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. 2020 Mar 1;23(1):152-154.
doi: 10.5770/cgj.23.452. eCollection 2020 Mar.

Age Alone is not Adequate to Determine Health-care Resource Allocation During the COVID-19 Pandemic

Manuel Montero-Odasso  1   2   3 , David B Hogan  4 , Robert Lam  5 , Kenneth Madden  6 , Christopher MacKnight  7 , Frank Molnar  8 , Kenneth Rockwood  7
Affiliations

Age Alone is not Adequate to Determine Health-care Resource Allocation During the COVID-19 Pandemic

Manuel Montero-Odasso et al. Can Geriatr J. .

Abstract

Background: The Canadian Geriatrics Society (CGS) fosters the health and well-being of older Canadians and older adults worldwide. Although severe COVID-19 illness and significant mortality occur across the lifespan, the fatality rate increases with age, especially for people over 65 years of age. The dichotomization of COVID-19 patients by age has been proposed as a way to decide who will receive intensive care admission when critical care unit beds or ventilators are limited. We provide perspectives and evidence why alternative approaches should be used.

Methods: Practitioners and researchers in geriatric medicine and gerontology have led in the development of alternative approaches to using chronological age as the sole criterion for allocating medical resources. Evidence and ethical based recommendations are provided.

Results: Age alone should not drive decisions for health-care resource allocation during the COVID-19 pandemic. Decisions on health-care resource allocation should take into consideration the preferences of the patient and their goals of care, as well as patient factors like the Clinical Frailty Scale score based on their status two weeks before the onset of symptoms.

Conclusions: Age alone does not accurately capture the variability of functional capacities and physiological reserve seen in older adults. A threshold of 5 or greater on the Clinical Frailty Scale is recommended if this scale is utilized in helping to decide on access to limited health-care resources such as admission to a critical care unit and/or intubation during the COVID-19 pandemic.

Keywords: COVID-19; aged; frailty; health-care resources; mechanical ventilation.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES MMO is a member of the Board of directors, Secretary-Treasurer, and co-Chair of the COVID-19 Working Group of the Canadian Geriatrics Society. DBH has none to declare. FM is CGS past president and co-chair of the Covid-19 Working Group of the Canadian Geriatrics Society. KM is editor-in-chief of the Canadian Geriatrics Journal. KR has asserted copyright of the Clinical Frailty Scale; use of the scale is free for research, educational, and not-for-profit health-care use.

Figures

FIGURE 1
FIGURE 1
Probability of survival of critically ill older adults with different Clinical Frailty Scale scores, since admission to an Intensive Care Unit. Reproduced with permission from Bagshaw et al. 2014(13)
See this image and copyright information in PMC

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