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Summary Transcript Summary What does the future hold for geriatrics? Historically, answers generally lamented the ever increasing need for geriatrics without a corresponding growth in the number of specialists in the field. On today’s podcast, we are going to do a deep dive on the future of geriatrics with three amazing guests.
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.
As background, we discuss Manju Kurella Tamura’s landmark NEJM paper that found, contrary to expectations, that function declines precipitously for nursinghome residents who initiate dialysis. So, for example, you know, we see somebody coming in from the nursing. A nursinghome. Let it be (hint hint).
Finally, we discuss Michelle Oddens study, which used a target trial emulation approach to investigate the effects of deprescribing antihypertensive medications on cognitive function in nursinghome residents. Emily 06:11 Yeah, we definitely have a pill for every ill. Go ahead, Connie. Eric 32:14 Yeah, I love that.
A dearth of coordination or integration between rehab teams and palliative care teams routinely forces some patients into a cycle between the hospital and the nursinghome in their last year of life. These results appeared in a 2019 New England Journal of Medicine study titled “Rehabbed to Death.”
If you develop dementia, odds are you will spend the last months to years of your life in a nursinghome or assisted living facility. This study explored nursinghome organizational factors and staff perceptions that are associated with the variation in care for residents with advanced dementia. 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.
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 nursinghome clinicians versus a clinical guideline. Welcome to the GeriPal podcast, Chrissy. Chrissy: Thank you so much for having me.
end of life care and advance care planning) to more geriatrics focused (e.g. Alex: And we’re also delighted to welcome back to the GeriPal podcast Kenny Lam, who’s assistant professor of medicine at UCSF in the Division of Geriatrics. RCFEs, boarding cares, nursinghomes. Welcome back, Kenny. Welcome back.
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. I’m going to turn to you Lauren.
valproic acid and gabapentin), in nursinghomes, particularly patients with Alzheimer’s disease and related dementias. J Am Geriatr Soc. Donovan Maust is a geriatric psychiatrist and health services researcher at the University of Michigan. Donovan discusses the growth of “mood stabilizers/antiepileptics” (e.g.
Second, as we discussed in last week’s podcast , older adults, particularly those in nursinghomes, were far more likely to die than younger individuals. Alex: We are delighted to welcome Ramona Rhodes, who is a geriatrician and palliative care doctor, and member of the Board of Directors for the American Geriatric Society.
So, it’s definitely possible in sort of that oldest old category that there may be what we call silent aspiration, where someone aspirates, and then they don’t cough or clear their throat, so you actually wouldn’t even know that they’re aspirating. Raele: Yep, they definitely can be. Raele: Yes, definitely.
They’re going to get older, they’re going to struggle with geriatric conditions, and they’re going to need palliative services and eventually end-of-life care. It was built in 1955, so it wasn’t designed for a geriatric population. Michele: So that number’s really growing. The doors aren’t locked.
Abhilash Desai, MD , geriatric psychiatrist, adjunct associate professor in the department of psychiatry at University of Washington School of Medicine, and poet! Alex: And we have Ab Desai, who’s a geriatric psychiatrist in Idaho. She created TimeSlips which we talk about in our podcast. Anne, welcome to the GeriPal podcast.
That’s why we do this podcast- to address real world issues in palliative care, geriatrics, and bioethics. Ann: I definitely do. Sarguni: Yeah, definitely. And so I became more interested in what are the outcomes of patients with cancer when they do go to a nursing facility? Sweet Caroline. Once you discharge them.
She’s Professor and Vice Chair for Research at the Mount Sinai School of Medicine, Department of Geriatrics and Palliative Medicine. Alex: We’re delighted to welcome back to the GeriPal podcast, Krista Harrison, who is a Health Policy Researcher, an Associate Professor of Medicine, UCSF Division of Geriatrics.
When I’m on nursinghome call, the most common page I receive is for a blood sugar value. And we invited Tamryn Gray from the Dana Farber joins us to ask insightful questions, including: What blood sugar range should we target for patients in the nursinghome or hospice? Summary Transcript Summary Diabetes is common.
Eric: Martha – breaking the definition for palliative care, no longer an extra layer of support. Alex: Nursinghomes. The post GeriPal Special: Hopes and Worries for Hospice and Palliative Care appeared first on A Geriatrics and Palliative Care Podcast for Every Healthcare Professional. Eric: BlackRock.
Kevin’s study looks at a period of time in the COVID pandemic when a large multistate nursinghome provider created a “nonessential medication on hold” (NEMOH) policy in order to conserve critical nursing resources and PPE, and to limit exposure risk for residents by reducing unnecessary contact. nursinghomes.
For a trial to have value, it should not exclude patients over age 80, or those with dementia, or patients residing in nursinghomes. Additional links mentioned in the podcast: Recent JGIM article on POLST in California nursinghomes, hospitalization, and nursinghome care Karl’s GeriPal post on appropriate use of POLST Enjoy!
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.
Alex: Also returning Rebecca Sudore, who is professor of medicine at the UCSF in the division of geriatrics, and is a geriatric and palliative care doctor. I have done a lot of work on POLST and nursinghomes and I’ve seen POLST forms. Welcome back, Rebecca. Rebecca: Thanks for having us. Rebecca: Can I jump in.
In the US, geriatrics “grew up” as an academic profession with a heavy research base. Clinical growth of geriatrics programs has lagged academic research, despite the rapid aging of the population. . But definitely always had the bug to be the one to jump into the family meetings in the ICU, lead them. Kate: Yeah.
Alex 00:15 We are delighted to welcome back Louise Aronson, who’s a geriatrician and author in the UCSF division of Geriatrics. And now I’m almost 90, so definitely I don’t need to do suffering. Louise 13:48 Definitely some thoughts, and I think slightly different for different people. I’m not brave.
So I think when you start combining these trials and you’re faced with an older adult that the option would be to now put in a PICC line and send them to a nursinghome and then you can have a really sit down with the patient through shared decision making decide we stop at seven days. Lona: Absolutely. Tell me about this study.
Lauren: Yeah, I think I can definitely see Joe’s point of view. Yes, my hair is definitely on fire. The for-profits stepped up and they have been serving people in nursinghomes, including with dementia who deserve our care, and the nonprofits haven’t. Eric: Great. Lauren, what do you think about you?
Alex: Today, we are delighted to welcome James Deardorff, who is a geriatrician and a T-32 research fellow in UCSF’s Division of Geriatrics. He’s a Geriatrician Palliative Care Clinician Researcher, also in the UCSF Division of Geriatrics. which is kind of the typical definition of osteoporosis at that time.
The Beers Criteria is one of the most frequently cited reference tools in geriatrics, detailing potentially inappropriate medications to prescribe to older people. We’re delighted to welcome Mike Steinman, who’s a geriatrician professor of medicine at UCSF in the division of geriatrics, prior guest on this podcast.
She’s an epidemiologist and assistant professor of medicine in the UCSF Division of Geriatrics. Alex Smith: And we’re delighted to welcome back James Deardorff, who is a geriatrician and research fellow in the UCSF Division of Geriatrics. James: Definitely not-. Welcome to the GeriPal podcast, Alex. 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. And the nurse can’t dose it, they have to individually dose it.
Medical cannabis is not legal in North Carolina, so there are definitely some limits. David 26:42 I discovered that one of the interviews I did for stoned was with a filmmaker in Israel whose debut film, I think, was based on time he spent in a nursinghome helping older adults to use cannabis. Eric 26:42 Yeah. David 43:09 Yeah.
It’s not something you can measure, but it’s definitely something that happens during these interviews. Jason Karlawish and Ken Covinsky appeared first on A Geriatrics and Palliative Care Podcast for Every Healthcare Professional. So I think that process is a magic process. Just go to www.geripal.org.
And I think that we would kind of enthusiastically say that it is definitely part of our role as palliative care clinicians to have a certain level of primary addiction, medicine, knowledge and competence. Eric: And that pain protocol significantly reduced behavioral issues in dementia nursinghome patients. Alex: Bye everyone.
It’s not something you can measure, but it’s definitely something that happens during these interviews. The post Storycatching: Podcast with Heather Coats and Thor Ringler appeared first on A Geriatrics and Palliative Care Podcast for Every Healthcare Professional. So I think that process is a magic process.
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. A lot has changed, but what motivated the study was a recognition that most advanced care planning interventional research had been undertaken in nursinghomes.
Next, we talk with James Deardorff about whether we can accurately predict nursinghome level of care in community-dwelling older adults with dementia. First, we have James Deardorff, who’s a geriatrician and assistant professor at UCSF in the division of Geriatrics. Good to be here. James, welcome back to GeriPal.
Geriatrics. Alex: We are delighted to welcome back Lee Lindquist, who’s a geriatrician and chief of geriatrics at Northwestern. That’s something that I figured we could definitely go after is using those negotiation skills and then moving them over towards the healthcare setting. Prof Case Manag. December 2020.
So I think when you start combining these trials and you’re faced with an older adult that the option would be to now put in a PICC line and send them to a nursinghome and then you can have a really sit down with the patient through shared decision making decide we stop at seven days. Lona: Absolutely. Tell me about this study.
Malaz: One day I was in internal medicine residency and I had to take care of a patient who was admitted from a nursinghome with dementia. For me, right now, the worst thing, my nightmare is dying from dementia alone in a nursinghome. People start thinking about putting them in a nursinghome. Diane: Huge.
Eric 02:48 Well, I want to thank you for joining us because you’ve done a lot of the studies around falls and fractures and like, how we think about, especially like in, in frailer older adults, those in nursinghomes. About one out of every three older adults falls each year in the nursinghome that’s higher.
Natural immunity definitely works. Let’s focus on outpatient management, nursinghome management. Monica: They definitely are, and they have multiple-. So far, because it’s a combination of two monoclonal antibodies, it definitely works against Omicron. Alex: Yes, it’s definitely my thing.
Our conversation covers: The current state of COVID Evidence for COVID boosters, who should get them, and preferences between Novavax and mRNA vaccines COVID treatments like Molnupiravir and Paxlovid Differences in COVID impact on nursinghome residents and those with serious illnesses We wrap up with a “magic wand” question.
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