AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond

Timothy W Farrell^{1

2

3}, Lauren E Ferrante⁴, Teneille Brown^{5

6}, Leslie Francis^{7

8}, Eric Widera^{9

10}, Ramona Rhodes^{11

12}, Tony Rosen¹³, Ula Hwang^{14

15}, Leah J Witt^{9

16}, Niranjan Thothala^{17

18}, Shan W Liu¹⁹, Caroline A Vitale^{20

21}, Ursula K Braun^{22

23}, Caroline Stephens²⁴, Debra Saliba^{25

26

27}

Affiliations

¹ Division of Geriatrics, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
² VA SLC Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, USA.
³ University of Utah Health Interprofessional Education Program, Salt Lake City, Utah, USA.
⁴ Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
⁵ Center for Law and the Biomedical Sciences, University of Utah S.J. Quinney College of Law, Salt Lake City, Utah, USA.
⁶ Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
⁷ University of Utah S.J. Quinney College of Law, Salt Lake City, Utah, USA.
⁸ Department of Philosophy, University of Utah, Salt Lake City, Utah, USA.
⁹ Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
¹⁰ San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.
¹¹ Division of Geriatric Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
¹² Central Arkansas Veterans Healthcare System, Geriatric Research, Education, and Clinical Center, Little Rock, Arkansas, USA.
¹³ Department of Emergency Medicine, Division of Geriatric Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA.
¹⁴ Department of Emergency Medicine & Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹⁵ Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York, USA.
¹⁶ Division of UCSF Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, California, USA.
¹⁷ Hospitalist Division, Department of Medicine, Good Samaritan Hospital, Vincennes, Indiana, USA.
¹⁸ Hospitalist Division, Department of Medicine, Union Hospital, Terre Haute, Indiana, USA.
¹⁹ Department of Emergency Medicine, Division of Geriatric Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
²⁰ Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
²¹ VA Ann Arbor Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan, USA.
²² Section of Geriatrics and Palliative Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
²³ Rehabilitation and Extended Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.
²⁴ University of Utah College of Nursing, Salt Lake City, Utah, USA.
²⁵ UCLA Borun Center for Gerontological Research, Los Angeles, California, USA.
²⁶ VA Los Angeles Geriatric Research Education and Clinical Center, Los Angeles, California, USA.
²⁷ RAND Corporation, Santa Monica, California, USA.

PMID: 32374440
PMCID: PMC7267615
DOI: 10.1111/jgs.16537

AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond

Timothy W Farrell et al. J Am Geriatr Soc. 2020 Jun.

. 2020 Jun;68(6):1136-1142.

doi: 10.1111/jgs.16537.

Authors

Affiliations

¹ Division of Geriatrics, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
² VA SLC Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, USA.
³ University of Utah Health Interprofessional Education Program, Salt Lake City, Utah, USA.
⁴ Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
⁵ Center for Law and the Biomedical Sciences, University of Utah S.J. Quinney College of Law, Salt Lake City, Utah, USA.
⁶ Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
⁷ University of Utah S.J. Quinney College of Law, Salt Lake City, Utah, USA.
⁸ Department of Philosophy, University of Utah, Salt Lake City, Utah, USA.
⁹ Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
¹⁰ San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.
¹¹ Division of Geriatric Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
¹² Central Arkansas Veterans Healthcare System, Geriatric Research, Education, and Clinical Center, Little Rock, Arkansas, USA.
¹³ Department of Emergency Medicine, Division of Geriatric Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA.
¹⁴ Department of Emergency Medicine & Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹⁵ Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York, USA.
¹⁶ Division of UCSF Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, California, USA.
¹⁷ Hospitalist Division, Department of Medicine, Good Samaritan Hospital, Vincennes, Indiana, USA.
¹⁸ Hospitalist Division, Department of Medicine, Union Hospital, Terre Haute, Indiana, USA.
¹⁹ Department of Emergency Medicine, Division of Geriatric Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
²⁰ Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
²¹ VA Ann Arbor Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan, USA.
²² Section of Geriatrics and Palliative Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
²³ Rehabilitation and Extended Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.
²⁴ University of Utah College of Nursing, Salt Lake City, Utah, USA.
²⁵ UCLA Borun Center for Gerontological Research, Los Angeles, California, USA.
²⁶ VA Los Angeles Geriatric Research Education and Clinical Center, Los Angeles, California, USA.
²⁷ RAND Corporation, Santa Monica, California, USA.

PMID: 32374440
PMCID: PMC7267615
DOI: 10.1111/jgs.16537

Abstract

Coronavirus disease 2019 (COVID-19) continues to impact older adults disproportionately, from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these needs have focused attention on how resources are ultimately allocated and used. Some strategies misguidedly use age as an arbitrary criterion, inappropriately disfavoring older adults. This statement represents the official policy position of the American Geriatrics Society (AGS). It is intended to inform stakeholders including hospitals, health systems, and policymakers about ethical considerations to consider when developing strategies for allocating scarce resources during an emergency involving older adults. Members of the AGS Ethics Committee collaborated with interprofessional experts in ethics, law, nursing, and medicine (including geriatrics, palliative care, emergency medicine, and pulmonology/critical care) to conduct a structured literature review and examine relevant reports. The resulting recommendations defend a particular view of distributive justice that maximizes relevant clinical factors and deemphasizes or eliminates factors placing arbitrary, disproportionate weight on advanced age. The AGS positions include (1) avoiding age per se as a means for excluding anyone from care; (2) assessing comorbidities and considering the disparate impact of social determinants of health; (3) encouraging decision makers to focus primarily on potential short-term (not long-term) outcomes; (4) avoiding ancillary criteria such as "life-years saved" and "long-term predicted life expectancy" that might disadvantage older people; (5) forming and staffing triage committees tasked with allocating scarce resources; (6) developing institutional resource allocation strategies that are transparent and applied uniformly; and (7) facilitating appropriate advance care planning. The statement includes recommendations that should be immediately implemented to address resource allocation strategies during COVID-19, aligning with AGS positions. The statement also includes recommendations for post-pandemic review. Such review would support revised strategies to ensure that governments and institutions have equitable emergency resource allocation strategies, avoid future discriminatory language and practice, and have appropriate guidance to develop national frameworks for emergent resource allocation decisions. J Am Geriatr Soc 68:1136-1142, 2020.

Keywords: COVID-19; aging; bioethics; pandemic; rationing.

PubMed Disclaimer

References

1. Rosenbaum L. Facing COVID‐19 in Italy—ethics, logistics, and therapeutics on the epidemic's front line. N Engl J Med. 2020; 382(20):1873‐1875. 10.1056/NEJMp2005492. - DOI - PubMed
1. Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) . SIAARTI Web site. Clinical ethics recommendations for the allocation of intensive care treatments, in exceptional, resource‐limited circumstances. http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/.... Accessed April 29, 2020. - PubMed
1. White DB, Lo B. A framework for rationing ventilators and critical care beds during the COVID‐19 pandemic. JAMA. 2020; 323(18): 1773‐1774. 10.1001/jama.2020.5046. - DOI - PubMed
1. Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce resources in the time of COVID‐19. N Engl J Med. 2020. 10.1056/NEJMsb2005114. - DOI - PubMed
1. Truog RD, Mitchel C, Daley GQ. The toughest triage—allocating ventilators in a pandemic. N Engl J Med. 2020. 10.1056/NEJMp2005689. - DOI - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond

Affiliations

AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond

Authors

Affiliations

Abstract

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical