Unilateral DNR? Gina Piscitello, Erin DeMartino, Will Parker
GeriPal - A Geriatrics and Palliative Medicine Podcast
Release Date: 02/19/2026
Can We Prevent Cognitive Decline in Aging? Multi-Domain Trials with Laura Baker and Ellen Binder
GeriPal - A Geriatrics and Palliative Medicine Podcast
Can we prevent age-related cognitive decline, and perhaps even head off Alzheimer’s disease and related dementias before they start? Pharmaceutical companies are spending billions searching for a magic bullet pill to answer that question. But what if the solution requires more than a single drug? What if real prevention demands a multi-domain approach that combines targeted diet, exercise, social engagement, and vascular risk factor management among other things? On today’s episode, we explore multi-domain interventions for cognitive risk reduction with two leading experts: Laura D....
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When to Start or Stop Statins in Older Adults: Tim Anderson, Rita Redberg, Mike Rich
GeriPal - A Geriatrics and Palliative Medicine Podcast
In 1987, lovastatin became the first FDA-approved statin in the United States. Four decades later, statins are among the most frequently prescribed medications nationwide, with atorvastatin topping the overall list. Now, updated guidelines have expanded statin eligibility to cover nearly every older adult. On today’s episode, we are joined by experts Tim Anderson, Rita Redberg, and Mike Rich to discuss when to start, and when to stop, statin therapy in older adults. Topics we talk about on starting and stopping statins in older adults include: Updates and changes for statin use in older...
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Hot New Drugs in Palliative Care: Max Stevenson, Alex McPherson, and Nisha Iyer
GeriPal - A Geriatrics and Palliative Medicine Podcast
When you think of palliative care pharmacotherapy, you probably think about the tried-and-true mainstays of our field like morphine, haloperidol, and senna. But the landscape of palliative symptom management is rapidly evolving, with hot new drug classes and rediscovered old-school opioids (and not just buprenorphine!) On today’s episode of the GeriPal Podcast, we sit down with three expert palliative care clinical pharmacists, Max Stevenson, Alex McPherson, and Nisha Iyer, to talk about 5 hot new drugs (or rediscovered): Suzetrigine: It works for bunions (at least as well as opioids,...
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Interactive Maps of Aging: Judy Salerno and Lindsay Goldman
GeriPal - A Geriatrics and Palliative Medicine Podcast
Love the story Judy Solerno tells at the start of this podcast. The story is about how mapped out cases of Cholera in London in the year 1854. He was able to identify a concentration of cases near a neighborhood water pump. Simply removing the handle from the pump halted the outbreak. This is one of the earliest recorded uses of maps for public health purposes. Our guests today, Judy Salerno (President Emeritus of the ) and Lindsay Goldman (CEO of ) have done some wonderful work creating detailed, in-depth, interactive maps of aging in New York City. Go to and try it...
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Flu, COVID, RSV, & Shingles Vaccines in Older Adults: Ken Schmader and Sharon Brangman
GeriPal - A Geriatrics and Palliative Medicine Podcast
Just in time for respiratory virus season, this episode of the podcast breaks down essential vaccine guidance for older adults. From flu, COVID-19, and RSV to an added bonus deep dive into shingles, we cover everything you need to know to protect older adults this season. Our expert guests include: Kenneth Schmader, MD: A geriatrician and vaccine researcher who helped develop the zoster vaccine. Ken serves on the Working Groups for the Herpes Zoster, Influenza, COVID-19, RSV and General Adult Immunization Guidelines for the US Centers for Disease Control (CDC) Advisory Committee on...
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Financial Mistakes and Exploitation in Dementia: Lauren Nicholas, Duke Han, Jason Karlawish
GeriPal - A Geriatrics and Palliative Medicine Podcast
Difficulty managing money is often one of the earliest signs of Alzheimer's disease and related dementias, frequently appearing years before an official diagnosis. This loss of financial capacity leaves individuals vulnerable to costly mistakes and exploitation, threatening the financial security and quality of life of entire families. In this episode, we sit down with Dr. Lauren Hersch Nicholas, Dr. Duke Han, and Dr. Jason Karlawish to examine the intersection of cognitive decline, financial decision-making, and patient protection. We covered a lot of topics, including these key ones: The...
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Weight loss, GLP-1s and Sarcopenia: A Podcast with John Batsis, Shen Dewar, Aruna Josyula
GeriPal - A Geriatrics and Palliative Medicine Podcast
GLP-1 receptor agonists (the "Ozempics of the world") have been a truly revolutionary pharmacological advance in modern medicine. In randomized controlled trials (RCTs), these agents have been shown to do much more than just reduce weight, including significantly reducing cardiovascular events, lowering all-cause mortality in patients with type 2 diabetes, and even slowing the progression of chronic kidney disease. But as we see their use rapidly expand among older adults, we have to ask: at what cost? In geriatrics, weight loss is rarely simple. In older bodies, GLP1s carry increased risks,...
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Who Should Palliative Care See? Diane Meier, Bob Arnold, and Justin Sanders
GeriPal - A Geriatrics and Palliative Medicine Podcast
As Diane Meier remarks to start today’s podcast, palliative care has come a long way from the days when we were the “brink of death” consult. We’re seeing patients earlier and earlier in the course of illness. In fact, the for specialist palliative care is arguably stronger in the outpatient setting than the inpatient setting. In some ways, as Eric remarked, we are a victim of our own success. We’ve pushed on the boundaries of seeing patients earlier in the course of illness, we’ve demonstrated remarkable value to our colleagues and health systems: now they want us to see...
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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...
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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_outlineDo 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 Covid, 3% of critically ill patients receiving pressors had a unilateral DNR order. Black patients and those who spoke Spanish had higher rates of unilateral DNR. That variation should trouble those in favor of unilateral DNR orders. We talk about variation Gina found at the state and health system level, and what exactly is concerning, the variation itself, or the lack of thought and care that went into some of these policies.
Are you a heartbreaker? Dream Maker? Love taker? Don’t you mess around with me. (song hint)
-Alex