Position statement addresses difficult issue: allocating scare resources in COVID-19 era

May 06, 2020

The COVID-19 pandemic has placed unprecedented pressure on societies worldwide, given the pandemic's rapid, often deadly spread. In health care, the pandemic has raised the pressing question of how society should allocate scarce resources during a crisis. This is the question experts addressed today in a new position statement published by the American Geriatrics Society (AGS) in the Journal of the American Geriatrics Society (DOI: 10.1111/jgs.16537). The statement focuses primarily on whether age should be considered when making decisions to allocate scarce resources.

"A just society strives to treat all people equally, so there's something particularly unjust about characteristics beyond our control--like age--determining whether we receive care," explains Timothy W. Farrell, MD, AGSF, who led the writing group responsible for the statement. "The AGS believes we must focus on the most relevant clinical factors for each person and case when considering how to distribute resources fairly without placing arbitrary weight on age."

COVID-19 continues to impact older adults disproportionately when it comes to serious consequences, from severe illness and hospitalization to increased risk for death. Concerns about potential shortages of ventilators, hospital beds, and other supplies to address these shortages have focused attention on decision-making about who gets access to these resources.

"Unfortunately, some strategies use age as an arbitrary criterion, which disfavors older adults regardless of their function and health relative to COVID-19," said AGS President Annie Medina-Walpole, MD, AGSF. "With this statement, we hope to support hospitals, health systems, and policymakers as they develop resource allocation strategies for use in emergent situations that do not rely on age as a criterion."

After reviewing existing frameworks, recommendations, and research, an expert panel of interprofessional experts, AGS leaders and members of the AGS Ethics Committee devised seven principles aimed at helping develop strategies to allocate resources equitably when they remain in short supply:

1. Age should never be used as a means for categorically excluding someone from what is ordinarily the standard of care, nor should age "cut-offs" be used in allocation strategies.

2. When assessing comorbidities (the medical term for multiple health concerns we live with concurrently), decision-makers should carefully consider the impact of race, ethnicity, and other "social determinants," especially since these often are beyond a person's control.

3. Strategies for making allocation decisions should primarily--and equally--weigh how severe comorbidities and survival in hospital might contribute to the short-term risk for death. This means that health professionals should focus primarily on what is most within their control: Potential outcomes over the next 6 months (and not beyond, which could disproportionately impact care for older people).

4. In order to avoid bias in decision making, health professionals also should avoid criteria that might disadvantage us all as we age. These include characteristics such as:5. Committees and officers tasked with triage (the technical term for organizing and prioritizing a health system's response, especially in times of crisis) also need to be chosen carefully. Ideally, these individuals not only have expertise in medical ethics and geriatrics (the healthcare specialty dedicated to our needs as we age) but also work outside "day-to-day" care so triage officers can maintain impartiality.

6. Institutions should develop resource allocation strategies that are transparent, and applied uniformly. Ideally, that means leveraging advanced planning and input from multiple disciplines, including ethics, law, medicine, and nursing. To make the work of an officer or committee transparent, institutions also should develop consistent strategies available to all for review. "Clinicians at the front lines should be applying--not selecting--emergency rationing criteria when resources are limited," the AGS position statement explained.

7. The COVID-19 pandemic highlights the critical importance of appropriate advance care planning (ACP)--the technical term for working with a health professional and anyone else you choose to document preferences for possible care situations, such as whether you'd want to be placed on a ventilator if you weren't able to breathe on your own. While engaging in these conversations early and often remains critical, they also never should be viewed as a form of rationing, nor should someone be compelled into documenting care preferences primarily because of a broader health crisis. ACP is most effective when it lives up to its name: A conversation in advance, planned with personal preferences at heart.

To help with the urgent need to put in place policies and approaches within the context of the COVID-19 pandemic, the AGS also suggested frameworks to aid health leaders and health systems. They include:Long-term, the AGS also advocated for post-pandemic reviews of COVID-19 rationing strategies, with the goal of removing discriminatory provisions--including age-based cutoffs--which disfavor older adults.

"Health care is unlike other 'goods' or services in that it's a prerequisite for pursuing virtually every other opportunity that makes life meaningful," summarized Dr. Farrell. "Our position statement is aimed at recognizing resource allocation shouldn't be a question of 'if' but rather how we can make decisions safely and smartly, making good on our societal commitment to treat all people fairly."
-end-
About the American Geriatrics Society

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has--for more than 75 years--worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.

American Geriatrics Society

Related Health Care Articles from Brightsurf:

Study evaluates new World Health Organization Labor Care Guide for maternity care providers
The World Health Organization developed the new Labor Care Guide to support clinicians in providing good quality, women-centered care during labor and childbirth.

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

MU Health Care neurologist publishes guidance related to COVID-19 and stroke care
A University of Missouri Health Care neurologist has published more than 40 new recommendations for evaluating and treating stroke patients based on international research examining the link between stroke and novel coronavirus (COVID-19).

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.

International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.

The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .

Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.

High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.

Read More: Health Care News and Health Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.