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 adults in the new 2026 Guideline on the Management of Dyslipidemia including:

The transition to the new PREVENT (Predicting Risk of Cardiovascular Disease EVENTs) equations.

Raising the target age for 10-year ASCVD risk estimation from 75 to 79.

Lowering ASCVD risk threshold categories: Low ( Clinical Implications of these new guidlines: 

A new study led by Tim Anderson reveals that over 93% of adults aged 70–79 now meet the criteria for primary prevention statins.

Does the STAREE trial change anything? 

The STAREE trial showed a 30% reduction in major cardiovascular events with atorvastatin in older adults, yet found no significant improvement in disability-free survival or all-cause mortality. 

Statin Discontinuation Trials: Should we change our practice now that the SAGA/SITE trial showed stopping statins in older adults who have been on them for more than a year had no impact on mortality, quality of life, cognitive function, functional status, symptom burden, and adverse events.

Lastly, while we didnt talk about it, this is another great RCT on statin discontinuation in individuals nearing the end of life, finding no significant difference in 60-day mortality or 1-year cardiovascular event risk between statin discontinuation and continuation.

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, maybe?), but can it work in palliative care?  My take-home point here is that its not ready for prime time, but you may have a different take after listening.

Levorphanol: The forgotten opioid that looks a lot like methadone but more NMDA.  Should we bring it back to the living?  Maybe if it were cheaper (why does an old drug cost this much?)

Tapentadol: Basically a better version of tramadol (aka Tamadont) that combines mu-opioid agonism with norepinephrine reuptake inhibition. Expensive but our guests varied in the potential benefit here.

Dual Orexin Receptor Antagonists (DORAs): Rerouting sleep management away from sedating Z-drugs and benzodiazepines to these new agents seems reasonable (again if cost was no concern) given that they appear safer (check out this JAGS article on DORAs and the risk of falls)

GLP-1 Receptor Agonists: Wait, GLP1's in palliative care (not just stopping it when we get consults for weight loss)? There may be a couple reasons to consider…

Also check out some of these podcasts that we talked about in this episode:
Gabapentinoids – Gabapentin and Pregabalin: Tasce Bongiovanni, Donovan Maust and Nisha Iyer

Tramadon't: a podcast with David Juurlink about the dangers of Tramadol

Buprenorphine Use in Serious Illness: A Podcast with Katie Fitzgerald Jones, Zachary Sager and Janet Ho

All the Questions You Had About Opioids But Were Afraid To Ask: A Podcast with Mary Lynn McPherson

Love the story Judy Solerno tells at the start of this podcast. The story is about how John Snow, the father of modern epidemiology, 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 New York Academy of Medicine) and Lindsay Goldman (CEO of Grantmakers in Aging) have done some wonderful work creating detailed, in-depth, interactive maps of aging in New York City. Go to IMAGENNYC and try it yourself.
Today we talk about:
How the whole country became familiar with these sort of maps during Covid

The case for using these maps for health needs of older adults, outside of the use cases in infections like Cholera and Covid

Our "favorite" density maps of resources, services, and amenities, including: benches, crosswalks, tree canopy, heat vulnerability, among others.

Use cases for these maps in public health and planning, grantmaking/philanthropy, and politics/policy advocacy.

Judy's work creating similar maps for Sao Paulo Brazil (will add link here when website is up).

How others can replicate this process in their home cities or counties

And I get to sing Tapestry, by Carol King, which Judy chose in honor of two recently deceased giants of feminism, Dolly Parton and Gloria Steinem.  My wife Cindy plays piano on the audio only podcast.
-Alex Smith

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 Immunization Practices (ACIP).

Sharon Brangman, MD: a geriatrician extraordinaire whom we've had in the past for her work in Alzheimer's, and whom we've now asked to talk about her work with the AGS Older Adults Vaccine Initiative.

We covered a lot of topics, including:
Who needs which vaccine at what age: Clear guidelines for COVID-19, RSV, flu, and shingles vaccines.

Optimal seasonal timing: What the optimal timing during the year to receive the schedule their shots?

Vaccine selection: How to choose between options, including standard-dose, high-dose, and new mRNA flu vaccines?

Does the shingles vaccine really prevent dementia?

Listen now and explore the links below for more resources.
Eric

Resources:
AGS Vaccine Initiative Website.  They have a variety of resources including:

Get the Basics: Essential Vaccines for Older Adults

Learn More: What You Need to Know About COVID-19 Vaccines for Older Adults (Age 65+)

Ask The Expert: The Flu Vaccine

Learn More: What You Need to Know About the Shingles Vaccine

Get the Basics: RSV Vaccines for Older Adults (60+)

CDC Adult Immunization Schedule

The Nature study we discussed on the effect of herpes zoster vaccination on dementia

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 Financial Prodrome: Dr. Nicholas shares her health economics research showing that missed payments and credit score drops can appear up to six years before a dementia diagnosis—causing major wealth loss long before healthcare providers catch the issue, especially in lower-income communities.

Brain Function & Social Buffers: Dr. Han discusses new neuroimaging research on how cognitive decline impairs financial judgment and explains how strong social connections can serve as a critical protective buffer.

Clinical & Policy Solutions: Dr. Karlawish outlines the medical, policy, and financial-sector interventions needed to safeguard vulnerable patients.

For a deeper dive on some of the articles we discussed, check out these references:
My first JAMA paper on Finances in the Older Patient With Cognitive Impairment 

Lauren's plant money podcast on how your bank account might predict dementia 

Lauren's article on Management of Financial Assets by Older Adults With and Without Dementia or Other Cognitive Impairments 

Jason's editorial on the Importance of Asking Older Adults Whether They Are Having Difficulty Managing Finances. 

Jason's article on Desktop Medicine and the Practice of Wealth Care

Duke's article on Financial exploitation vulnerability and social connectedness in middle-aged and older adults without dementia https://www.tandfonline.com/doi/full/10.1080/13607863.2025.2475331