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Alex 01:27 We’re delighted to welcome back Tim F a rrell, who’s a geriatrician, associate chief for Age Friendly care at the University of Utah and chair of the American Geriatric Society Ethics Committee. All right, and finally we have Yael Zweig, who is a geriatric nurse practitioner at NYU. Tim, welcome back to GeriPal.
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.
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. And the hospital administrator says, “No, the hospital definitely values your contributions to the interdisciplinary team. Nathan: Yeah.
And that helped them focus on that instead of, say, the blood pressure, the vasopressors or the ventilator settings that day. And then they had to be receiving 48 hours of continuous mechanical ventilation at a minimum and be an adult. Eric: And how did you do that? There were nine disease categories. Eric: Okay.
I think one of the residents you asked how would they broach a subject, and he said wording like, “Unfortunately, he still needs a ventilator.” ” You talk about this too, even in your own training, where even around CPR, the training is like he might need a ventilator if he couldn’t protect his airway.
Yeah, I think we took a pretty broad definition in the article, but really it’s any failure to communicate clearly and adequately. To me, that’s the definition of miscommunication. ” Don: It was part of the palliative care fellowship, a study of linguistics and communication. I didn’t assign somebody to ask.
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.
I can on one hand count the patients I’ve cared for who didn’t want mechanical ventilation. I can correspondingly count on one hand the number of patients I’ve cared for who said I want to be on mechanical ventilation at all costs, even if it means I will never come off. Kelly: Yeah, no, definitely. Abby: Yeah.
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 think I’m heartened by the fact that over the last decade or so, the definition of advance care planning has evolved. Welcome back, Rebecca. Rebecca: Can I jump in.
I think that for me, it seems like an argument of extremes where people definitely wanted to consider it, oftentimes I think because they were angry that people weren’t being vaccinated and then wanted access to resources. Emily: Yeah. I’d actually echo that. So they probably know something that we don’t. Govind: Yeah.
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. Danny 00:52 Thank you very much.
Winston’s paper on the “fuzziness” around all definitions of brain death, titled, Brain Death without Definitions. So the kind of technological bind we’re talking about that first became recognized in the sixties or so with ventilators, the kinds of technologies that we have to sustain different kinds of bodily function.
We did the Geriatric 5M approach to telemedicine with Lauren Mo. We sometimes take care of patients who are on home ventilators, so coming in for an office visit is not practically feasible. laughter] Carly: Definitely. Brooke: I feel like you’re getting better year after year, so good. Alex: Hope so. Major Tom is Carly.
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