Zara Cooper the Need to Integrate Geriatrics and Palliative Care into Trauma Surgery

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GeriPal - A Geriatrics and Palliative Medicine Podcast 26 min 4 speakers 4 chapters transcribed 8 hours ago

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Who is Zara Cooper and what inspired her to combine geriatrics, palliative care, and trauma surgery?

Eric Widera 0:00

Welcome to the Jerry Powell Podcast. This is Eric Quadera.

Alex Smith 0:02

This is Alex Smith. And Alex, who's our guest today? We have a wonderful guest today. We have Zara Cooper, who is a trauma surgeon, critical care doctor, and palliative care doctor, and is also associate professor of surgery at Brigham Women's Hospital and Harvard Medical School. Welcome to the Jerry Powell Podcast, Zara.

Zara Cooper 0:21

Thanks. It's a pleasure to be here.

Eric Widera 0:22

So we start off with a song request. Zara got a song for Alex.

Zara Cooper 0:27

Yes, I'm a huge Rolling Stone fan. I think they're underplayed and underappreciated these days. So Alex, I would love it if you would play something from the Stones.

Alex Smith 0:35

Totally agree. Yeah. Can't always get what you want though.

0:45

I saw her today at the reception. A glass of wine in a hand. I knew she was gonna meet her connection. At a feet was a footloose mayhem. No you can't always get what you want. You can't always get what you want. You can't always get what you want. But if you try sometimes, you might find you get what you need. Que eu te ni.

Alex Smith 1:36

Nice.

Zara Cooper 1:37

Thank you. Nice. Thanks, Alex.

Alex Smith 1:40

We sang I sang that with Christian Sinclair who was, you know, president of AHPM last year at a conference. And our favorite line is because we're both, you know, we're palliative caradox. Um I sang my song to Mr. Jimmy. Yeah, and he said one word to me and then Christian says he just yells it

1:56

and that was dead

Alex Smith 2:00

Ah, palliative care humor. So we want to talk with you about your fascinating mixture of fields here. Um you are one of a few people who are both surgeons and geriatrics interested in surgery and geripal, geriatrics and palliative care. So Zara, tell us how you got interested in geriatrics, palliative care, and trauma surgery. What an interesting mix.

Zara Cooper 2:27

Um, I think my interest really started during my critical care fellowship. And over the years I've recognized that there's really Um, been a dramatic increase in the number of older patients who are coming under my care. Um, I did a palliative care fellowship at Dana Barber, and what was interesting for me was when I was rounding Um, on our patients with advanced cancer, I realized, you know, these folks look a lot like my trauma patients. Um and a lot of that was because we have such high rates of of frailty. um among our trauma patients and our geriatric trauma patients in particular. And I realized that there were Um, lessons that I could learn from palliative care and geriatrics, uh, especially around prognostication.

Zara Cooper 3:11

um, you know, goal setting, symptom management um that would be really relevant to my trauma patients as well.

Alex Smith 3:18

So so paint a picture for us of what the patients that you're seeing at sort of this JerryPowl uh trauma intersection look like.

Zara Cooper 3:28

So I I think it's no surprise to this audience that the number of older patients who are falling is rising. Um, but the folks who come to my attention are those that are more severely injured. So, you know, patients who have rib fractures, cervical spine fractures, traumatic brain injury, um, you know, and and other internal organ injuries related to their falls will end up on the trauma service. And the numbers of those patients are escalating rapidly. Um, and so now you have trauma centers. Like mine, where, you know, either almost fifty percent or even over fifty percent of the patients on the trauma service are, you know, geriatric and the vast majority of those are frail elders.

Eric Widera 4:08

W over fifty percent?

Zara Cooper 4:10

Yeah. So in folks in places like Florida and Arizona, um, you know, you have centers where, you know, the majority of their patients are geriatric trauma. Um, and those numbers are increasing. And it's interesting because actually the biggest burden is not being borne by the trauma centers, it's by the non-trauma centers. um and you know acute care hospitals.

Alex Smith 4:31

Interesting. So uh w what are the needs and the barriers? You were talking uh you alluded to this a little bit uh before about prognosis, symptoms, setting goals of care. What ta uh can you tell us a little bit more about what the n the the sort of geriatric and palliative care needs are of this population?