The role of geriatrician-hospitalists in the care of older adults: A retrospective cohort study.

INTRODUCTION: Medicare patients account for over 50% of hospital days at a cost of over $1 trillion per year. Yet, hospitalization of older adults often results in poor outcomes. We evaluated the role of geriatrician-hospitalists in the care of older adults. Materials and methods A retrospective cohort study was conducted in a 764-bed tertiary care hospital with patients 65 and older admitted to medicine. Geriatrician-hospitalists care was compared to usual care by non-geriatrician hospitalists (staff and non-staff). Outcome measures included length of stay (LOS) and 30-day readmissions. Process measures included geriatric-focused care practices, such as early mobilization, safety precautions, delirium management, use of potentially inappropriate medications and documentation of advanced directives as well as discharge disposition. RESULTS: Of the 10,529 patients, 2949 (28.0%) were cared for by staff hospitalists, 7181 (68.2%) by non-staff hospitalists and 399 (3.79%) by geriatrician-hospitalists. Patients cared for by geriatrician-hospitalists were significantly older with more comorbidities than those admitted to staff and non-staff hospitalists (average age: 86.3, 79.7, and 80.3, respectively, p < 0.0001; Charlson Comorbidity Index: 7.46, 7.01, and 7.17, respectively, p = 0.0005). Multivariate analysis showed no difference in LOS, 30-day readmissions, and discharge disposition. In terms of care practices, significant differences were found for the following: time to PT (p < 0.0001), duration of indwelling bladder catheters (p = 0.018), documentation of Do-Not-Resuscitate (p < 0.0001), benzodiazepine use (p < 0.0001) and anticholinergics (p = 0.0029), respectively. CONCLUSIONS: As the population continues to age at unprecedented rates and hospitals struggle to meet the demands and expectations, geriatrician-hospitalists may improve care practices important for older adult care management.

Genetic variance contributes to ingestive processes: a survey of 2-deoxy-D-glucose-induced feeding in eleven inbred mouse strains.

The feeding response following administration of the anti-metabolic glucose analogue, 2-deoxy-d-glucose (2DG), is conceptualized as an experimental model of glucoprivation, which may contribute to the understanding of inter-individual differences in glucose and carbohydrate intake and, ultimately, obesity. Although variation in the intake of several nutrients as well as food and water are known to be associated with genetic variation, it is not known whether 2DG-induced feeding is similarly genotype dependent. The present study therefore examined 2DG-induced feeding in mice of 11 inbred (A/J, AKR/J, BALB/cJ, CBA/J, C3H/HeJ, C57BL6/J, C57BL10/J, DBA/2J, SJL/J, SWR/J, 129P3/J) and one outbred (CD-1) strains across a wide range of previously determined effective 2-DG doses (200, 400, 600, 800 mg/kg) and test times (1-4 h). Orderly dose-dependent increases in 2DG-induced feeding occurred after all four doses in outbred CD-1 and inbred DBA/2J mice, across the three highest doses for BALB/cJ, SJL/J and 129P3/J mice, and across the two highest doses for CBA/J and AKR/J mice. Limited instances of 2DG-induced feeding were noted only at the highest dose in A/J and C3H/HeJ mice, or at a moderate dose in C57BL/6J mice. Further, the full 2DG dose range failed to alter food intake in C57BL/10J mice, and produced significant reductions in food intake in SWR/J mice. Food intake after 2DG doses of 200-600 mg/kg, but not 800 mg/kg, displayed significant cross-correlation, suggesting that large 2DG doses may recruit non-specific effects upon food intake. There was no correlation between food intake in the absence (vehicle baseline) of and presence of 2DG, suggesting that the regulation of glucose intake in non-challenged mice does not predict subsequent responses to glucoprivic challenge. The data demonstrate genotype-dependent variability in this glucoprivic response, and may provide the basis for the subsequent identification of trait-relevant genes.

Reciprocal opioid-opioid interactions between the ventral tegmental area and nucleus accumbens regions in mediating mu agonist-induced feeding in rats.

Feeding elicited by the mu-selective agonist, [D-Ala2, M-Phe4, Gly-ol5]-encephalin administered into the nucleus accumbens is blocked by accumbal pre-treatment with mu, delta1, delta2 and kappa, but not mu1 opioid antagonists. Correspondingly, mu-agonist-induced feeding elicited from the ventral tegmental area is blocked by ventral tegmental area pre-treatment with mu and kappa, but not delta opioid antagonists. A bi-directional opioid-opioid feeding interaction has been firmly established such that mu-agonist-induced feeding elicited from the ventral tegmental area is blocked by accumbal naltrexone, and that accumbal mu-agonist-induced feeding is blocked by naltrexone pre-treatment in the ventral tegmental area. To determine which opioid receptor subtypes mediate the regional bi-directional opioid-opioid feeding interactions between these two sites, the present study examined the dose-dependent ability of either general (naltrexone), mu (beta-funaltrexamine), kappa (nor-binaltorphamine) or delta (naltrindole) opioid antagonists administered into one site to block mu-agonist-induced feeding elicited from the other site. General, mu and kappa, but not delta opioid receptor antagonist pre-treatment in the ventral tegmental area dose-dependently reduced mu-agonist-induced feeding elicited from the nucleus accumbens. General, mu and delta, and to a lesser degree kappa, opioid receptor antagonist pre-treatment in the nucleus accumbens dose-dependently reduced mu-agonist-induced feeding elicited from the ventral tegmental area. Thus, multiple, but different opioid receptor subtypes are involved in mediating opioid-opioid feeding interactions between the nucleus accumbens and ventral tegmental area regions.

Opioid receptor subtype antagonists differentially alter GABA agonist-induced feeding elicited from either the nucleus accumbens shell or ventral tegmental area regions in rats.

Food intake is significantly increased by administration of either GABAA (e.g., muscimol) or GABAB (e.g., baclofen) agonists into either the shell region of the nucleus accumbens (NAC) or the ventral tegmental area (VTA); these responses are selectively blocked by pretreatment with corresponding GABAA and GABAB antagonists. Previous studies found that a single dose (5 microg) of the general opioid antagonist, naltrexone reduced feeding elicited by muscimol, but not baclofen in the NAC shell, and reduced feeding elicited by baclofen, but not muscimol in the VTA. The present study compared feeding responses elicited by either muscimol or baclofen in either the VTA and NAC shell following pretreatment with equimolar doses of selective mu (0.4, 4 microg), delta (0.4, 4 microg), or kappa (0.6, 6 microg) opioid receptor subtype antagonists. Muscimol (25 ng) and baclofen (200 microg) each significantly and equi-effectively increased food intake over 4 h following VTA or NAC shell microinjections. Muscimol-induced feeding elicited from the VTA was significantly enhanced by mu or delta antagonists, and was significantly reduced by kappa antagonists. Baclofen-induced feeding elicited from the VTA was significantly reduced by mu or kappa, but not delta antagonists. Muscimol-induced feeding elicited from the NAC was significantly reduced by either mu, kappa or delta antagonists. Baclofen-induced feeding elicited from the NAC was significantly reduced by kappa or delta, but not mu antagonists. These data indicate differential opioid receptor subtype antagonist-induced mediation of GABA receptor subtype agonist-induced feeding elicited from the VTA and NAC shell. This is consistent with previously demonstrated differential GABA receptor subtype antagonist-induced mediation of opioid-induced feeding elicited from these same sites. Thus, functional relationships exist for the elaborate anatomical and physiological interactions between these two neurochemical systems in the VTA and NAC shell.