Literature Collection

OBJECTIVES: To evaluate the prevalence of the Determinants of Malnutrition in Aged Persons (DoMAP) and identify determinants of malnutrition among older adults attending primary healthcare. DESIGN AND SETTING: Prospective, observational, monocentric study in primary healthcare. PARTICIPANTS: 500 older adults. MEASUREMENTS: Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Potential causes of malnutrition were assessed by the attending physician using the DoMAP model with a 1:1 recruitment of malnourished and non-malnourished older persons. RESULTS: Malnourished individuals (mean age 81.7 ± 5.0 years; 59% women) exhibited a significantly higher prevalence of almost all DoMAP determinants compared to non-malnourished persons, particularly low intake (88 vs. 11%), high requirements (83 vs. 49%), poor appetite (73 vs. 9%), shopping difficulties (59 vs. 26%), inflammation (81 vs. 49%), gastrointestinal disease (17 vs. 2%), cancer (11 vs. 1%), depression (35 vs. 19%), dementia (21 vs. 6%), polypharmacy (60 vs. 38%), and hospitalization (27 vs. 4%). The mean total determinants count was significantly higher in malnourished participants (14.9 ± 5.0) than in non-malnourished ones (6.8 ± 4.4; p < 0.001). Regression analysis revealed low intake as the strongest determinant at Level1; poor appetite, forgetting to eat, shopping difficulties and inflammation at Level2; gastrointestinal disease, cancer and depression at Level3, and frailty and hospitalization at Level4. CONCLUSION: This study highlights the complex multifactorial nature of malnutrition in older adults attending primary healthcare, confirming the superior role of low intake and poor appetite among other determinants. The DoMAP model offers a structured framework for potential causative factors of malnutrition in older subjects.

In recent years, neonatal abstinence syndrome (NAS) rates have increased rapidly across the United States, rising from 1.2 (2000) to 5.8 (2012) per 1000 hospital births annually. Because most NAS infants are treated in an intensive care setting, associated hospital charges are high and continue to escalate, rising on average from $39,400 in 2000 to $66,700 in 2012. An innovative NAS treatment program, which includes early-initiated methadone therapy, rooming-in, and combined inpatient/outpatient weaning in a low-acuity nursery, has been in place since 2003 at a large Southeastern hospital. The program has proven safe, effective and low cost for treating infants of >/=35 weeks gestational age whose mothers used long-acting opioids. Given that 81% of NAS cases in the United States are funded by Medicaid programs and that the cost burden is rising rapidly, researchers considered the potential saved charges associated with implementing the same program in other hospitals state- and nationwide. Researchers used regression models to project state and national NAS birth rates from 2015-2025 and to predict future NAS charges under current treatment protocols. Three scenarios were developed to compare the potential saved charges of implementing the innovative NAS treatment program across the state and nation with assumptions related to the percent of NAS infants eligible for the program, percent funded by Medicaid, and fluctuations in average length of stay. The potential saved charges are substantial, creating a compelling case for policy makers and hospitals in the pursuit of safe, effective, and cost-conscious NAS care.