To the Editor.Ìý —The need for instruments to accurately assess functional impairment of the elderly will undoubtedly increase markedly as the number of geriatric patients steadily rises, and problems with respect to appropriate placement and disposition proliferate. In most instances, clinical evaluation by a concerned and knowledgeable health care professional familiar with the patient's past and present status provides the best mechanism for achieving optimal results. However, this is not always available, and fiscal intermediaries as well as regulatory agencies require more objective criteria to justify their participation in matters dealing with reimbursement and placement. The article by Pinholt et al,¹ which compares "specific instruments and scales to measure mental status, nutritional state, visual acuity, gait, and activities of daily living" assessments with ratings by physicians and nurses, provides useful information in this regard. However, it entirely ignores the important issue of hearing loss, which is a serious and