GeriPal

FEBRUARY 23, 2023

The patient is sick and getting sicker, and refuses to let you talk with family or other members of her inner circle. We owe it to the patient to explore the reasons behind the “no,” commonly not wanting to be a burden to their family. Should you stop at “no?” We will have to reach out to your daughter then to help with decisions.

Families 97

Families Family Patient-Centered IT 97

GeriPal

JULY 21, 2022

Often the work of the certified driving rehab specialist is to assess the older drivers goals, assess prognosis for driving, and help the family navigate discussions around driving cessation (hmmm…sounds like an approach to family meetings). Emmy: I was seeing people in the hospital setting, saying they had had a massive brain injury.

IT 102

IT Family Families Diagnosis 102

GeriPal

FEBRUARY 15, 2024

Eric: Well, what are the odds that two family members focus on a similar topic and do research together? laughter] Alex: We love the family theme. So it’s just a wide-opening lens that most of us never really get to see if we’re on the hospital-based side. Welcome, Katie, to the GeriPal podcast. Katie: Awesome.

Community 114

Community Transportation IT PCP 114

GeriPal

JANUARY 25, 2024

You can also listen to an audio interview with Alex and JAMA Deputy Editor Preeti Malani about this study and the other RCT of default palliative care for hospitalized older adults with noncancer serious illness published in the same issue. I was really passionate about helping the people and also their families. David: Right.

Patient-Centered 122

Patient-Centered IT Illness Patients 122

GeriPal

AUGUST 29, 2024

We must often deliver complex medical information that carries heavy emotional weight in pressured settings to individuals with varying cultural backgrounds, values, and beliefs. So I think it’s a bit of both acknowledging it and the emotion that may be in the room, but also just seeing the family. Alex 19:04 Yep.

IT 132

IT Illness Family Families 132

GeriPal

DECEMBER 8, 2022

Our loves, our triumphs, our failures, our work, our families. . As Thor notes, capturing patient stories has face validity as positively impacting the patients who share their stories and have them documented, and for the clinicians who get to truely and deeply know their patients in far greater depth than “what brought you to the hospital?”

Patient-Centered 115

Patient-Centered Illness Healthcare IT 115

GeriPal

APRIL 4, 2024

The hospital refused without a court order, and the case eventually made its way to the Supreme Court. The Cruzan ruling led to a flood of interest in Advance Directives, and eventually to the Patient Self Determination Act, which mandates provision of information about advanced directives to all hospitalized patients.

Family 112

Family Families Patient-Centered IT 112

GeriPal

JANUARY 16, 2025

Summary Transcript CME Summary Many older adults lose decision-making capacity during serious illnesses, and a significant percentage lack family or friends to assist with decisions. How should we care for unrepresented individuals in inpatient and outpatient settings? Why not use the older term unbefriended? Is that fair?

Patient-Centered 109

Patient-Centered IT Patients Healthcare 109

GeriPal

MAY 15, 2025

Prior podcasts on the ethics of nudging , and a different trial conducted by Kate and Scott in which the default for hospitalized seriously ill patients was to receive a palliative care consult. Many were community hospitals. The intervention was a negative study for the primary outcome, hospital length of stay. What is sludge?

Patient-Centered 116

Patient-Centered Hospital IT Illness 116

GeriPal

OCTOBER 26, 2023

Within hours of recording this podcast, I joined a family meeting of an older patient who had multiple medical problems including cancer, and a slow but inexorable decline in function, weight, and cognition. And I started my career at Barnes-Jewish Hospital in St. But rarely does the podcast and clinical reality meet in the same day.

Patient-Centered 132

Patient-Centered Hospital Patients IT 132

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. And so when you have that, that’s so good for the family. That’s so good for us.

IT 102

IT Family Families Clinic 102

GeriPal

SEPTEMBER 21, 2023

Fayron: I think I was interested in family caregiving early on because I had it in my family, but it wasn’t until my postdoc days when I was writing my application that I needed to narrow it down. I think, again, it’s the person’s individual, their preference. Alex: Yeah, I like that approach too.

Community 128

Community Family Families IT 128

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. But we’re not perfect individuals.

Primary Care 113

Primary Care Patient-Centered IT Patients 113

GeriPal

DECEMBER 15, 2022

So I think as palliative care clinicians, we use narrative as we try to understand more about the persons that we’re caring for and their families. Been in the hospital four times, vented, been told the story to her family, she won’t live. Within the VA it’s now at 70 VA hospitals. Heather: Sure.

IT 105

IT Patient-Centered Healthcare Illness 105

GeriPal

SEPTEMBER 12, 2024

Ishwaria 05:29 And that’s really how this field of professional well being, healthcare professional well being, clinician well being, has evolved, is that there is an important place in our overall professional well being for personal resilience and our individual coping strategies, recovery methods from day to day.

IT 110

IT Healthcare Healthcare Professional Patient-Centered 110

GeriPal

MAY 26, 2022

They argue that the current guidelines, which prioritize immunocompromised people and unvaccinated older people on the same level, should be re-done to prioritize the immunocompromised first, and additionally move up older vaccinated individuals or vaccinated persons with comorbidities. What’s wrong with that? Why not prioritize them?

Vaccination 87

Vaccination Individual IT Healthcare 87

GeriPal

JULY 28, 2022

Alex: And we are also delighted to welcome Areej El-Jawahri, who is an oncologist at Massachusetts General Hospital as well, who specializes in blood cancers. This is my early father’s day gift from the family. Welcome to the GeriPal podcast, Jennifer. Jennifer: Thanks. Welcome to the GeriPal Podcast, Areej. Eric: Yeah.

Illness 110

Illness Hospital Patient-Centered Patients 110

GeriPal

JUNE 22, 2023

When they built a new prison hospital in Stockton, the dialysis went there. Eric: So in some ways, this is kind of like the VA, where you don’t have to follow Medicare guidelines, but you can actually actively do concurrent care for these individuals. In many cases, the families were the victims of the crime. We have that.

Family 132

Family Families IT Community 132

GeriPal

JUNE 30, 2022

Joel: The Brigham and Women’s Hospital likes me to say that too. Alex: And the Brigham and Women’s Hospital. Eric: So we’re going to be talking about dementia and considerations around surgery for individuals with dementia. And she was rushed to the hospital. Did I get that right? Joel: Oh yeah.

Patient-Centered 101

Patient-Centered Complication Patients IT 101

GeriPal

MAY 4, 2023

We remember bucking the rules, figuring out who you are, hair on fire, feeling invulnerable, trying to figure out who you are – and now those adolescents are stuck in the hospital, with doctors and parents telling them what to do, having their autonomy crushed by the medical institution, realizing they’re not invulnerable.

IT 83

IT Family Families Illness 83

GeriPal

JULY 11, 2024

So if one of my patients gets admitted, I also see them on the inpatient side of our hospital. I think for families and for other providers who are not trained in that, it’s very hard to predict. I’m embedded in the ICU in one of our smaller hospitals. You still want to go to the hospital if you get sick?

Patient-Centered 109

Patient-Centered IT Patients Clinic 109

GeriPal

FEBRUARY 8, 2024

Hospital Chaplains, Spirituality, and Pain Management: A Qualitative Study. So there’s this, what is suffering to the individual, and is there some threshold that we could say, “This is real suffering,” or “This is the suffering we talk about in geriatrics or palliative care”? Pain Manag Nurs. 2023.11.004.

IT 137

IT Family Families Physicals 137

GeriPal

MARCH 13, 2025

Summary Transcript CME Summary As far as weve come in the 50 years since Balfour Mount and Sue Britton opened the first palliative care at the Royal Victoria Hospital in Quebec, have we lost something along the way? I was trained in the hospital where it started, and we were trained to be bedside nurses. Sue 01:26 Thank you.

IT 104

IT Patient-Centered Family Families 104

BMJ

MAY 10, 2022

Family physicians and family health workers, considered reliable sources of vaccine information, have a unique position where individuals in rural and urban areas can access frequently, uninterruptedly, cheaply, and easily [2]. Two hundred seventy-six of the healthcare professionals were reached (response rate: 85.4%).

Vaccination 40

Vaccination Healthcare Professional Healthcare Primary Care 40

GeriPal

JANUARY 30, 2025

In one corner, weighing in at decades of experience, well known for heavy hits of bedside assessments, strong patient-family relationships, and a knockout punch of interdisciplinary collaboration, we have in-person palliative care consults. Lynn 37:39 I was in the hospital. But watch out! Alex 01:06 Yeah, go in person.

Telehealth 105

Telehealth Patient-Centered IT Patients 105

GeriPal

MARCH 24, 2022

And especially for those who may have nontraditional families. I think if you’re from a nontraditional family, it’s very important to make sure that people understand who you would want to talk to. So it’s an example of something that can start outside of the healthcare system and move its way in.

Illness 72

Illness IT Healthcare Patient-Centered 72

GeriPal

MAY 9, 2024

Alex: And Sammy Winemaker, who’s a palliative care physician and Associate Clinical Professor at McMaster University in the Department of Family Medicine, Division of Palliative Care. Alex: Generally in the hospital-based hospice. Matt: I’m more of a hospital guy. Hsien: Hey, great to be here. Sammy: Oh, okay.

Education 127

Education IT Illness Healthcare 127

GeriPal

OCTOBER 19, 2023

Certainly SOME of those avoided hospitalizations, CPR, and ICU stays were due to documentation of those orders in the POLST. Additional links mentioned in the podcast: Recent JGIM article on POLST in California nursing homes, hospitalization, and nursing home care Karl’s GeriPal post on appropriate use of POLST Enjoy!

Patient-Centered 126

Patient-Centered IT Patients Illness 126

GeriPal

AUGUST 25, 2022

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. It’s really a pretty traumatic experience for a lot of patients and families. And I had a blast playing Take the Money and Run!

Family 106

Family Families IT Patients 106

GeriPal

MAY 25, 2023

And, you know, I really leaned in from my perspective as a primary care geriatrician to hearing from what my patients and their family caregivers are asking me for and asking me about, and they’re asking me about how they can prepare. Health care system drives where you end up, which hospital, which state you live in.

Community 95

Community IT Patient-Centered Primary Care 95

GeriPal

NOVEMBER 14, 2024

Sarah 11:14 So it’s really assessing patients for their individual risk factors for falls. I think there’s a few studies in dialysis patients and in hospitalized patients suggesting that gabapentin and pregabalin is associated with an increased risk of falls. Eric 11:10 And tell me, what is a multifactorial intervention?

IT 124

IT Screening Patient-Centered Community 124

GeriPal

MARCH 28, 2024

Kate: It was done in 10 hospitals, 17 ICUs in Atrium Health down in North Carolina. Asking clinicians to document prognosis did not change the primary outcome of hospital length of stay or really any of the secondary outcomes, which I’ll get into. Also the same hospital system? That’s when they got enrolled.

Consulting 115

Consulting Patient-Centered IT Patients 115

GeriPal

MARCH 24, 2023

2021 Association of Hospice Profit Status With Family Caregivers’ Reported Care Experiences. I think some individuals thought there was cherry-picking of stories that made it seem like hospice is this bad thing, that it’s taking advantage of vulnerable individuals and it didn’t talk enough about the good things that hospice does.

IT 113

IT Provider Patients Families 113

GeriPal

JUNE 9, 2022

Palliative care, in contrast, saw explosive growth in US hospitals. But definitely always had the bug to be the one to jump into the family meetings in the ICU, lead them. They were at the VA, but not so much at our main hub hospital where I trained. I do tend to focus in the hospital setting. It’s what I know.

Consulting 99

Consulting Patient-Centered Diagnosis Referral 99

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. Have you had a family history of substance use disorder?

Illness 136

Illness Patient-Centered Screening IT 136

GeriPal

APRIL 13, 2023

Summary Transcript Summary Social connections impact our health in profound ways, whether it is the support we receive from family and friends in navigating serious illness, the joy from shared social activities, or connecting with our community. They may have few family members, live alone. I would say that.

IT 99

IT Community Patient-Centered Medical 99

GeriPal

OCTOBER 5, 2023

So I first want to just say thank you to Ernesto’s family. And I met with his family over Zoom, which was how many of us had to meet with families during that time. We were doing a lot of this without a whole lot of guidance, as is common, I think, from family, because all they knew was who he was. Sunita: Yes.

Illness 136

Illness IT Patient-Centered Family 136