Dialysis vs Conservative Management for Older Adults: Manju Kurella Tamura, Susan Wong, & Maria Montez-Rath
GeriPal - A Geriatrics and Palliative Care Podcast
Release Date: 11/07/2024
Coping with Serious Illness: Danielle Chammas and Amanda Moment
GeriPal - A Geriatrics and Palliative Care Podcast
Denial. Substance use. Venting. Positive reframing. Humor. Acceptance. All of these are ways we cope with stressful situations. Some we may consider healthy or unhealthy coping strategies, but are they really that easy to categorize? Isn’t it more important to ask whether a particular coping behavior is adaptive or not for a particular person,in a particular time or situation? We are going to tackle this question and so many more about coping on this week's podcast with , a recurring GeriPal guest, psychiatrist, and palliative care doc at UCSF, and , a Palliative Care Social Worker at...
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Falls and Fractures: A Podcast with Sarah Berry
GeriPal - A Geriatrics and Palliative Care Podcast
Falls are very common among older adults but often go unreported or untreated by healthcare providers. There may be lots of reasons behind this. Patients may feel like falls are just part of normal aging. Providers may feel a sense of nihilism, that there just isn't anything they can do to decrease the risk of falling. On this week's podcast, we try to blow up this nihilism with our guest Sarah Berry. Sarah is a geriatrician at Hebrew SeniorLife in Boston where she does research on falls, fractures, and osteoporosis in older adults. We pepper Sarah with questions ranging from: Why...
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Dialysis vs Conservative Management for Older Adults: Manju Kurella Tamura, Susan Wong, & Maria Montez-Rath
GeriPal - A Geriatrics and Palliative Care Podcast
We recently published a podcast on palliative care for kidney failure, focusing on conservative kidney management. Today we’re going to focus upstream on the decision to initiate dialysis vs conservative kidney management. As background, we discuss Manju Kurella Tamura’s landmark that found, contrary to expectations, that function declines precipitously for nursing home residents who initiate dialysis. If the purpose of initiating dialysis is improving function - our complex, frail, older patients are likely to be disappointed. We also briefly mention Susan Wong’s terrific studies...
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COVID Updates: A Podcast with Peter Chin-Hong and Lona Mody
GeriPal - A Geriatrics and Palliative Care Podcast
In March 2020, we launched our first podcast on COVID-19. Over the past four years, we’ve seen many changes—some positive, some negative. While many of us are eager to move past COVID (myself included), it’s clear that COVID is here to stay. This week, we sit down with infectious disease experts and to discuss living with COVID-19. Our conversation covers: The current state of COVID Evidence for COVID boosters, who should get them, and preferences between Novavax and mRNA vaccines COVID treatments like Molnupiravir and Paxlovid Differences in COVID impact on nursing home...
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Medical Cannabis Revisited: A Podcast with David Casarett and Eloise Theisen
GeriPal - A Geriatrics and Palliative Care Podcast
Cannabis is complicated. It can mean many things, including a specific type of plant, the chemicals in the plant, synthetic analogs, or products that have these components. The doses of the most widely discussed pharmacologically active ingredients, THC and CBD, vary by product, and the onset and bioavailability vary by how it is delivered. If you believe the evidence for efficacy to manage symptoms like neuropathic pain, how do you even start to think about recommending these products to patients? On today’s podcast, we answer that question with our guests, David Casarett and Eloise...
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Guidelines or Goals in Heart Failure: Parag Goyal, Nicole Superville, and Matthew Shuster
GeriPal - A Geriatrics and Palliative Care Podcast
When treating heart failure, how do we distinguish between the expanding list of medications recommended for “Guideline Directed Medical Therapy” (GDMT) and what might be considered runaway polypharmacy? In this week’s podcast, we’ll tackle this crucial question, thanks to a fantastic suggestion from GeriPal listener Matthew Shuster, who will join us as a guest host. We’ve also invited two amazing cardiologists, Parag Goyal and Nicole Superville, to join us about GDMT in heart failure with reduced ejection fraction (HFrEF) and in Heart Failure with preserved EF (HFpEF). We talk...
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Intentionally Interprofessional Care: DorAnne Donesky, Michelle Milic, Naomi Saks, & Cara Wallace
GeriPal - A Geriatrics and Palliative Care Podcast
In fellowship, one of the leaders at MGH used to quote Balfour Mount as saying, “You say you’ve worked on teams? Show me your scars.” Scars, really? Yes. I’ve been there. You probably have too. On the one hand, I don’t think interprofessional teamwork needs to be scarring. On the other hand, though it goes against my middle-child “can’t we all get along” nature, disagreement is a key aspect of high functioning teams. The key is to foster an environment of curiosity and humility that welcomes and even encourages a diversity of perspectives, including direct...
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Images of the Dying: A Podcast with Wendy MacNaughton, Lingsheng Li, and Frank Ostaseski
GeriPal - A Geriatrics and Palliative Care Podcast
Can death be portrayed as beautiful? In this episode, we share the joy of talking with (artist, author, graphic journalist) and (Buddhist teacher, author, founder of the and Zen Hospice Project) about using drawings and images as tools for creating human connections and processing death and dying. You may know Wendy as the talented artist behind or . Our focus today, however, was on her most recently published book titled . This beautiful book began as a very personal project for Wendy while she was the artist-in-residence at Zen Hospice. As BJ MIller writes in the foreword, “May this...
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Stepped Palliative Care: A Podcast with Jennifer Temel, Chris Jones, and Pallavi Kumar
GeriPal - A Geriatrics and Palliative Care Podcast
If palliative care was a drug, one question we would want to know before prescribing it is what dose we should give. Give too little - it may not work. Give too much, it may cause harm (even if the higher dose had no significant side effects, it would require patients to take a lot of unnecessary additional pills as well as increase the cost.) So, what is the effective dose of palliative care? On today’s podcast, we talk about finding an evidence-based answer to this dosing question with three leaders in palliative care: , , and . All three of our guests were co-authors of...
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Well-being and Resilience: a Podcast with Jane Thomas, Naomi Saks, Ishwaria Subbiah
GeriPal - A Geriatrics and Palliative Care Podcast
Well-being and resilience are so hot right now. We have an endless supply of CME courses on decreasing burnout through self-care strategies. Well-being committees are popping up at every level of an organization. And C-suites now have chief wellness officers sitting at the table. I must admit, though, sometimes it just feels off… inauthentic, as if it's not a genuine desire to improve our lives as health care providers, but rather a metric to check off or a desire to improve productivity and billing by making the plight of workers a little less miserable. On today’s podcast, we talk with ,...
info_outlineWe recently published a podcast on palliative care for kidney failure, focusing on conservative kidney management. Today we’re going to focus upstream on the decision to initiate dialysis vs conservative kidney management.
As background, we discuss Manju Kurella Tamura’s landmark NEJM paper that found, contrary to expectations, that function declines precipitously for nursing home residents who initiate dialysis. If the purpose of initiating dialysis is improving function - our complex, frail, older patients are likely to be disappointed.
We also briefly mention Susan Wong’s terrific studies that found a disconnect between older adults with renal failure’s expressed values, focused on comfort, and their advance care planning and end-of-life care received, which focused on life extension; and another study that found quality of life was sustained until late in the illness course.
One final briefly mentioned piece of background: John Oliver’s hilarious and disturbing takedown of the for profit dialysis industry, focused on DaVita.
And the main topic of today is a paper in Annals of Internal Medicine, Maria first author, that addressed the tradeoffs between initiating dialysis vs continued medical/supportive management. Turns out, in summary people who initiate dialysis have mildly longer lives, but spend more time in facilities, away from home. We also discuss (without trying to get too wonky!) immortal time bias and target emulation trials. Do target trials differ from randomized trials and “ordinary” observational studies, or do they differ?!? Eric is skeptical.
Bottom line: if faced with the decision to initiate dialysis, waiting is generally better. Let it be (hint hint).
-Additional link to study with heatmaps of specific locations (hospital, nursing home, home) after initiating dialysis.
-@AlexSmithMD