome back to GeriPal. Jessie: Rught.
Is there a formal definition, or one that you think about? Ariel: As we all know, as geriatricians in geriatrics research, people accumulate conditions and accumulate medicines over the years. ” So feeding them little soundbites that they might be able to take off the tip sheet and use if they had the opportunity.
And whether tube feeding should be on there, that’s never an emergency decision. But the point is that EMS is a big piece of this discussion and national going forward, National POLST’s Collaborative is making that definitely a priority because it is forgotten a bit in some states. Kelly: Yeah, no, definitely.
Alex 00:54 And Jasmine Santoyo-Olsson, who’s a social behavioral scientist and a fellow in the T32 Research Fellowship at the UCSF Division of Geriatrics. Danny 07:39 Yeah, definitely. So some of our approaches definitely altered based on the availability of what we could get done. So intubation, cpr, feeding tubes.
Most of the debate seems rather wonky, as honestly it feels like we are getting stuck in the weeds of semantics and definitions, like what counts as ACP versus in the moment decisions. Rachelle: One of the things, they are definitely ordered steps, right? Or the cases where someone actually said, “I never want a feeding tube.”
We could have talked for 4 hours and will definitely revisit this issue! They often have behavioral issues stemming from their disorder, their life circumstances, all sort of feeding into each other. We all have questions. We addressed as many of your listener questions as we could. Sometimes the drugs dont work.
Would such ethical guidelines foster or feed suspicion of the motivations of bioethics? . Eric: This is a geriatrics and palliative care podcast and we’re talking about reproductive rights, abortions, looks like we’re talking about medical aid in dying, all encompassing this question of rights of conscious. It’s bigger.
And I definitely don’t sing as well as him. So we definitely don’t want to use this concept to warp it, to inappropriately justify non treatment or abandonment or letting off the hook a system that isn’t great always at meeting people’s needs because this is a really vulnerable patient population.
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