GeriPal

JUNE 8, 2023

Should we use Ozempic (if we can find it) in patients with serious illness, which often results in undesirable and profound weight loss? And my hypothesis is that’s because it’s no longer the individual managing their own diabetes, it’s the nursing home staff managing their diabetes. Listen in to learn more!

Diabetes 73

Diabetes Management Patient-Centered Family 73

GeriPal

APRIL 14, 2022

On today’s podcast we talk with three experts on buprenorphine on why, when, and how to use it in serious illness. Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness . Katie, before we jump into the topic of buprenorphine in serious illness, what’s the song request?

Illness 102

Illness Patient-Centered IT Patients 102

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. Transcript Eric: Welcome to the GeriPal podcast. This is Eric Widera.

Illness 136

Illness Patient-Centered Screening IT 136

GeriPal

FEBRUARY 6, 2025

Eric 00:27 So we’re going to be talking about making the diagnosis of Alzheimer’s disease in a primary care setting, not specialty care, but maybe we could talk a little bit about that. How much should it change how we think about making a diagnosis of Alzheimer’s disease in primary care? Great to be back. Absolutely.

Primary Care 95

Primary Care Diagnosis Screening IT 95

GeriPal

AUGUST 31, 2023

Summary Transcript Summary How do people react when they hear they have a serious illness? And some people, in addition or instead, engage in deep introspection on how to make meaning or live with or understand this experience of serious illness. Shock, “like a car is rushing straight at me” (says Bill Gardner on our podcast).

Illness 128

Illness IT Diagnose Medical 128

GeriPal

DECEMBER 19, 2024

Still, we havent talked about integrating palliative care into psychiatry or in the care of those with severe mental illness. What does it look like to take a palliative approach to severe mental illness? Is “terminal” mental illness a thing? Eric 01:34 Oh, I love that. Dani 01:36 More to talk about there.

Illness 101

Illness Mental Health IT Patient-Centered 101

GeriPal

JUNE 19, 2025

Eric 01:04 So we’re going to be talking about transgender health in older adults and those with serious illness. To note that I am an individual who goes through this world. I face a lot of different stressors and challenges similar to other individuals, but I also have my own unique experiences. Noelle Marie 01:15 I do.

Individual 85

Individual Community IT Chronic Condition 85

GeriPal

JULY 21, 2022

Love to talk about also in the serious illness population. 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.” How did you both get interested in this as a topic? Alex: Yeah.

IT 102

IT Family Families Diagnosis 102

GeriPal

AUGUST 29, 2024

Summary Transcript CME Summary Serious illness communication is hard. We must often deliver complex medical information that carries heavy emotional weight in pressured settings to individuals with varying cultural backgrounds, values, and beliefs. Eric 01:42 So we’ ve got an exciting topic today. Eric 05:03 Nice.

IT 132

IT Illness Family Families 132

GeriPal

JUNE 9, 2022

By diagnosis? We can’t possibly meet the needs of all people with newly diagnosed serious illness. She’s also a member of the PAIR Center, which stands for Palliative Advanced Illness Research Center. And bringing more palliative care to the living with serious illness instead of dying from serious illness population.

Consulting 99

Consulting Patient-Centered Diagnosis Referral 99

GeriPal

FEBRUARY 29, 2024

Not the most common circumstances that people with serious illness face where attention and understanding of what my goals and values are. We’re willing to spend $50,000 a year for individuals for their expensive pharmacy medication. There are also increasing proportion of people in nursing homes who have serious mental illness.

IT 126

IT Patient-Centered Illness Education 126

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

JULY 28, 2022

GeriPal post on “fast food” style palliative care in chronic critical illness. 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. Transcript.

Illness 110

Illness Hospital Patient-Centered Patients 110

GeriPal

JANUARY 11, 2024

To be eligible in Canada patients must have a “ grievous and irremediable ” condition, including disability ; they do not have to have a terminal illness with a prognosis of less than 6 months. A planned expansion of MAID to include people with mental illness was placed on hold until March 2024. So less than six months to live.

Illness 144

Illness IT Medical Provider 144

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. What do we do with that?

Telehealth 105

Telehealth Patient-Centered IT Patients 105

GeriPal

MAY 4, 2023

There’s all this stuff that we’re supposed to be doing at that stage of life and then you add the complexity of the serious illness. If there’s a serious illness, all of a sudden, you’re in this place where now you’re struggling between this growing independence and also then this dependence that you may have.

IT 83

IT Family Families Illness 83

GeriPal

MAY 9, 2024

all of whom focus their efforts on educating the general public about living and dying with a serious illness. So we are going to leapfrog over the healthcare system education and we’re going to go straight to the citizens of the world and we’re going to give them the insider tips to how to improve their illness experience.”

Education 127

Education IT Illness Healthcare 127

GeriPal

JUNE 30, 2022

Eric: So we’re going to be talking about dementia and considerations around surgery for individuals with dementia. But we know that 30% of all decedents who are Medicare beneficiaries either die from dementia or have an existing diagnosis of dementia, which is something we talk about quite often, Joel and I. It was Remember Me.

Patient-Centered 101

Patient-Centered Complication Patients IT 101

GeriPal

MARCH 7, 2024

He looked very ill. We are doulas for those with serious illness and those at end-of-life, just a longitudinal relationship, nonmedical support to provide presence. It sets space between us and the individuals we’re trying to take care of. The last thing I’ll say is I actually saw his very last performance.

Provider 117

Provider Illness IT Healthcare 117

GeriPal

FEBRUARY 27, 2025

Today we talk with experts Janet Ho, Sach Kale, and Julie Childers about opioid use disorder and serious illness. Eric 00:51 So we’re gonna be talking about caring for people with serious illness and substance abuse. Who has a song request for Alex before we talk about substance use disorder and serious illness?

Patients 72

Patients Clinic Patient-Centered Illness 72

GeriPal

OCTOBER 19, 2023

And we have Scott Halpern, who is Professor of Medical Ethics and Health Policy and Director of the Palliative and Advanced Illness Research Center or Payer Center at the University of Pennsylvania. And he’s a professional Uber driver for his daughter’s softball games.[laughter] Alex: National POLST Collaborative.

Patient-Centered 126

Patient-Centered IT Patients Illness 126

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 I think that there is room for shortening the duration if your patient is non-immunocompromised and not severely ill. Eric: That’s pretty impressive.

Complication 52

Complication Patient-Centered IT Patients 52

GeriPal

JULY 11, 2024

We get a bit of, in the veteran population, kind of a mix of a lot of mental health issues thrown into these comorbid illnesses, including cirrhosis, but it’s usually the decompensated cirrhotics or the folks with liver cancer and cirrhosis, or one of both. Can you come and be in our clinic once a week? Amy 24:21 For me, I always.

Patient-Centered 109

Patient-Centered IT Patients Clinic 109

GeriPal

FEBRUARY 17, 2022

When we have a medication with up front harms and downstream benefits, it’s critical that we consider the time to benefit, or how long it will take an individual to benefit from a test or treatment. For individuals with a life expectancy less than the time to benefit, the up front harms outweigh the downstream benefits. .

Clinic 67

Clinic IT Patients Medical 67

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? You begin with psychosocial assessment and care. Eric: Yeah.

IT 102

IT Family Families Clinic 102

GeriPal

AUGUST 25, 2022

Second, Hospice was originally designed for patients with advanced cancer, but the fastest growing admitting diagnosis is dementia. And yet, disenrollment from hospice, either due to patient/family revoking the benefit or stabilization of illness (extended prognosis) is remarkably high for people with dementia among some hospices.

Family 106

Family Families IT Patients 106

GeriPal

MAY 12, 2022

It’s easier to concentrate on cure, diagnosis, cure. When we think about palliative care delivered here, like individuals with chronic pain, non-serious illness chronic pain, non-life threatening illness, oftentimes if we get consulted on them, we don’t even see them, may just be discontinued in most palliative care places.

Community 115

Community IT Relationship Healthcare 115

GeriPal

JUNE 22, 2023

But now we have older people dying of older people illnesses. Alex: And are the regulations similar or different in terms of six month required prognosis or less, should the disease take its usual course, or illnesses leading to a short prognosis? He struggled with mental illness, substance use disorder. Eric: Mm-hmm.

Family 132

Family Families IT Community 132

GeriPal

FEBRUARY 9, 2023

For example, we spend the first half talking about a RCT simulation study of clinician verbal and non-verbal communication with a seriously ill patient with cancer. So we did a perfect cross so that the race and actual primary diagnosis was perfectly matched across groups. There’s that recognition piece.

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

SEPTEMBER 8, 2022

Holly has accumulated mountains of evidence for the diagnosis of prolonged grief disorder as a specific condition primarily notable for a yearning over a year after the death. Alex: Their own death in advance, terminally ill people. This led her on a remarkable journey. Bargaining just so you know is more end of life before the death.

IT 100

IT Relationship Complication Specialization 100

GeriPal

JUNE 26, 2025

I think part of this does stem from a clinical experience and also some of the theoretical models that have evolved around serious illness, you know, to think specifically about dementia. And so trying to think a little bit more about what could be driving some of those alterations in the trajectory for all kinds of serious illness.

Illness 93

Illness Hospital IT Patient-Centered 93

GeriPal

SEPTEMBER 19, 2024

Alex 12:36 And most of our listeners are like clinician, practicing clinicians caring for older adults, people with serious illness. Within eight weeks of diagnosis of advanced disease. So in chronically critically ill patients, the idea that one visit is going to do anything is just. Is this superior to that? Palliative care.

Patient-Centered 119

Patient-Centered IT Patients Hospital 119

GeriPal

JULY 25, 2024

The PPS is one of the most widely used prognostic tools for seriously ill patients, but the prognostic estimates given by the PPS are based on data that is well over a decade old. So the palliative performance scale, or PPS, is essentially a tool to help clinicians with prognostication for seriously ill or palliative care populations.

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

Alex 02:44 Still suffering from some illness from there, which is why I was sick and not in the office with Eric today. And is it at all individualized to the patient? Danny 12:07 I don’t know how individualized it is. Like, how close to the end of life is it all just in seriously ill patients, I guess. Yeah, yeah.

Primary Care 79

Primary Care IT Clinic Illness 79

GeriPal

MAY 1, 2025

Alex 16:55 My guess is probably not something that most geriatricians or internists or family medicine docs caring for older people have on their differential diagnosis. Is a new diagnosis of HIV. If they did, it was before AIDS was a diagnosis. Meredith 17:07 Yes. And I think patients too, don’t always people.

Primary Care 94

Primary Care IT Provider Clinic 94