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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.
In 1988, Cruzan’s parents requested that her feeding tube be removed, arguing that she would not want to continue in this state. On the one hand, this was unfortunate, as it meant Nancy Cruzan could not be disconnected from the feeding tube immediately. And I think that’s where we want to be.
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.
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.
Certainly SOME of those avoided hospitalizations, CPR, and ICU stays were due to documentation of those orders in the POLST. And whether tube feeding should be on there, that’s never an emergency decision. Because we haven’t done our job to document the value of what we’re doing. But yeah, full treatment.
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. You’ll have a feeding tube. Yep, for geriatrics? You may end up there indefinitely. Samir: Yeah.
You’ve had three documented conversations to “clarify code status.” 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.
And I told her I quote LaVera every year when I teach the geriatrics fellows, the palliative care fellows, I would love for you to tell the story that I quote because you experienced it. On the one hand people have said research is the meticulous documentation of the blatantly obvious, which is kind of LaVera’s point 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. It’s not well-documented. Who do we have with us today? Devon: Right.
Potential that documenting advance directives without a robust conversation about prognosis might have led to these findings. 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. So intubation, cpr, feeding tubes.
So one that the primary outcome was supposed to be documentation, which it improved documentation, it wasn’t powered to actually look at any utilization or hard outcomes. Painstaking work to go through each outcome and really characterize and document what works and what doesn’t. They were slightly mischaracterized.
They often have behavioral issues stemming from their disorder, their life circumstances, all sort of feeding into each other. We try to document that it’s for cravings or withdrawal symptoms or Sach. Folks with uncontrolled substance use disorder typically are very impulsive. They’re often angry.
So, and actually, all of this is actually document, I think what you guys are looking for is more practical advice on sort of management. The post Sexual Function in Serious Illness: Areej El-Jawahri, Sharon Bober, and Don Dizon appeared first on A Geriatrics and Palliative Care Podcast for Every Healthcare Professional.
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