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May 1, 1987

The Merits of Geriatric Consultation

Author Affiliations

Massachusetts General Hospital Harvard Medical School Boston

Massachusetts General Hospital Harvard Medical School Boston

JAMA. 1987;257(17):2336-2337. doi:10.1001/jama.1987.03390170092035

Consultation entails anticipation. The valued consultant brings the experience and expertise needed to anticipate complications as well as to discover elusive diagnoses. To benefit the patient, the consultant's wisdom must result in clear communication and reasonable compliance, both of which may be sizable challenges in themselves.1,2

An ambitious goal of the consultant geriatrician is to avert the ills that can befall the hospitalized elderly. However, specific complications remain very difficult to anticipate. Only a minority of the major complications were anticipated in Becker and colleagues'3 well-designed study appearing in this issue of The Journal: infection-related (10%), procedural (14%), trauma-related (28%), and medication-related (39%). None of the ten falls were predicted.

In this study age alone seems once again to predict little except birth year. The art of averting complications is still imprecise. Effective interventions require more accurate clinical prediction. The powerful, though retrospective, wisdom of multivariate analysis will