GeriPal

DECEMBER 2, 2022

So on today’s podcast we invite four brilliant individuals to talk about their perspective on how to change how we as a society and health care system partner with individuals with dementia. We’re going to be talking about things like creative engagement in individuals with dementia. Susan: Yeah, that was me.

Community 101

Community IT Individual Patient-Centered 101

GeriPal

OCTOBER 13, 2022

And so there was a report in 2009 by the Institute of Medicine saying that we need to equip all of these individuals in caring for older person in an evidence based manner. And so to develop that equation, they use the cohort of individuals and their data, their blood samples, creatine and other physical attributes.

Complication 97

Complication Patient-Centered IT Patients 97

GeriPal

JUNE 20, 2024

Incontinence and avoiding issues can present in an older individual, in some cases, just like they do a younger person. Biological aging or physiological aging varies from individual to individual. How do you think about this from a clinical perspective when you’re seeing individuals in your office? Everybody ages.

IT 120

IT Patient-Centered Patients Clinic 120

GeriPal

NOVEMBER 9, 2023

We make a diagnosis. But oftentimes, a therapist has deeper training and really history of trauma and specific diagnoses, versus a coach may be a little bit more future-focused and really works with people, regardless of whether they’re having any diagnosable challenge at the moment. It’s so different from therapy.

Board-Certified 110

Board-Certified IT Primary Care Referral 110

Rao Doctor

APRIL 3, 2025

In case you have missed it, click below to read- FEVER FAQ- Part 1 Fever Diagnosis: How is your health assessed? When assessing a fever, we doctors employ a systematic approach to ensure accurate diagnosis and effective management. Understanding the patient’s medical history is crucial for an accurate diagnosis.

Diagnosis 130

Diagnosis Management Illness Diagnose 130

GeriPal

MAY 11, 2023

Issues with sleep, like insomnia, does it lead towards a diagnosis of dementia, increase your risk, or is it that people with cognitive impairment, an early-on symptom is sleep disturbances and it’s more of a sign or symptom of early cognitive issues? Alex: Yeah. Eric: Okay. Let’s talk about sleep. Alex: Mm-hmm. It’s funny.

Physicals 85

Physicals IT Hypertension Education 85

GeriPal

FEBRUARY 6, 2025

So, the question becomes, what, if anything, should we do differently in the primary care setting to diagnose the disease? We address the following questions with Nate: Has anything changed for the primary care doctor when diagnosing Alzheimers? How should we screen for cognitive impairment? Does a good history matter anymore?

Primary Care 95

Primary Care Diagnosis Screening IT 95

GeriPal

JUNE 19, 2025

Noelle Marie 01:24 I think it really speaks a lot to my own personal journey and I’m pretty sure a lot of trans and gender diverse individuals also resonate with and it really speaks about our transition, celebrating our authentic selves, how society views us and how we view ourselves when we stand in front of a mirror.

Individual 85

Individual Community IT Chronic Condition 85

GeriPal

JULY 21, 2022

Often when there’s a cognitive concern, it’s a family member that is calling saying, “I just want to make sure my mom should still be driving after this happened, or after this diagnosis.” That’s where it really gets to this individual risks and balances, individual situation. Alex: Yeah.

IT 102

IT Family Families Diagnosis 102

GeriPal

OCTOBER 17, 2024

We talk about what is heart failure, particularly HFpEF, how we treat it (including the use of sodium–glucose cotransporter-2 inhibitors (SGLT2’s), and how we should apply guidelines to individual patients, especially those with multimorbidity who are taking a lot of other medications. Eric 12:05 Any pearls on the diagnosis of HFpEF.

Primary Care 113

Primary Care Patient-Centered IT Patients 113

Doctor On Demand

APRIL 28, 2025

Urgent care clinics provide quick diagnoses and treatments, including antibiotics if needed. In fact, most sore throat symptoms resolve in three days for 60-70% of patients, according to March 2025 UpToDate, an evidence-based clinical decision support system used by healthcare professionals.

ER 52

ER Telehealth Primary Care Doctor Appointment 52

GeriPal

JANUARY 18, 2024

We start off the conversation by talking about whether patients with cancer and cancer pain are really that different, and their paper that was just published on January 11 th in JAMA Oncology showing that substance use disorder is not uncommon in individuals with cancer. Jessie: Yes. Jessie: Exactly. Eric: Which brings us to an article.

Illness 136

Illness Patient-Centered Screening IT 136

GeriPal

JUNE 9, 2022

By diagnosis? We can’t possibly meet the needs of all people with newly diagnosed serious illness. Should we have like a list of diagnoses or prognosis. And that’s where things like diagnosis triggers, if you will, prognostic triggers, and then the ideal need-based triggers. By prognosis? Kate: Softball question.

Consulting 99

Consulting Patient-Centered Diagnosis Referral 99

GeriPal

AUGUST 17, 2023

So what is the role of individuals like geriatricians in prescribing amyloid antibodies and caring for individuals who are receiving them? And I do think geriatricians need to as individuals make that decision, largely based on their comfort with the diagnostics and the specifics of the therapeutics. I’m a prescriber.

Patient-Centered 98

Patient-Centered IT Clinic Patients 98

GeriPal

JANUARY 30, 2025

But in reality, given workforce shortages and just the challenges and the resources necessary to be able to provide early integrated palliative care from the time of diagnosis of advanced cancer, the model simply is not implementable, at least not in our current state with our available infrastructure and resources. Joe 41:30 Yeah.

Telehealth 105

Telehealth Patient-Centered IT Patients 105

GeriPal

OCTOBER 20, 2022

And so there was a report in 2009 by the Institute of Medicine saying that we need to equip all of these individuals in caring for older person in an evidence based manner. And so to develop that equation, they use the cohort of individuals and their data, their blood samples, creatine and other physical attributes.

Complication 52

Complication Patient-Centered IT Patients 52

GeriPal

JUNE 16, 2022

We discuss with her how we should work-up and manage “urinary tract infections” (I’ve added air quotes to “UTI” in honor of Tom Finucane’s JAGS article titled “Urinary Tract Infection”—Requiem for a Heavyweight in which he advocated to put air quotes around the term UTI due to the ambiguity of the diagnosis.). Is that right? Chrissy: Right.

Management 122

Management IT Medical Patient-Centered 122

GeriPal

APRIL 14, 2022

And I remember being there and there was a patient who had seen inpatient and then subsequently outpatient who was so thankful in the weirdest in just this irrational way for having been diagnosed with liver cancer. They have poor pain, they have poor function, but you also can’t clearly make a diagnosis.

Illness 102

Illness Patient-Centered IT Patients 102

GeriPal

AUGUST 31, 2023

So she had them early in diagnosis and then a little bit later. I just love her conclusion because what she realizes is when you’re first diagnosed… This is research. That’s what normal means when you’re first diagnosed, wanting to go back to before the illness. Brad: Yeah. It was a complete shock.

Illness 128

Illness IT Diagnose Medical 128

GeriPal

FEBRUARY 23, 2023

My favorite line from Emily’s paper: “Geriatric assent has not been widely adopted in clinical care, but bioethicists should advocate for this, as adoption of partial-involvement strategies can prolong the period in which individuals are (appropriately) engaged in decisions about their health care.” This is Eric Widera. Eric: Lynn or Anne?

Families 97

Families Family Patient-Centered IT 97

GeriPal

MARCH 7, 2024

It sets space between us and the individuals we’re trying to take care of. I think that consistency of what is the expectation of our roles is crucial in a lot of ways, but that role is determined by the individuals we’re serving. Well, I’d agree, John, for palliative care ideally starts around the time of diagnosis.

Provider 117

Provider Illness IT Healthcare 117

GeriPal

SEPTEMBER 1, 2022

Social workers augment a team’s ability to provide whole-person care, often aiding to identify and meaningfully address the wide variety of challenges and unmet needs faced by individuals and families facing serious illness. What does this diagnosis mean to you? And then my mom was diagnosed with lung cancer and she was treated there.

IT 102

IT Family Families Clinic 102

GeriPal

JULY 28, 2022

Jennifer: Yeah, so I think as all the listeners of this podcast know, and I know he did do a podcast with you guys when he was still able to verbally communicate, with Randy Curtis’ diagnosis of, I keep wanting to say AML, ALS. I have oncology on the brain. And most people just haven’t dealt with that before.

Illness 110

Illness Hospital Patient-Centered Patients 110

GeriPal

JANUARY 11, 2024

Alex: Self-administer and psychiatric illness is not considered a qualifying diagnosis. The last time we had you on the podcast, Bill, you talked about your cancer diagnosis and a personal experience with MAID, which you also, we’ll have a link to your blog post too about this as well. So they have to self-administer. Eric: Yeah.

Illness 144

Illness IT Medical Provider 144

GeriPal

MAY 9, 2024

And then for Hsien and for Sammy, this is a real social movement that you’re trying to… The movement upstream, getting people to consider what are the serious issues at the time of diagnosis with serious illness. And that’s not particularly sexy. So people want to hear more about gurgling and things like that. Eric: Great.

Education 127

Education IT Illness Healthcare 127

GeriPal

AUGUST 25, 2022

Second, Hospice was originally designed for patients with advanced cancer, but the fastest growing admitting diagnosis is dementia. Melissa: The other scenario that exists is just disenrollment because an individual is hospitalized. People across all diagnoses want hospice care. There’s a cost avoidance aspect to it, too.

Family 106

Family Families IT Patients 106

GeriPal

FEBRUARY 9, 2023

And when you and I talk about, what’s the key medical decision or diagnosis that we’re making all the time, we’re making a decision about like, “Is this patient sick enough to die? So we did a perfect cross so that the race and actual primary diagnosis was perfectly matched across groups. Thanks everybody.

Patient-Centered 111

Patient-Centered Patients IT Healthcare 111

GeriPal

OCTOBER 27, 2022

James: Yeah, so I guess just to start… I mean, prognosis in general is kind of a term for predicted course of disease, and I think people commonly use it to refer to an individual’s life expectancy or how long the person has to live. I think this is a really difficult topic to talk about with patients.

IT 95

IT Clinic Screening Patients 95

GeriPal

FEBRUARY 27, 2025

For those individuals, how do you think about that? So let’s say a patient who has lung cancer, relatively newly diagnosed, has a long history of substance use disorder, had been taking methadone as an outpatient, and now has this pain. Sach 17:32 For me, it’s our first line opioid. You know the case.

Patients 72

Patients Clinic Patient-Centered Illness 72

GeriPal

JUNE 26, 2025

Those are all things that could dramatically be a major health shock for an individual. May not even know that the patient has dementia, or they might think that, but it’s not been diagnosed. Maybe you lose your home or you get evicted from where you’re living or you’re suddenly, no, you no longer have stable housing.

Illness 93

Illness Hospital IT Patient-Centered 93

GeriPal

SEPTEMBER 19, 2024

So, for example, everyone who was diagnosed with an advanced or metastatic lung cancer had a prognosis on the order of months. Within eight weeks of diagnosis of advanced disease. Eric 16:38 So everybody was diagnosed with an advanced lung cancer sometime in the last twelve weeks and then they were randomized.

Patient-Centered 119

Patient-Centered IT Patients Hospital 119

GeriPal

JULY 6, 2023

I have 24,500 veterans on our caseload, 14,000 individuals with diagnosed mental health issue, 8,500 with an alcohol and substance abuse. Again, as Greg said, where the individual chooses what works best for them. 60% of all medical costs have nothing to do with your health diagnosis. To Susan’s point.

Community 89

Community Nurse Practitioner Provider IT 89

GeriPal

MAY 1, 2025

One in 10 people with newly diagnosed HIV is an older adult. And over that first 15 years, which was a very difficult time when there was no treatment at all available, everybody died and usually within months or a year or two of when they were diagnosed. And I also read that 1 out of 10 newly diagnosed HIV cases are in older adults.

Primary Care 94

Primary Care IT Provider Clinic 94

GeriPal

JULY 25, 2024

So we really wondered, you know, in modern palliative care practice, where we’re seeing patients a lot farther upstream than we used to, and we’re seeing patients with a wider range of diagnoses, we wanted to update, sort of. That just leads to issues that can make home care very difficult for these individuals.

Family 106

Family Families Patient-Centered IT 106

GeriPal

DECEMBER 1, 2023

If you are interested in learning more about the draft guidelines and the response from AGS to these guidelines, check out the following links: Revised Criteria for Diagnosis and Staging of Alzheimer’s Disease: Alzheimer’s Association Workgroup AGS’s response to the revised criteria Transcript Eric: Welcome to the GeriPal Podcast.

IT 115

IT Clinic Illness Hypertension 115

GeriPal

MARCH 27, 2025

But most people with dementia are initially diagnosed and medically managed in primary care, and they really desire clinicians to initiate these conversations but there are a number of really important barriers for these conversations taking place. And is it at all individualized to the patient? Before the primary care visit.

Primary Care 79

Primary Care IT Clinic Illness 79

GeriPal

DECEMBER 21, 2023

Eric: And looking back at that time, what do you think the healthcare system could have done to help with that? With your journey, with your dad’s journey- Diane: They could have diagnosed him earlier. They could have diagnosed him earlier. So that’s I think diagnoses. But it was also later on in the disease.

Patient-Centered 125

Patient-Centered IT Family Families 125