To the Editor.—
The study by Epstein et al1 emphasizes the importance of targeting patients for geriatric assessment. Epstein et al found no differences in benefits for ambulatory patients randomly assigned to treatment via a geriatric assessment, a second-opinion internist, or a traditional health maintenance organization.It is well documented that patients who benefit from geriatric assessment are those whose health is significantly compromised relative to the average health status of persons older than 65 years.2,3 Dementia, falls, incontinence, malnutrition, and isolation are a few of the disorders for select targeting of patients for geriatric assessment.The baseline health status of the patients in the study by Epstein et al was good. In general, they were not debilitated, did not have a social situation that posed significant risk, and did not represent the most rapidly increasing segment of the elderly population: those aged 85 years and older. With
Schultz AK, France A, Tyler SC. Consultative Geriatric Assessment. JAMA. 1990;264(3):338. doi:10.1001/jama.1990.03450030054030
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