Eighty-one geriatric consultations conducted on behalf of 71 patients (mean patient age 78 years, range 59-99; M34 , F37 ) at San Francisco General Hospital were analyzed. Seventy-nine per cent of requests were for medical or psychiatric evaluation; 19 per cent social; and 3 per cent rehabilitation. The authors made 50 new diagnoses, many of which identified conditions that adversely affected patients' functional levels, including cardiovascular disorders (8), medication effects (8), malnutrition (7), misdiagnosis of dementia (7), and gait disorders (4). Recommendations focused on treating those conditions whose alleviation could improve self-care ability: medication adjustment (62 per cent), management of dementia, delirium, or depression (59 per cent), rehabilitation (32 per cent), and treatment of malnutrition (30 per cent). Geriatric consultations resulted in rerouting 18 patients (51 per cent) from nursing homes to lower levels of care. Fourteen of these eventually returned home. By focusing on reversible conditions that affect patients' functional levels, geriatric consultation can improve the management of elderly patients and prevent unnecessary nursing home placement.

A delayed hypersensitivity response to skin tests was observed in 47 healthy elderly participants in a geriatric screening clinic. Forty-four subjects (94 per cent) reacted to at least one antigen. It was concluded that anergy is uncommon in the healthy elderly and should not be considered a normal aging phenomenon.Data regarding the incidence of anergy or delayed hypersensitivity skin reactions in an ambulant elderly population appear to be conflicting. Four have shown that from 0 to 36 per cent of healthy elderly persons are anergic. We defined anergic patients as follows: those in whom there was no reaction to any of five skin test antigens with at least 6 mm of induration. To further investigate cell-mediated immunity in the elderly, we performed a series of five skin tests on a group of ambulant elderly patients seen in a hospital screening clinic. PATIENTS AND METHODSForty-seven subjects were drawn from among 50 elderly patients seen consecutively in a geriatric screening clinic at Mount Zion Hospital; three patients refused to participate. The 47 subjects had the following characteristics: All were aged 60 or older, were ambulant, and had not been under the care of a physician or been hospitalized during the preceding year. No nursing home residents were included. The mean age was 70 years; 26 subjects were in the 60-69 age group, 18 in the 70-79 group, and three in the 80+ group. There were 31 women and 16 men. Thirty-three (70 per cent) were Caucasian, six (13 per cent) had Spanish surnames, six (13 per cent) were Asian, and two (4 per cent) were Negro. A medical history was obtained from each patient, and a complete physical examination and laboratory analyses (complete blood count, serum biochemical determinations, and urinalysis) were performed.Five antigens were used: Candida 1/100 (Hollister-Stier), mumps skin test antigen (Eli Lilly), coccidioidin 1/100 (Berkeley Biologicals), Trichophyton 1/100 (Hollister-Stier), and tuberculin 5 TU purified protein derivative (PPD). Each antigen (0.1 ml) was injected intradermally. Reactions were read 48 hours later by two physicians, following Sokol's model as described by Bates et al.s Induration measuring 0.6 mm or more in diameter was considered a positive result; this included tuberculin reactions. RESULTSSkin test results are listed in Tables 1 and 2. One patient who had had a severe tuberculin skin reaction in the past was not tested with PPD, but data are included for the four other antigens. Only three patients (6 per cent) showed no reactions with the skin tests and were considered anergic. Their ages were 63, 64, and 79 years. In the 79-year-old subject, a 40-mm area of erythema, but no induration, developed in response to Trichophyton. Another of the anergic patients, who had undergone a mastectomy for breast cancer three years previously, was hypercalcemic. Of the 14 positive results with PPD skin tests, 13 showed an induration larger than 10 mm; of these patients, all but two were Caucasian. DISCUSSIONThis study was undertaken to investigate delayed...