De-intensify Anti-Hypertensives for Nursing Home Residents? Athanase Benetos and Mike Steinman
GeriPal - A Geriatrics and Palliative Medicine Podcast
Release Date: 03/19/2026
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...
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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...
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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...
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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...
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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_outlineA few weeks ago, I was skimming this NEJM 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 study 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% reduction in mortality. What?!? Why would deprescribing be associated with reduced mortality? That’s not the main reason or even the first reason I think of for deprescribing. Reducing side effects that impair quality of life, sure. Less pill burden, of course. But prolonged life? Seemed a stretch.
Today we hear from the first author of this study, Athanase Benetos, an esteemed geriatrician-researcher from France. For context, we also interviewed Mike Steinman, co-chair of the Beers criteria and co-lead of the US Deprescribing Research Network.
We learned about:
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Why the hypothesis of reduced mortality in deprescribing was justified, based on natural decreases in blood pressure with aging, and the Partridge study, an observational study that found higher risks of mortality associated with using multiple anti-hypertensive and low blood pressure.
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Why mortality was chosen as the primary outcome.
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Is a negative superiority study the same as what they might have found in a non-inferiority study? (stay with us)
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Variation in outcome by frailty status
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How to place this study in context with other research, such as the Danton study mentioned on a recent podcast about deprescribing near the end of life. Dantos was a study of deprescribing for nursing home residents with dementia that was stopped early due to safety concerns. Other studies for context include Sprint, Optimize, and an observational study by Bocheng Jing (UCSF statistician in our group).
At the end, we ask our guests to put it together. With all that we know at this point, what’s a clinician to do? To deprescribe or not to deprescribe?
And, zoot alors! I get to sing Hymne A L’amour in French! Athanase recounts the moving story of how Edith Piaf sang this song the night she learned the man she loved, Marcel Cerdan, died in a plane crash.
-Alex Smith