Geripal-podcast

Eric and I were delighted to be invited to Brazil to give a series of presentations in Sao Paulo at their annual geriatrics meeting.  We met people doing important, interesting, and innovative work in Brazil and throughout Latin America. We got the audience to sing along, including (in another talk) the magnificent Brazilian song Sozinho by Caetano Veloso in Portuguese, with my son Renn playing guitar. For our final talk, a podcast in front of a live conference audience, we asked our 3 guests, Eduardo Ferriolli, Marlon Aliberti, & Edison Iglesias to select a recent article to discuss.  We talked about: Intrinsic capacity (selected by Eduardo).  What is it? What is it used for? How do you measure it?  (hint ICOPE).  Eduardo emphasized that intrinsic capacity is a positive aspect of aging, focused on potential rather than deficit.  We asked him to work intrinsic capacity into George Kushel's famous analogy using the golden gate bridge to describe phenotypic frailty (pillars), deficit accumulation frailty

Lynn Flint and Anne Kelly join as hosts in a reprise of last year's ask us anything format.  Thank you for sending in your terrific questions!  Lynn and Anne condensed them to about 20, and we ran through them rather rapid fire.  Also on fire? Our mouths.  As with our 300th episode, we did this Hot Ones-style. Every few questions, we had to eat a chicken wing slathered in hot sauce.  The hot sauces got progressively hotter, though as we discovered, the ordering may have been a littttttle bit off.  Still, by the time we hit the really hot ones, our mouths were on fire, we were blowing our noses, gulping down milk, and terrified of what the next hot wing would bring… We covered so much in this podcast, including: Coffee or tea? What jokes do you make with patients? Where do we see ageism? Why are we still advocating for advance care planning? Concerns about expansion of medical aid in dying Should doctors reveal that they're using AI in clinical care (thanks for the question mom!) The future of geri

Rural populations in the United States face unique healthcare challenges. These communities tend to be older, have higher mortality rates, and experience higher rates of chronic conditions and physical disabilities compared to urban populations. Despite the increased need for palliative care in rural areas, access remains alarmingly limited. Even in hospital settings, where palliative care programs are more common in urban areas, only 35% of rural hospitals report having such programs, compared to 81% of urban hospitals. In this week's podcast, we explore the challenges and opportunities of delivering palliative care in rural communities with our esteemed guests Karl Bezak, Jeanie Youngwerth, Adie Goldberg, and Gregg Vandekieft. We begin by discussing what inspired each of them to focus on rural palliative care. From there, we dive into what rural palliative care looks like and examine how it differs from care provided in urban settings. Our guests also share insights into the challenges of delivering this ca

Today we're delighted to talk with Anne Walling, Neil Wenger, and Rebecca Sudore about a pragmatic implementation trial aimed at increasing advance care planning for primary care patients with serious illness in University of California clinics, published in Annals of Internal Medicine. Seriously ill primary care patients were identified using structured data fields (meaning routinely captured without needing to read the chart or use natural language processing). This study focused on patients without a completed advance directive or POLST form. This was a 3 arm trial that tested a nudge in the patient portal and a mailed advanced directive vs. the nudge plus a link to PrepareForYourCare vs. the nudge plus PrepareForYourCare plus a navigator reminding patients to talk with their doctor and bring any completed advance directives or POLST forms to the PCP visit. In brief, the study found that at 2 years there were higher rates of advance directive or POLST in the electronic health record (about 20%) in the arm

In 2025, the Centers for Medicare and Medicaid Services (CMS) began requiring hospitals participating in the Hospital Inpatient Quality Reporting (IQR) program to report on a new "Age-Friendly Hospital Measure."  The hope is that, by attesting to this measure, hospitals will develop evidence-based processes to improve care for older adults in hospital settings. On this week's podcast, we explore this new measure with Sheri Ling, CMS's Deputy Chief Medical Officer serving in the Center for Clinical Standards and Quality (CCSQ). We've also invited some returning guests from our past Age Friendly Health Systems podcast, Julia Adler-Milstein and Stephanie Rogers, to discuss how they are thinking about this new measure and how we should operationalize it. We go over everything you will want to know about the new measure, including: How does this CMS measure differ from both Age-Friendly Health Systems and the 4Ms movement we've been hearing about for years (and that we did the podcast on in 2020 here) Why is C

A few weeks ago, I was skimming this NEJM paper for UCSF's Division of Geriatrics Journal club on de-prescribing anti-hypertensive medications for older adults in nursing homes. Seemed to make a world of sense. The study found no difference between the deprescribing arm and the usual care arm in mortality, the primary study outcome. I thought, great! So we can deprescribe anti-hypertensives without changing mortality, that must be what the authors concluded. I was shocked, therefore, to read in the first paragraph of the discussion that the deprescribing arm did not achieve the hypothesized 25% reduction in mortality.  What?!?  Why would deprescribing be associated with reduced mortality? That's not the main reason or even the first reason I think of for deprescribing.  Reducing side effects that impair quality of life, sure. Less pill burden, of course.  But prolonged life?  Seemed a stretch. Today we hear from the first author of this study, Athanase Benetos, an esteemed geriatrician-researcher from France

It's an era of breakthroughs in Alzheimer's research, yet for many clinicians, it's also a time of profound uncertainty. We are currently navigating competing definitions of the disease, multiple new biomarkers coming on market seemingly every week, and the clinical rollout of new amyloid antibodies. How do we translate this rapid-fire science into daily practice? On this week's GeriPal podcast, we sit down with dementia experts Halima Amjad, Barak Gaster, and Heather Whitson. We dive deep into: The evolving definitions of Alzheimer's disease.  Does someone have Alzheimer's disease if you have only an abnormal biomarker as defined by the Alzheimer's Association, or is amyloid pathology necessary but not sufficient to define Alzheimer's as per the International Working Group (IWG) recommendations? Where do blood-based biomarkers for Alzheimer's fit into the diagnostic workup, and should they be used at all in primary care?  FYI - here is my take on that question in a recent JAMA IM article titled "The L

Today we're doing something different. Today, dear listeners, you get two podcasts for the price of one! (OK, our podcasts are both free, but you get the idea). We're joined today by Chris Comeaux, host of TCN Talks, a podcast about leadership, strategy, innovation, and the future of serious illness care, and author of The Anatomy of Leadership. We are also joined by TCN Talks' frequent guest host Cordt Kassner, CEO of Hospice Analytics, which provides in depth data on hospice quality, utilization, and access, and publisher of Hospice and Palliative Care Today, a daily email about the hottest stories and news in the field. This is an "ask us anything" style podcast in which we get to ask each other questions.  Our discussions focus on concerning trends in hospice, Ira Byock's white paper, concerning trends in hospice, certificate of need, danger of losing a generation of junior researchers and hope in the form of ASCENT, various measures of hospice quality including Cordt's National Hospice Locator, which r

Philippe Pinel remarked in 1800 that "It is an art of no little importance to administer medicines properly, but it is an art of much greater and more difficult acquisition to know when to suspend or altogether to omit them." This insight remains profoundly relevant today, especially in hospice care, where inappropriate prescribing is a common issue. Studies show that 20%–70% of hospice patients receive at least one unnecessary medication near the end of life, including drugs like antihypertensives, statins, and vitamins. In this episode of the GeriPal Podcast, we tackle the pressing topic of deprescribing at the end of life with expert guests Jennifer Tjia, Jon Furuno, and Simon Mooijaart. The conversation focuses on identifying medications that should almost always be discontinued—such as statins, osteoporosis meds, finasteride, and vitamins, which offer minimal benefit for patients with limited life expectancy. We also delve into more nuanced cases, such as antithrombotics, which present complex decision

Do you think your hospital should allow unilateral DNR orders? Under what circumstances? Through what process?  Do you think that when you obtain the assent of a family to not code their loved one, that assent DNR should be counted as a unilateral DNR order? Should we document unilateral DNR and the rationale? Why for DNR, when we don't document unilateral dialysis not offered, or unilateral no ECMO offered?  Is the assent of a family member to a statement that we will not code their loved one a nudge, and is the assent approach ethical? Reasonable people will disagree, as we do on this podcast. Our guests today are Gina Piscitello, Erin DeMartino, and Will Parker, authors of a terrific viewpoint in JAMA about the need to address inadequate documentation of unilateral DNR orders.  You might recall Gina was a guest on our lively podcast about slow codes, and we pick up where that podcast left off. We highlight the many clinical, practical, and ethical issues at stake, including Gina's finding that during Cov

The idea of embedding various forms of non-emergency care in the emergency department makes a WORLD of sense.  If an older adult comes into the ED with a fall, the minimum the ED has to do is address the fall injury and send them out. But many emergency providers realize this is often a band aid.  They see that patient again the next time they fall.  And again.  And again.  The same could be said for the patient who is malnourished and dehydrated and admitted for "failure to thrive," again. And again. Our two guests today, Liz Goldberg and Lauren Southerland, both emergency medicine physician-researchers, have had enough.  On our podcast today they discuss how these sorts of experiences led them to argue that other services that can address the underlying causes that lead to ED visits.  Liz Goldberg developed the GAPcare model to address falls, which includes a physical therapist and pharmacist seeing patients on the spot in the ED.  Lauren Southerland got Columbus Ohio Office of Aging staff to re-locate fro

Today we interviewed Bob Wachter about his book, "A Giant Leap: How AI Is Transforming Healthcare and What That Means for Our Future."  You may recall we interviewed Bob in April 2024 about AI, and at that time he was on the fence about AI - more promise or more peril for healthcare?  As his book's title suggests, he's come down firmly on the promise side of the equation.  On our podcast we discuss: Why Bob wrote this book, at this time, and concerns about writing a static book about AI and Healthcare, a field that is dynamic and shifting rapidly.  He's right though - we've not had a "ChatGPT"-launch type moment recently. Top 5 or so ways in which Bob uses AI for work, from clinical care to book writing Concerns about job losses in healthcare, and will we still need doctors? AI for diagnosis, and the recent NEJM Clinical Case in which recent GeriPal guest and superstar clinician-educator Gurpreet Dhaliwal beats an AI.  UpToDate vs OpenEvidence Trust issues - should we trust AI after being let dow

Recent randomized controlled trials have shown that routine perioperative palliative care does not improve outcomes for patients undergoing curative-intent cancer surgery. No, that wasn't a typo. Regardless of how the data were analyzed, the findings remained consistent: perioperative palliative care DID NOT improve outcomes in the only two randomized controlled trials conducted in this area—the SCOPE and PERIOP-PC trials. Null trials like these often receive less attention in academic and clinical settings, but they can be profoundly practice-changing. Consider the Shannon Carson study on palliative care for chronically critically ill patients. While some have argued it "wasn't a palliative care study," I've always regarded it as one of the most significant studies for understanding not what works—but what doesn't—for palliative care in specific patient populations. The same holds true for the SCOPE and PERIOP-PC trials. Both were null, but their findings are deeply relevant to clinical practice. That's why

"I just want to say one word to you.  One word.  Plastics… There's a great future in plastics." This iconic line from the movie The Graduate is at the top of my mind when I think about where we are heading in healthcare. I've interpreted "plastics" as symbolizing a dystopian, mass-produced future of medicine—where artificiality and inauthenticity dominate in the pursuit of efficiency and profit margins. After listening to today's podcast on the growth of community-based palliative care, I find my perspective shifting on this quote. Perhaps the advice given for a future in plastics reflects the past generation's established worldview, failing to recognize a countercultural revolution seeking transformation and meaningful change, even if it may come across as a little brash. In this thought-provoking episode of the GeriPal podcast, we are joined by Alan Chiu (Chief of Palliative Care at Monogram Health), Mindy Stewart-Coffee (National Vice President of Palliative Care at Optum Home and Community), and Ben Thomp

The only certainty in medicine is uncertainty. It touches every aspect of clinical practice, from diagnosis to treatment to prognosis. Despite this, many clinicians view uncertainty as something to tolerate at best or eliminate at worst. But what if we need to rethink and reframe our relationship with uncertainty in medicine? In this episode, we sit down with Jonathan Ilgen and Gurpreet Dhaliwal, co-authors of the New England Journal of Medicine article, "Educational Strategies to Prepare Trainees for Clinical Uncertainty." Together, we explore the nature of uncertainty in clinical practice, its effects on trainees and seasoned clinicians, and strategies to embrace it as a fundamental part of medical reasoning rather than a regrettable byproduct. Jonathan and Gurpreet share insights from research and clinical experience, offering practical methods to help trainees and clinicians recognize, manage, and even embrace uncertainty. Key topics we discuss include: The paradoxical nature of uncertainty: When percei

In a recent episode of the GeriPal podcast, we explored whether the field of palliative care is in need of saving—and, if so, how to save it—with guests Ira Byock, Kristi Newport, and Brynn Bowman. Today, we shift focus to one actionable way to improve palliative care: through quality improvement (QI) collaboratives, registries, and benchmarking.  To guide this discussion, we've invited three leading experts in the field—Drs. Steve Pantilat, David Currow, and Arif Kamal—who bring invaluable experience as pioneers in developing QI collaboratives and registries. Together, they authored a recent paper in JPSM titled "The Case for Collaboration to Optimize Quality," which underscores the importance of these efforts. In this episode, Dr. David Currow shares lessons from Australia's Palliative Care Outcomes Collaborative (PCOC), a national model for standardized data collection and benchmarking that has driven measurable improvements in palliative care. Meanwhile, Drs. Steve Pantilat and Arif Kamal reflect on the

Have you had one of those consults in which you're thinking, huh, sounds like the patient's goals are clear, it's really that the clinician consulting us disagrees with those goals?  To what extent is it our job as consultants to navigate, manage, or attend to clinician distress?  What happens when that clinician distress leads eventually to conflict between the consulting clinician and the palliative care team? Today our guests Sara Johnson, Yael Schenker, & Anne Kelly discuss these issues, including: A recent paper first authored by Yael asking if attending to clinician distress is our job, published in JPSM. See also the wonderful conversation in the response letters from multidisciplinary providers (e.g. of course  that's our job! And physicians may not be trained in therapy, but many social workers and chaplains are, and certainly psychologists). A SPACE pneumonic for addressing clinician conflict developed by Sara Johnson, Anne Kelly and others. They presented this at a recent AAHPM/HPNA meeting

In this week's podcast, we sit down with Drs. Sarguni Singh, Christian Furman, and Lynn Flint, three authors of the recent Journal of the American Geriatrics Society article, "Rehab and Death: Improving End-of-Life Care for Medicare Skilled Nursing Facility Beneficiaries."  The authors dive into the challenges facing seriously ill older adults discharged to Skilled Nursing Facilities (SNFs), where fragmented care transitions, misaligned Medicare policies, and inadequate access to palliative care often result in burdensome hospitalizations and goal-discordant care.  The discussion highlights key barriers in Medicare's SNF and hospice benefits, including the inability to access concurrent hospice and SNF care, and explores solutions to improve care. Among the recommendations is leveraging Medicare's Patient Driven Payment Model (PDPM) to reimburse SNFs for providing palliative care, commissioning a Government Accountability Office (GAO) report on SNF utilization at the end of life, and piloting a model that al

Six years ago we had John Newman on GeriPal to talk about Geroscience (Song choice Who Wants to Live Forever by Queen, perfect selection).  John explained the basics of geroscience, what is it, what are the key theories in geroscience, what is senescence, why people who provide clinical care for older adults should care about geroscience, and potential therapeutics like metformin and rapamycin. Today we bring on three rising stars in Geroscience, Brian Andonian, Sara LaHue, Joe Hippensteel, to talk about one of the key pillars of Geroscience: inflammaging.  We use this terrific paper they published in Geroscience as a springboard.  We discuss: What is inflammaging? Chronic progressive low grade inflammation with aging. I try to get one of them to stake a claim that inflammaging should be the organizing principle of geroscience How does inflammaging operate in rheumatologic conditions like rheumatoid arthritis (Brian), neurologic conditions like traumatic brain injury  (Sara), and critical illness (Joe).

In this week's episode, we delve into the powerful documentary The Chaplain and The Doctor with two extraordinary guests: Betty Clark, the chaplain at the heart of the film, and Dr. Jessica Zitter, the physician and filmmaker who brought this story to the screen.  The film provides a deeply moving look into the ways personal stories and biases shape our interactions in healthcare. Through our conversation with Betty and Jessica, I gained a valuable insight: the narratives we carry within ourselves—whether conscious or unconscious—act as invisible forces that influence how we engage with patients and colleagues. I also learned that recognizing these stories and the biases they may produce, rather than avoiding them, can foster more genuine and empathetic care. They also may lead to deep friendships, as is clearly shown between Betty and Jessica. I love both this podcast episode and the film itself, as they shine a light on the deeply human—and oftentimes flawed—experience of working in healthcare. They remind