VeriGeri

In this special holiday episode, hosts Patty, Sam, and Megan, along with guest Tessa Garcia McEwen, discuss the challenges and strategies for caregivers and families of older adults with dementia during the holiday season. Tessa, a licensed clinical social worker with extensive experience in dementia care, shares valuable advice on modifications to holiday traditions, travel tips, and effective communication about dementia within families. This episode also covers coping techniques for grief and suggestions for engaging dementia patients in stimulating activities, emphasizing the importance of personalized care and support. We also learn about resources for grief counseling and practical tips for managing dementia symptoms in different environments.

Show Notes: https://verigeripodcast.com/show-notes/f/navigating-dementia-during-the-holidays

Please follow us on Instagram @verigeripodcast and follow us on Apple and Spotify! We are grateful to University of Chicago's BSD Office of Diversity and Inclusion for their support.

Guru: Tessa Garcia McEwen, AM, LCSW, DCCS, CDP Guest Host and Show Writer: Megan Teramoto, BS, MS Hosts: Patty Lee, MD, Sam Ing, MD Editor & Graphic Designer: Patty Lee, MD Host Bio: Tessa has over 20 years of experience supporting diverse populations in the nonprofit and medical sectors, focusing on personalized care and intergenerational connection. Currently at UChicago Medicine, she primarily supports patients and families dealing with Alzheimer's disease and related dementias. Through the Memory Center and consults across outpatient neurology and neurosurgery clinics. She's also a global facilitator for Lorenzo's House, co-leading programs for youth and care partners impacted by dementia. Also a recipient of the Schweitzer Fellowship, Tessa emphasizes grief support, cultural humility, and compassionate care in her work. She co founded Dementia Friendly Hyde Park she holds a BA in sociology from Notre Dame and a master's in clinical social work from the University of Chicago. Tessa's full bio here Guest Host Bio: Megan Teramoto, BS, MS, is a first year medical student at the Pritzker School of Medicine. She received her Bachelor's and Master's degrees after studying Biochemistry at the University of Arizona. Outside of school, Megan enjoys volunteering and hiking. Timestamps: 00:28 Introducing Our Special Guest: Tessa Garcia McEwen 02:14 Warm-Up Questions and Holiday Traditions 03:28 Navigating the Holidays with Dementia 07:39 Celebrating in Nursing Homes 09:52 Communicating Dementia Diagnosis to Family 15:20 Traveling with Dementia 18:52 Coping with Grief During the Holidays 23:13 Final Thoughts

In this episode, we're lucky to have Josh Sevier, an audiologist who delves into his personal journey from being a trauma medic to an audiologist and shares valuable insights on hearing loss, its diagnosis, treatment options, and its broader health impacts. He shares about the evaluation process, recommendations for hearing aids, cochlear implants, and tips for communication strategies. We're proud that this episode was written by Nihar Rama, a current medical student at University of Chicago, with show notes written by Kylie McElheran, a medical student from Oregon Health and Science University. Check out the show notes here!

& check out cool graphic design by medical student Jai Daniels from University of Chicago on our instagram! Suscribe, like and follow - you know what to do!

Host Bio: Dr. Josh Sevier is an audiologist and clinical program manager of the cochlear implant program at UChicago Medicine. His clinical interests are research, objective measures, cognition, and training in cochlear implants, which he teaches about at multiple universities and publishes in numerous peer-reviewed journals. He's been involved with advocacy and legislation on a state and national level, including the Government Relations Committee for the American Academy of Audiology, Executive Board for the Illinois Deaf and Hard of Hearing Commission. He is the current President of the Illinois Academy of Audiology.

Guest Host Bio: Nihar is a third-year medical student at the University of Chicago Pritzker School of Medicine and a Cincinnati native. He is interested in pursuing a career in otolaryngology-head and neck surgery. Outside of medicine, Nihar loves staying active, playing and discovering music, and working on his comedic timing.

Writer: Nihar Rama, BS

Co-Producers: Nihar Rama, BS, Patty Lee, MD, Samantha Ing, MD

Primary editor: Patty Lee, MD

Graphic designer: Jai Daniels, BA

Timestamps:

1:20 Introductions

2:38 Josh's journey to becoming an audiologist

4:32 Signs that someone might have hearing loss

7:15 Social impacts of hearing loss in geriatric patients

8:41 Referrals to audiology and types of hearing loss

10:52 Audiology evaluation details

13:50 ENT vs. Audiology

15:07 Case of Liz Senning, communication strategies/tips for families

16:47 Hearing Aids (commitment, costs, insurance coverage)

21:22 OTC Hearing Aids

24:28 Cochlear implants

27:42 Case 2 (90 y/o patient with severe vascular dementia and hearing loss)

29:34 Recommendations for patients adjusting to hearing aids

We are grateful to the University of Chicago Biological Sciences Division Office of Diversity and Inclusion for support.

WELCOME TO SEASON 2!!!! This episode we're going a little bit back and going over the diagnosis and prognosis of dementia (see episode 7 for management of dementia). Does it take just a test score? A hunch? Probably not, but we'll go through the details. Our superstar guest is Dr. Sing Palat, MD (bio below), and our guest host is Andrew Dang, MD, a primary care physician. Don't forget to follow up on Instagram at @verigeripodcast!

Show notes

Guest bio:

Sing Palat MD, from Golden Colorado, completed her geriatrics fellowship at the University of Colorado after medical school and an internal medicine residency at the University of Pittsburgh. She is currently a medical director with Optum Senior Community Care, supporting clinicians practicing in long-term care communities. On weekends, she plays the piano, volunteers at The Well free clinic, and goes sightseeing with her husband and teenage son.

Time stamps:

02:55: what's the difference between normal aging and pathologic cognitive impairment?

05:45: what are some misconceptions about dementia?

07:15: what are some common questions about dementia, including family history?

08:45: how do you diagnose dementia?

10:13: Summary

11:27: Staging dementia

14:50: how often do you assess for progression?

16:05: how can families support their loved ones in diagnosis of dementia?

16:44: what can we counsel families about?

18:27: what about Andrew's experience in residency clinic?

19:22: how do you navigate assisted living services?

20:32: when should we start considering assisted living?

24:43: how do you help families try to preserve the patient's identity in dementia?

This episode was in part funded by the Small Grants Program at University of Chicago BSD Office of Diversity & Inclusion. We are truly grateful for the support.

Guru: Sing Palat, MD Peer Reviewer: Elizabeth Zavala, MD Guest Host: Andrew Dang, MD Hosts: Patty Lee, MD, Sam Ing, MD Graphics designer: Jai Daniels Show notes writer: Patty Lee, MD

Elder abuse...who you gonna call???????? ADULT PROTECTIVE SERVICES IN YOUR STATE! Think you know what to do, how to report, and when to report? Think again! For no specific reason, we have tea time with Annie Vernon-Cwik, LCSW, ASW-G, to discuss.

State specific reporting contacts

Show Notes: https://verigeripodcast.com/show-notes

Reference to episode 2 on dispo, safety, and independence in the older adult:

Apple EP2

Spotify EP2

Timestamps 1:30 Annie's background in Adult Protective Services 2:44 What is Adult Protective Services and who do they serve? 3:38 How to report (in Illinois) 4:27 9 types of abuse 4:43 Physical abuse 5:00 Emotional abuse 5:26 Financial exploitation 5:57 Sexual abuse 7:38 Confinement 8:04 Passive neglect and willful deprivation 9:28 Abandonment 10:18 Self neglect 11:30 We are mandated reporters 12:43 How to report and what happens after a report is filed 14:10 What does reporting look like in a nursing home? 17:35 Cases 17:46 Case of a man with moderate dementia with significant weight loss and weakness and refusal of help 21:55 Case of a woman with dependence on daughter for medication 23:21 Case of a woman with anxiety and threat of being placed in a nursing home 26:18 Case of a woman who is worried about fraudulent credit card charges

Gurus: Erin Zahradnik, MD, Carrie Jackson

Hosts: Patty Lee, MD, Sam Ing, MD

Guest Host: Marissa Korte, MD

A patient and family member come in stressed because of wandering/paranoia at home, and they need help! Time is ticking. What do you say? What are nonpharmacological interventions anyway? Does it live up to its character count? When and how do you use antipsychotics? What about THC? Also, some other things to add to the potpourri - what about THC and benzos? AHHHH!!!! In this episode, we talk with Dr. Zahradnik, a geriatric psychiatrist, for her advice, and with Carrie Jackson, who is a writer and was a caregiver for her father in her 20s as her mother was diagnosed with Parkinson's around the same time.

Erin K. Zahradnik is an associate professor and director of geriatric psychiatry in the Department of Psychiatry at the University of Chicago Medical Center. She received her medical degree from University of Kansas School of Medicine, completed psychiatry residency at Yale-New Haven Hospital, and finished fellowship training in Geriatric Psychiatry and in Hospice and Palliative Medicine, both through the Icahn School of Medicine at Mount Sinai in NYC.

Carrie Jackson is an Evanston-based freelance writer and communications specialist, with a focus on holistic health and fostering sustainable communities. Music and art fill her up, and she enjoys exploring Chicago's rich cultural offerings while also curating her own events. A year-round biker, you can find Carrie trekking around the world or getting lost in the great outdoors here at home. Connect at CarrieJacksonWrites.com.

Show notes for summary and bonus tips!: https://verigeripodcast.com/show-notes/f/yes-and---management-of-behavioral-symptoms-in-dementia

Timestamps

2:01 About Dr. Erin Zahradnik and Geriatric Psychiatry

2:57 What are behavioral symptoms anyway?

4:12: Introduction to Carrie Jackson, who was a caregiver for her dad with dementia

05:27 Comorbid mood disorders

07:09: How do you screen for comorbid mood disorder in people with dementia?

08:12: A case of dementia and agitation

10:15 Nonpharm treatment – what are the options & the clinician perspective

12:19 Nonpharm treatment – the caregiver perspective

17:25 When to use pharmacological treatment

17:50 SSRIs in mild dementia with comorbid anxiety and depression

19:17 Black box warning of antipsychotics

20:38 Antipsychotics: type, dosing, schedule

25:46 THC

28:52: Two bonus rounds

29:30 Case of delusions

34:29 Case of benzos

What is hospice? What is inpatient hospice? What happens when you press "discharge to hospice"? What are some pearls and pitfalls of communicating about hospice? Find out in this episode as Dr. Khan addresses misconceptions, myths, pearls and pitfalls, settings, a case of anoxic brain injury, and concepts on end of life management.

1:39 Introduction to the Guru

4:23 Origins of hospice

7:19 Taboos of hospice

8:39 What does comfort mean to you?

10:44 A Case of anoxic brain injury

15:22 Guiding communication

18:04 Pearls and Pitfalls

23:07 Where can the service of hospice be provided?

26:43 A little about payment

30:29 End of Life symptoms

Guru: Mohammed Ilyas Ahmed Khan, MD

Hosts: Patty Lee, MD, Sam Ing, MD

Guest Host: James Fan, MD

Editor: Sam Ing, MD

Show Notes Editor: Marissa Korte, MD

Peer Reviewer: Vasyl Hereha, MD

Infographic Peer Reviewers: Vasyl Hereha, MD, and Jigar Joshi, MD

Ever toss and turn after a goals of care meeting? Wondered when to consult ethics and palliative care? Had moral distress before, during, or after a family meeting in the dead of night after missing a meal and back-to-back pages? Have we got an episode for you! Join us as Dr. Mark Watson, a palliative care, hospice, and ethics expert, goes through the differences between a surrogate and a healthcare power of attorney (POA), and then we throw him into the deep end of increasingly difficult situations with more and more heat! How will he fare? Will us fellows continue to deeply breathe in the second stall of the bathroom with silent tears rolling after reliving the trauma of situations, mistakes, and disagreements in residency (this is not personal I swear)? Will Marissa, M4 now MD, be able to take the heat? FIND OUT!

Show notes edited by Caroline Montag, BA: https://verigeripodcast.com/show-notes/f/spicy-difficult-situations-with-dr-mark-watson

0:40 Intro to our guru

0:57 Outline

1:53 Intro by Dr. Watson

3:04 Bread & Butter of surrogate versus healthcare power of attorney

3:36 Healthcare Power of Attorney (HCPOA)

5:51 Surrogate

8:25 What about the capacity of a surrogate or HCPOA?

11:08 Introduction of the challenges for Dr. Watson

11:45 Case 1: A patient with frailty, severe dementia, and full code

18:36: Case 2: Advance Care Planning says one thing about a feeding tube, but family wants another

25:02: Case 3: Asking about code status to a patient in distress

32:36: Case 4: An unbefriended patient

35:24: Case 5: Surrogate wants to reverse code status

39:31: BONUS: Hospice with Full Code

42:06: A brief summary and short motivational comments by Dr. Watson

Guru: Dr. Mark Watson

Hosts: Patty Lee, MD, Samantha Ing, MD, Marissa Korte, MD

Editor: Patty Lee, MD

Our Very Excellent Peer Reviewers: Melissa Marinelli, MD, Jason Lyou, MD

Show Notes Editor: Caroline Montag, BA

Theme Song: Samantha Ing and Patty Lee, mixed by Tak Ikuma

Piano transitions: Patty Lee

In this episode, we delve into the complexities of managing feeding difficulties in patients with advanced dementia. Dr. Kostas, a seasoned clinician in geriatric medicine, shares insights and strategies for counseling patients and families facing these challenging situations. Then, we'll turn to Dr. Kochar, a gastroenterologist with extensive experience in procedural medicine with a unique geriatric lens. She shares insights into the complexities of assessing patients for percutaneous endoscopic gastrostomy (PEG) tubes. Drawing from a case involving a 70-year-old patient with multiple comorbidities, Dr. Kochar, explores the nuanced considerations involved in deciding whether a PEG tube is appropriate in cases where it's not severe dementia.

Check out the show notes for more nuggets of wisdom and quick links & references: https://verigeripodcast.com/show-notes/f/goals-before-holes

Inspiration for episode: a question from Nicole Lum, MD

Inspiration for episode title: Coined by Dr. Mark Watson and adopted by the Regional Palliative Fellows of Chicago 2023-2024

Gurus: Tia Kostas, MD, and Bharati Kochar, MD, MS Hosts and Co-Producers: Patty Lee, MD & Samantha Ing, MD Guest Host: Marissa Korte, MS Editor: Patty Lee, MD Peer reviewer: Katherine Thompson, MD Show notes creator: Marissa Korte, BS Faculty Mentor: Christopher Chiu, MD, FAAP, FACP Music: - Theme Song: Samantha Ing and Patty Lee, mixed by Takakuni Ikuma - Piano transitions and background: Patty Lee

Diarrhea. Abdominal pain. Weight loss. Patient might not be able to tolerate colonoscopy. What do you do?! Join us and Dr. Kochar as we go through the bread and butter of diarrhea and IBD and the "beyond" of an intersection between Geriatrics and GI.

Check out the show notes for more nuggets of wisdom and quick links & references: https://verigeripodcast.com/show-notes/f/diarrhea-and-inflammatory-bowel-disease-in-the-older-adult

02:08 Introduction of Dr. Bharati Kochar

05:57 The Case

06:46 The Questions

09:05 IBS vs IBD

10:07 Microscopic colitis

10:38 Review

11:34 Scratching the surface on PPIs

13:30 Ddx

14:20 Workup

16:18 Flex sig?

17:45 What's a really red flag?

18:26 Coordinate care with GI

19:27 What if dx'd with IBD?

20:36 UC vs Crohn's

20:51 Treatments

21:57 What Geriatricians should know about IBD treatments

22:22 The 'Roids

Guru: Bharati Kochar, MD, MS Hosts and Co-Producers: Patty Lee, MD & Samantha Ing, MD Editor: Patty Lee, MD Peer reviewers: Christopher Chiu, MD, FAAP, FACP, Antoinette Pusateri, MD Show notes creator: Marissa Korte, BS; edited by Antoinette Pusateri, MD Faculty Mentor: Christopher Chiu, MD, FAAP, FACP Music: - Theme Song: Samantha Ing and Patricia Lee, mixed by Takakuni Ikuma - Piano transitions and background: Piano by Patricia Lee

"They can't live alone at home." "What's the discharge plan???" Ever meet the conundrum of providing the "right" support of an older adult at home trying to balance independence and safety? We speak with one of our star social workers, Annie Cwik-Vernon, LCSW, Advanced Social Worker in Gerontology (ASW-G), as she walks us through a difficult clinical situation, navigates different levels of care, and clarifies the selection of a decision maker.

Check out the show notes for more info or the too-long-didn't-listen:

https://verigeripodcast.com/show-notes/f/balancing-independence-and-safety-in-an-older-adult

Timestamps:

01:29: Introduction of our guest

04:29: The case

06:50 Evaluating support in the house

08:10 Medication support

11:49 Finances and logistics for a caregiver

16:35 Different discharge locations

17:00 Assisted vs supportive living

20:04 Memory Care

23:54 Senior and independent living

28:23 How to assess for a decision maker

30:00 Illinois surrogacy act

35:46 We attempt to trap Annie in a legal guardianship scenario

Edited by: Samantha Ing, MD

Co-produced by: Patty Lee, MD, Samantha Ing, MD

Show notes by: Marissa Korte, BS

Music:

- Theme Song: Samantha Ing and Patricia Lee, mixed by Takakuni Ikuma - Piano transitions and background: Piano by Patricia Lee