Age Alone is not Adequate to Determine Health-care Resource Allocation During the COVID-19 Pandemic.
Age Alone is not Adequate to Determine Health-care Resource Allocation During the COVID-19 Pandemic.
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DOI：
10.5770/cgj.23.452
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发表时间：
2020-03-01
期刊：
影响因子：
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通讯作者：
Rockwood, Kenneth
中科院分区：
文献类型：
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作者：
Montero-Odasso, Manuel;Hogan, David B;Rockwood, Kenneth
背景：加拿大老年医学协会（CGS）促进加拿大老年人和全世界老年人的健康和福祉。尽管严重的COVID-19疾病和显著的死亡率在整个生命周期中都会发生，但死亡率会随着年龄的增长而增加，特别是对于65岁以上的人群。有人提议按年龄对COVID-19患者进行二分法，作为在重症监护室床位或呼吸机有限时决定谁将接受重症监护入院的一种方法。我们提供的观点和证据，为什么替代approaches should be used.METHODS：从业人员和研究人员在老年医学和老年学导致的替代方法的发展，使用实足年龄作为唯一的标准分配医疗资源。结果：在COVID-19大流行期间，年龄不应单独驱动卫生保健资源分配的决策。卫生保健资源分配的决定应考虑到患者的偏好和他们的目标的护理，以及患者的因素，如临床虚弱量表评分的基础上，他们的状态两周前的症状oncissions.CONCLUSIONS：年龄本身并不能准确捕捉的变化，功能能力和生理储备看到在老年人。如果临床虚弱量表用于帮助决定在COVID-19大流行期间获得有限的医疗保健资源，如进入重症监护室和/或插管，则建议临床虚弱量表的阈值为5或更高。
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.