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Nikki Davis: I’m a nurse practitioner and have been working in geriatrics and palliative care for about 21 years now. Anthony Spano: We are very lucky to have Nikki Davis on stage, so I wanted to just open up and give her the chance to tell us a little bit about herself.
Ariel: As we all know, as geriatricians in geriatrics research, people accumulate conditions and accumulate medicines over the years. We used a large online survey panel, the Ipsos Knowledge Panel, and we presented older adults with two vignettes. And as we’ve all witnessed, it gets to a point where things are just unmanageable.
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?
So just by the nature of prognosis there, and I think, you know, this, this is really where I think the, the value of an interdisciplinary team, which we do so well in geriatrics and palliative care, is important in thinking about approach to these patients because perspective. Ashwin 23:46 Yeah. And I love the structured approach.
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.
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. In 1990 the Supreme Court ruled…for the state of Missouri.
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.
Alex Smith Links Link to the McGill National Grand Rounds Series on Palliative Care , Michael Kearney as initial presenter, and registration for future events. Is that how we presented ourselves? And love that Jim Croce choice. Whats in a name? Ive got a name. No, you dont need to be Canadian. Canadians are welcoming.
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.
I am constantly talking to clinical social workers about what are the ways that you can be contributing to research, to publications, to scholarship, to presentations, even if it’s a reflection paper? And you feed the medicine in. Barbara: … to conduct the research, write the paper, do the thing that creates a publication.
Today we have a star-studded lineup, including Lexy Torke of Indiana University, who discusses her RCT of a chaplaincy intervention for surrogates of patients in the ICU , published in JPSM and plenary presentation at AAHPM/HPNA. And I want to thank all of our listeners for supporting this podcast. Good night, everybody.
And so in that way, it’s not the letterhead or the four walls and the roof that are perpetuating the present, it’s the people. That, as you were saying, Eric, that bring me joy that I can pursue because they feed me, as well as whatever the reward system that I’m in. We should be writing. We should be doing this.
And for a few reasons, which I’m sure we’ll get into, I think it’s probably most effective upstream of the acute care setting, more in the nursing home setting or for patients who are not presenting in the hospital or emergency department setting. But yeah, full treatment.
I felt like I was always told to present people with a buffet of options and, really, without guidance, ask them to choose, which is, it would always make me feel sick to my stomach. Alex: A feeding tube. And I described a code that I led as a senior resident. We’re giving some biologic information if they want it.
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. Eric 19:31 So it was interventions like feeding tubes, mechanical ventilation, dialysis at the very end of life. Excited to be here.
But one of the things that I try to teach, because both Juliet and I have done a ton of teaching about this, is that if you follow these steps, that outcome sort of presents itself. Or the cases where someone actually said, “I never want a feeding tube.” Why did they choose to be DNR or not have a feeding tube?
Areej 03:50 So at the state of the science, I was actually presenting a study that was focused on addressing sexual health concerns in transplant survivors, and I actually told the story of the state of the science for those of you who were there. So we got a lot to cover on sexuality, sexual health, and serious illness.
Butstay with us heremight AI help to address some of the major issues present in surrogate decision making? But I do think that there’s a tension here, which is that in order for these algorithms to work, you need to feed them a ton of data. And then you think, well, what kind of data are you feeding it?
Dani 15:02 Speaking to the fact that we are talking about such a massive array of illnesses, of presentations of symptom severity, and trying to speak in generalizations. I think it’s very present in maid. Which is so hard to do because it’s really hard. Eric 25:46 We should talk about that too, that question.
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