#145 Heart Failure in Older Adults & Guardianship: Gray Matter Segment

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 14 February 2024

⏱️ 40 minutes

🔗️ Recording | iTunes | RSS

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Summary

How do you manage GDMT in a frail older adult? When is a guardian needed and what is the process for obtaining guardianship?

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Youtube Interviews:

When to consider a guardian?

Guardianship Process

Limitation and value of individualism

Show Notes & Transcript

Timestamp

04:03 Deep Dive 1: How do you approach guideline-directed medical therapy of heart failure with reduced ejection fraction in a frail older adult?
11:55 Deep Dive 2: When is a guardian needed and what is the process for obtaining guardianship?
28:30 Deep Dive 3: How do you re-evaluate GDMT in a frail older adult once an adverse event has occurred?
33:27 Reflections
37:06 Recap

Tags: IMCore, CoreIM, nursing home, primary care, cardiology, palliative care hospital medicine, interprofessional education, social work, case management

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Transcript

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0:00.0	Welcome to Gray Matters, where we unpack how medical management is rarely black or white.
0:07.0	And we go on deep dives along the way.
0:10.0	I'm Jason Freed, a hematologist at Beth Israel Decidus Medical Center.
0:13.4	And I'm Allie Trainer, a pulmonary and critical care attending at Mount Auburn Hospital.
0:17.4	And today we're also joined by our friend and colleague Dr. Emily Citron.
0:20.6	Hi, I'm a geriatrician at the University of North Carolina Chapel Hill. You know
0:25.8	Emily as a geriatrician you have some experience working in gray areas?
0:31.1	I definitely do but you know there is still one case that just really stood out to me
0:36.4	it's a particularly challenging case of heart failure and this patient actually lives
0:40.8	at the nursing home where I work and I've just learned a
0:43.3	ton along the way. Can you tell us about meeting your patient? Sure she was 91 years
0:49.2	old and I initially admitted her for rehab after a heart failure
0:52.6	hospitalization, where she was found
0:54.5	to have a newly reduced ejection fraction.
0:57.1	She was discharged on an aspirin,
0:59.6	a statin, carvatalol, spironolactone,
1:02.4	losartin,
1:03.2	and Pegloflosin, and Lasex, which were all new.
1:06.9	Prior to this admission, she actually didn't even
1:09.0	take a single medication.
1:11.5	Man, that sounds like a ton of new meds.
1:15.0	But I was actually just listening to the Cori M5 Pearls episode on GDMT for heart
	...

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