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, 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

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, including accelerated muscle loss, functional decline, and possibly decreased bone density. So are we just trading weight loss for frailty?
To help us untangle this complex web, we sit down with three expert geriatricians in obesity: Dr. John Batsis, Dr. Shen Dewar, and Dr. Aruna Josyula.
What We Discuss in This Episode:
How age-related changes alter the distribution of fat and muscle, even when body weight stays exactly the same.

What are sarcopenia (muscle loss) and sarcopenic obesity, and why are they so dangerous for independence?

A discussion on what happens to fat, muscle, and bone during standard weight loss versus weight loss accelerated by GLP-1s.

Whether GLP-1-induced muscle loss a direct biological side effect from suppressed muscle protein synthesis, or is it simply the indirect result of a massive caloric deficit and dropping protein intake?

A broad, geriatric-focused approach to weight, including a vital review of common medications that might actually be causing weight gain in the first place.

Practical, actionable strategies to protect muscle mass and function when prescribing GLP1s

A discussion of red flags in older adults, where we should have major hesitation before ever writing a prescription for a GLP-1

We cover this and more in the podcast. There is a forthcoming article in JAGS that addresses this topic, and we will add the link here once published.  If you want to take a deeper dive, take a look at some of the following references we discuss:
Aruna's article in JAGS titled "One Size Fits None: Developing a Person-Centered Approach to Weight Management in Older Adults"

John's Annal's article on the "Effect of Incretin-Based and Nonpharmacologic Weight Loss on Body Composition: A Systematic Review"

John's article on the "Unintended risks of sarcopenic obesity during weight-loss interventions in older people" in Nature Med.  

An article titled "The Effects of Incretin Mimetic Therapies on Muscle and Bone Health in Older Adults"

A systematic review of the effect of weight loss on muscle-based indices

An article on "Treating Sarcopenic Obesity in the Era of Incretin Therapies: Perspectives and Challenges"

Shen's article describing "The Optimal Health Weight and Lifestyle (OHWL) Clinic"

Shen's article titled "A Geriatrician's Approach to Managing the Complex Older Adult with Obesity"

Another JAGs article on "Older Adults with Obesity: The Need for a 4Ms Age-Friendly Approach to Care"

Lastly, CMS's information on the GLP1 bridge program