Time for Geriatric Assessments in Cancer Care: William Dale, Mazie Tsang, and John Simmons
GeriPal - A Geriatrics and Palliative Medicine Podcast
Release Date: 09/07/2023
LATE vs Alzheimer’s: Biomarkers, Mixed Dementia, and Clinical Realities with Nate Chin & Sterling Johnson
GeriPal - A Geriatrics and Palliative Medicine Podcast
Up until just a couple years ago, an 85-year-old patient presenting with gradual, amnestic memory loss was almost automatically presumed to have Alzheimer’s disease. However, new biomakers and the recognition of conditions like Limbic-predominant age-related TDP-43 encephalopathy (LATE) are reshaping our understanding of cognitive decline in older adults. It’s looking more clear that pure Alzheimers dementia is rare in older adults, and co-occurring pathologies that may include Alzheimer's, LATE, Lewy Body, and vascular neuropatholigies, are the rule rather than the exception. In...
info_outline
Video-Enhanced Advance Care Planning: Joshua Lakin and Kei Ouchi
GeriPal - A Geriatrics and Palliative Medicine Podcast
Can simple, evidence-based video decision aids—paired with structured clinician training—improve Advance Care Planning (ACP) documentation and goal-concordant care? That’s the question we pose in this week's podcast with Dr. Joshua Lakin and Dr. Kei Ouchi. We break down the methodologies behind two major clinical trials in which they were involved that implemented this video-enhanced approach. The f was a multicenter, parallel randomized trial of 598 seriously ill older adults in emergency departments (EDs). It tested whether watching a 5-minute video and having a short, 10-minute...
info_outline
Longevity Treatments - Snake Oil or Breakthrough? John Newman & Mahtab Jafari
GeriPal - A Geriatrics and Palliative Medicine Podcast
The longevity industry is booming. Influencers are promoting this and that as promoting healthy aging, longevity, and healthspan, and it’s hard for us, much less our patients, to make sense of it. To be sure, we should always start by recommending exercise, nutritious foods, good sleep habits, and meaningful social interaction. We wanted to go beyond that to talk about the promise and potential and risks/harms of “biohacks.” Today we talk with Mahtab Jafari, PharmD, and John Newman, MD, PhD, and to discuss: How we clinicians should think about this movement, knowing many of...
info_outline
Who Should Deliver Palliative Care in Liver Disease? Chris Woodrell, Manisha Verma, Marie Bakitas
GeriPal - A Geriatrics and Palliative Medicine Podcast
Who's better at delivering palliative care to patients with liver disease: palliative care specialists, or hepatologists who have received liver disease-specific palliative care training? That’s the question we take a deep dive into on this week's podcast by breaking down the We’ve invited three of the trial's authors, , , and , to discuss this cluster-randomized clinical trial spanning 19 U.S. medical centers. We’ll discuss: Why was this trial done? Do we really need to run a separate palliative care trial for every single organ disease? What kind of specialized palliative...
info_outline
Why you should care about the shakeup at NIH: Sean Morrison, Ken Covinsky, Stacy Fischer
GeriPal - A Geriatrics and Palliative Medicine Podcast
Emergency Podcast! Our guests Sean Morrison, Ken Covinsky, and Stacy Fischer believe that you should care deeply about the proposed shakeup at the National Institutes of Health. Major at the would affect a huge range of government grants, from Headstart to Transportation to the National Science Foundation, as well as the National Institutes of Health (NIH), the subject of today’s podcast. You dear listeners should all care. You should care because you care for older adults, or you’re a researcher who studies palliative care, or you're a chaplain who visited with the family of...
info_outline
How We Limit Non-beneficial Life Sustaining Treatments: Jason Batten, Liz Dzeng, Teva Brender
GeriPal - A Geriatrics and Palliative Medicine Podcast
Today’s podcast is a natural follow up to our podcasts on and .Today we talk about a new study about how clinicians , published in JAMA Network Open. Do they adhere to society guidelines, which allow as permissible approaches only shared decision-making and following institutional policy. Or do they take alternative approaches, like not offering interventions, not mentioning interventions, or simply stating a plan to limit interventions? Turns out doctors are using these alternative approaches frequently. Our guests are Jason Batten, Liz Dzeng, and Teva Brender, all clinicians, all of...
info_outline
Elder Mistreatment Prevention and Solutions: Carrie Rubenstein, Julia Hiner, & Tony Rosen
GeriPal - A Geriatrics and Palliative Medicine Podcast
Today we revisit a topic we last discussed in a : elder mistreatment. Our guests today are geriatricians Carrie Rubenstein and Julia Hiner, and Tony Rosen, an emergency medicine doctor. They talk about where we are now, in 2026, with elder mistreatment, including: Terminology: elder mistreatment vs. abuse and neglect The need to incorporate prevention and solutions into how we talk about mistreatment This is not rocket science. Studying elder mistreatment is much harder than rocket science. Highlighting the reasons they focus on elder mistreatment, including inspiring words for...
info_outline
CCRCs, ALFs, and Private Equity: John Burton, Bill Applegate, & Melissa Aldridge
GeriPal - A Geriatrics and Palliative Medicine Podcast
Two retired luminaries in geriatrics join us today to share their personal experiences. First, John Burton, a geriatrician and Director of the Division of Geriatric Medicine at Johns Hopkins for some 35 years, shares his journey moving into a Continuing Care Retirement Community (CCRC) during Covid. You can read about John’s early experiences in his JAGS commentary titled, The tone is bleak. John’s experience since Covid, as you’ll hear, is very positive. Many of the concerns he raised about isolation have been addressed. Second, we hear from Bill Applegate,...
info_outline
Search for Geriatrician Identity: Mary Tinetti, Helen Fernandez, Jerry Gurwitz, Ken Covinsky
GeriPal - A Geriatrics and Palliative Medicine Podcast
Our focus today is on the search for the geriatrician identity, a continuation of the conversation we started with Jerry Gurtwitz on the . Today’s conversation is prompted by multiple articles in JAGS: (1) an article with a title the same as this podcast; (2) an article by Helen Fernandez on “”, a new combined 4 year internal medicine residency and geriatrics fellowship track; and (3) an article by Mary Tinetti titled, “?” Of note, Mary’s article is a follow up to her 2017 in which she wrote: Those outside the field have difficulty understanding what geriatrics is and...
info_outline
The Interior Experience of Prescribing Medical Aid in Dying: Carly Zapata and Dani Chammas
GeriPal - A Geriatrics and Palliative Medicine Podcast
I had the privilege of learning from fellow Lisa Harris about a term she termed, “.” As an ob/gyn and abortion provider, Lisa found the debate around the legality of abortion so polarizing that it created a false dichotomy: you’re either for or against. Any talk about misgivings, uncertainty, ambiguity, or ambivalence was silenced. Talking about these issues in the face of polarization was deemed dangerous and undermining to one side or another. “How could you?” For Lisa’s work in finding common ground and embracing nuance she was awarded the for forging...
info_outlineThe comprehensive geriatric assessment is one of the cornerstones of geriatrics. But does the geriatric assessment do anything? Does it improve outcomes that patients, caregivers, and clinicians care about?
Evidence has been mounting about the importance of the geriatric assessment for older adults with cancer, the subject of today’s podcast. The geriatric assessment has been shown in two landmark studies (Lancet and JAMA Oncology) to reduce high grade toxicity, improve patient and caregiver satisfaction, and improve completion of advance directives (can listen to our prior podcast on this issue here).
Based on this surge in evidence, the American Society of Clinical Oncologists recently updated their guidelines for care of older adults to state that all older adults receiving systemic therapy (including chemo, immuno, targeted, hormonal therapy) should receive geriatric assessment guided care.
We talk about these new guidelines today with William Dale, a geriatrician at City of Hope and lead author of the guideline update in the Journal of Clinical Oncology, Mazie Tsang, palliative care/heme/onc physician-researcher at Mayo Clinic Arizona who authored a study of geriatric and palliative conditions in older adults with poor prognosis cancers published in JAGS, and John Simmons, a retired heme/onc doctor, cancer survivor, and patient advocate. We talk about:
-
What is a practical geriatric assessment and how can busy oncologists actually do one? (hint: 80% can be done in advance by patients or caregivers)
-
Why is it that some oncologists are resistant to conducting a geriatric assessment, yet have no problem ordering tests that cost thousands of dollars?
-
What can you do with the results of a geriatric assessment?
-
How does the geriatric assessment lead to improved completion of advance directives, when the assessment doesn’t address advance care planning/directives at all?
-
How does palliative care fit into all this? Precision medicine?
-
What groups are being left out of trials?
-
What are the incentives to get oncologists and health systems to adopt the geriatric assessment?
And Mazie, who is from Hawaii, requested the song Hawaii Aloha in honor of the victims of the wildfire disaster on Maui. You can donate to the Hawaii Red Cross here.
Aloha,
-@AlexSmithMD
Additional Links:
Brief ASCO Video of how to conduct a practical geriatrics assessment
Brief ASCO Video of how to use the results of a practical geriatrics assessment
Time to stop saying the geriatric assessment is too time consuming