Age Alone is not Adequate to Determine Healthcare Resource Allocation during the COVID-19 Pandemic

  • Manuel Montero-Odasso Schulich School of Medicine and Dentistry, The University of Western Ontario
  • David B. Hogan University of Calgary
  • Robert Lam The University of Toronto
  • Kenneth Madden University of British Columbia
  • Christopher MacKnight Dalhousie University
  • Frank Molnar University of Ottawa
  • Kenneth Rockwood Dalhousie University
Keywords: aged, frailty, COVID-19, Health Care Resources, Mechanical Ventilation

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 alternatives 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.

Author Biographies

Manuel Montero-Odasso, Schulich School of Medicine and Dentistry, The University of Western Ontario

Department of Medicine and Division of Geriatric Medicine, Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, Department of Epidemiology and Biostatistics

David B. Hogan, University of Calgary

Division of Geriatric Medicine, Department of Medicine

Robert Lam, The University of Toronto

Department of Family Medicine, Toronto Western Hospital Family Practice Residency Program

Kenneth Madden, University of British Columbia

Division of Geriatric Medicine, Department of Medicine

Christopher MacKnight, Dalhousie University

Division of Geriatric Medicine, Department of Medicine

Frank Molnar, University of Ottawa

Department of Medicine

Kenneth Rockwood, Dalhousie University

Division of Geriatric Medicine, Department of Medicine

Published
2020-04-20
How to Cite
Montero-Odasso, M., Hogan, D. B., Lam, R., Madden, K., MacKnight, C., Molnar, F., & Rockwood, K. (2020). Age Alone is not Adequate to Determine Healthcare Resource Allocation during the COVID-19 Pandemic. Canadian Geriatrics Journal, 23(1), 152-154. https://doi.org/10.5770/cgj.23.452
Section
Clinical Practice Guidelines/Consensus Statements