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

Abstract

word count: 324 ABSTRACT 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, which inappropriately disfavors 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 de-emphasizes 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 shortterm (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 Accepted Article 5 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.consequences of severe illness, hospitalization and death. The extent to which this disproportionate impact is due to factors such as the disease itself, versus the response of health care systems to the disease, is unknown. Concerns about potential shortages of ventilators, ICU beds, and hospital bedsboth now and in the fall when resource shortages caused by any surge in COVID-19 will likely be intensified due to influenza -have focused attention on how decisions to allocate these scarce resources are being made. Many of the initially av...

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“…Clinicians should be mindful of misusing age as an arbitrary criterion, disfavoring elderly patients with COVID-19 in resource allocation decisions where there is healthcare shortage. According to the American Geriatrics Society, factors that are predictive of mortality include frailty and severe comorbidities (likely to result in death over a short period of time, such as <6 months), rather than chronological age alone [ 110 ].…”

“…Moreover, the current pandemic has further highlighted the urgent need to create an advance directive with establishing triage committees. Advance care and planning discussions should occur before patients are in crisis, with the aim of identifying people who do not wish to receive intensive care, including mechanical ventilation [ 110 ].…”

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“…There is also growing evidence that older adults of minority ethnic and racial backgrounds are disproportionately affected by COVID-19. It is likely that racial and ethnic differences in the social determinants of health contribute to these health disparities [ 15 , 16 ]. There is potential that decision-making based on grading by CFS could exacerbate the way that frailty is structured according to cumulative lifetime disadvantages (e.g.…”

“…race, gender, sexuality). This was recognised by the recent American Geriatric Society (AGS) position statement on resource allocation strategies during the COVID-19 pandemic, which recommends that stakeholders consider the inequitable distribution of social health determinants in decision-making [ 15 ].…”

“…The AGS and Canadian Geriatrics Society have both recommended against the unethical and unlawful allocation of resources on the basis of age alone, but crucially, the AGS also cautions against the use of ancillary criterion such as ‘long-term predicted life expectancy’ [ 15 ]. It is also advised that decision makers should focus on potential short-term outcomes, so as not to disadvantage older people.…”