Libsyn Directory

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

Pragmatic Trial to Increase Advance Care Planning: Anne Walling, Neil Wenger, & Rebecca Sudore

GeriPal - A Geriatrics and Palliative Medicine Podcast

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 . 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...

CMS's Age-Friendly Hospital Measure: Julia Adler-Milstein, Stephanie Rogers, and Shari Ling

GeriPal - A Geriatrics and Palliative Medicine Podcast

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...

De-intensify Anti-Hypertensives for Nursing Home Residents? Athanase Benetos and Mike Steinman

GeriPal - A Geriatrics and Palliative Medicine Podcast

A few weeks ago, I was skimming this 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 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%...

Alzheimer's Definitions, Biomarkers, and Antibodies: Halima Amjad, Barak Gaster, and Heather Whitson

GeriPal - A Geriatrics and Palliative Medicine Podcast

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 , , and . We dive deep into: The evolving definitions of Alzheimer’s disease. Does someone have Alzheimer's disease if you have only an abnormal...

Leadership, Quality, and the Future of Hospice: Guests Chris Comeaux and Cordt Kassner

GeriPal - A Geriatrics and Palliative Medicine Podcast

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 , a podcast about leadership, strategy, innovation, and the future of serious illness care, and author of . We are also joined by TCN Talks’ frequent guest host Cordt Kassner, CEO of , which provides in depth data on hospice quality, utilization, and access, and publisher of , a daily email about the hottest stories and news in the field. This is an “ask us anything” style podcast...

Deprescribing at the End of Life: Jennifer Tjia, Jon Furuno, Simon Mooijaart

GeriPal - A Geriatrics and Palliative Medicine Podcast

Philippe Pinel 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...

Unilateral DNR? Gina Piscitello, Erin DeMartino, Will Parker

GeriPal - A Geriatrics and Palliative Medicine Podcast

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 ? Reasonable people will disagree, as we do on this...

Embedding Care in the ED: Liz Goldberg and Lauren Southerland

GeriPal - A Geriatrics and Palliative Medicine Podcast

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...

AI and Healthcare: Bob Wachter

GeriPal - A Geriatrics and Palliative Medicine Podcast

Today we interviewed Bob Wachter about his book, “.” You may recall we , 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,...

The Role of Specialty Palliative Care in Cancer Surgery: Rebecca Aslakson & Myrick Shinall

GeriPal - A Geriatrics and Palliative Medicine Podcast

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 and trials. Null trials like these often receive less attention in academic and clinical settings, but they can be profoundly practice-changing. Consider the . While some have argued it...

More Episodes

The 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

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