How to Make an Alzheimer's Diagnosis in Primary Care: A Podcast with Nathaniel Chin
GeriPal - A Geriatrics and Palliative Medicine Podcast
Release Date: 02/06/2025
We Need a Care Revolution: Victor Montori
GeriPal - A Geriatrics and Palliative Medicine Podcast
In his book, “,” Victor Montori decries the industrialization of healthcare. We’ve become a healthcare factory, beholden to health systems motivated by profit. In particular, he laments the loss of the “care” aspect of healthcare. Clinicians are under the clock to churn through patients. Patients are tasked with doing work outside of the clinic. Patients are tasked with hours and hours of work to self manage, obtain and manage medications, track weights and fingersticks, not to mention scheduling visits and waiting around for the visit to start. Now we have an app for...
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System Wide Goals of Care Implementation: A Podcast with Ira Byock, Chris Dale, and Matt Gonzales
GeriPal - A Geriatrics and Palliative Medicine Podcast
Most health care providers understand the importance of goals-of-care conversations in aligning treatment plans with patients’ goals, especially for those with serious medical problems. And yet, these discussions often either don't happen or at least don't get documented. How can we do better? In today’s podcast, we sit down with Ira Byock, Chris Dale, and Matthew Gonzales to discuss a multi-year healthcare system-wide goals of care implementation project within the Providence Health Care System. Spanning 51 hospitals, this initiative was recently described in NEJM Catalyst, showing truly...
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Death Anxiety: Dani Chammas & Keri Brenner
GeriPal - A Geriatrics and Palliative Medicine Podcast
What is death anxiety? We spend the first 15 minutes of the podcast addressing this question. And maybe this was unfair to our guests, the fabulous dynamic duo of palliative psychiatrists Dani Chammas and Keri Brenner (listen to their prior podcasts on and the ). After all, we invited them on to our podcast to discuss death anxiety, then Eric and I immediately questioned if death anxiety was the best term for what we want to discuss! Several key points stood out to me from this podcast, your key points may differ: The “anxiety” in “death anxiety” is not a...
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Individualizing Blood Pressure Goals in Older Adults: A Podcast with Mitra Jamshidian, Simon Ascher and Mark Supiano
GeriPal - A Geriatrics and Palliative Medicine Podcast
What’s the ideal blood pressure target for older adults with hypertension? Should we aim for a systolic BP of 120 mmHg in all older adults, as suggested by the ? Or should we be more flexible—especially for those who are frail or among the oldest old? This week on the GeriPal Podcast, we explore the nuances of managing blood pressure in older adults with our guests Dr. Mark Supiano, Dr. Mitra Jamshidian, and Dr. Simon Ascher. Now, some of our astute GeriPal listeners may say, “wait, didn't you already talk about this with Mark Supiano in a 2017 podcast titled ” Yes, we sure...
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Should Palliative Care be in the Survivorship Business? A Podcast with Laura Petrillo, Laura Shoemaker
GeriPal - A Geriatrics and Palliative Medicine Podcast
In this week’s episode, we dig into two deceptively simple questions: When does someone become a cancer survivor, and should palliative care be in the business of caring for them? Spoiler: It’s more complicated than it seems. We’ve invited two palliative care doctors to talk about survivorship with us: , a physician-researcher at Mass General Hospital and Harvard Medical School, and , an outpatient palliative care doctor at the Cleveland Clinic. This episode is a must-listen for those navigating the evolving landscape of cancer care, and asking not just how we treat cancer, but how we...
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Health and Wealth Shocks: Lauren Hunt, Rebecca Rodin, Tsai-Chin Cho
GeriPal - A Geriatrics and Palliative Medicine Podcast
famously characterized the end of life functional course of people with dementia as a slow dwindle over time. later found that people with dementia do indeed have persistent severe disability throughout the last year of their lives. But from our clinical work, many of us are familiar with people with dementia who experience sudden shocks to their health, think hip fracture, think hospitalization for pneumonia. Those disruptive events or shocks often portend a major decline in function from which people with dementia never fully recover. And they’re often a sign of (or cause...
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Transgender Health, Aging, and Advocacy: A Podcast with Noelle Marie Javier and Jace Flatt
GeriPal - A Geriatrics and Palliative Medicine Podcast
Happy Pride Month GeriPal listeners! Transgender issues are in the news. Just today (June 17th) as we record this podcast: Ezra Klein released a wonderful , the first openly transgender member of congress A judge ruled that focused on minority groups, including transgender people, were illegal and ordered the government to restore funding. It’s Pride month, and our guests remind us of the in the Stonewall riots, which started the modern fight for LGBTQI+ rights and liberation. Today’s guests are Noelle Marie Javier, a geriatrician and palliative care doc who tells her story...
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What You Should Know About Radiation Oncology: A Podcast with Anish Butala, Emily Martin and Evie Kalmar
GeriPal - A Geriatrics and Palliative Medicine Podcast
If you’re anything like me, you might find the process of what happens to patients when they visit a radiation oncologist somewhat mysterious. During my training, I didn’t receive much education about radiation oncology, and I’m not entirely sure what some of the terms mean (hypofractionated means fewer sessions, right?). Well, today’s podcast aims to clear up all these uncertainties. We’ve invited , and , a palliative care doctor and past president of the Society for Palliative Radiation Oncology (SPRO), to explain everything we should know about radiation oncology. Additionally, ,...
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Implementing Palliative Care in Nursing Homes
GeriPal - A Geriatrics and Palliative Medicine Podcast
The need for better palliative care in nursing homes is significant. Consider this: the majority of the 1.4 million adults residing in U.S. nursing homes grapple with serious illnesses, and roughly half experience dementia. Many also suffer from distressing symptoms like pain. In addition, about 25% of all deaths in the United States occur within these facilities. Despite these substantial needs, specialized palliative care beyond hospice is rare in nursing homes. Furthermore, only about half of nursing home residents nearing the end of life receive hospice care. So, how can we improve...
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Lucid Episodes: Andrea Gilmore-Bykovskyi & Andrew Peterson
GeriPal - A Geriatrics and Palliative Medicine Podcast
Have any of you watched the movie “”? At the end, one of the characters, who has dementia, experiences an episode of lucidity. When I watched it, between tears (I’m a complete softie) I remember thinking, “Oh no! This will give people false hope! That their loved one is ‘in there.’ If only they could find the right key to unlock the lock and let them out.” Today we talk about lucid episodes and what they might mean to the person with dementia, their family and loved ones, to philosophers, to clinicians, to neuroscientists. Our guests are Andrea...
info_outlineThings are changing quickly in the Alzheimer’s space. We now have biomarkers that can reasonably approximate the degree of amyloid build-up in the brain with a simple blood test. We have two new FDA-approved medications that reduce that amyloid buildup and modestly slow down the progression of the disease. So, the question becomes, what, if anything, should we do differently in the primary care setting to diagnose the disease?
On today’s podcast, we’ve invited Nathaniel Chin back to the GeriPal podcast to talk about what primary care needs to manage this new world of Alzheimer’s disease effectively. Nate is a geriatrician and clinician-scientist at the University of Wisconsin, as well as the host of the Wisconsin ADRC's podcast, "Dementia Matters." In each bi-weekly episode, he interviews Alzheimer's disease experts about research advances and caregiver strategies. Nate also wrote a NEJM piece last year on “Alzheimer’s Disease, Biomarkers, and mAbs — What Does Primary Care Need?”
We address the following questions with Nate:
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Has anything changed for the primary care doctor when diagnosing Alzheimer’s? How should we screen for cognitive impairment?
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Does a good history matter anymore?
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What’s the role of assessing function?
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What do we do with those who have only subjective cognitive complaints?
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Can’t we skip all this and just send some blood-based biomarkers?
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What is the role of the amyloid antibody treatments?
Lastly, take a look at the following if you want to take a deeper dive into some of the other articles and podcasts we discuss:
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First, two competing definitions of what is Alzheimer’s:
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Revised criteria for diagnosis and staging of Alzheimer's disease: Alzheimer's Association Workgroup
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Podcasts we mentioned