AGSPosition Statement: Resource Allocation Strategies andAge-RelatedConsiderations in theCOVID-19 Era and Beyond
AGSPosition Statement: Resource Allocation Strategies andAge-RelatedConsiderations in theCOVID-19 Era and Beyond
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DOI：
10.1111/jgs.16537
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发表时间：
2020-06-01
影响因子：
6.3
通讯作者：
Saliba, Debra
中科院分区：
文献类型：
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作者：
Farrell, Timothy W.;Ferrante, Lauren E.;Saliba, Debra
2019年冠状病毒病（COVID-19）继续对老年人造成不成比例的影响，从严重疾病和住院到死亡风险增加。与此同时，人们对解决这些需求的保健专业人员和保健用品可能短缺的担忧使人们把注意力集中在如何最终分配和使用资源上。一些策略错误地将年龄作为武断的标准，不恰当地不利于老年人。本声明代表了美国老年医学会（AGS）的官方政策立场。它旨在告知包括医院、卫生系统和政策制定者在内的利益相关者，在制定涉及老年人的紧急情况下分配稀缺资源的战略时应考虑的伦理因素。AGS伦理委员会成员与伦理学、法律、护理和医学（包括老年病学、姑息治疗、急诊医学和肺科/重症监护）的跨专业专家合作，进行了结构化的文献综述并审查了相关报告。由此产生的建议捍卫了一种分配正义的特殊观点，即最大化相关的临床因素，减少或消除了对老年武断、不成比例的影响。AGS的立场包括(1)避免将年龄本身作为将任何人排除在护理之外的手段；(2)评估合并症并考虑健康社会决定因素的不同影响；(3)鼓励决策者主要关注潜在的短期（而非长期）结果；(4)避免使用“节省寿命年”和“长期预期寿命”等可能对老年人不利的辅助标准；(5)组建并配备分诊委员会，负责分配稀缺资源；(6)制定透明、统一的机构资源配置策略；(7)促进适当的预先护理计划。该声明包括应立即实施的建议，以解决COVID-19期间的资源分配战略，与AGS的立场保持一致。该声明还包括大流行后审查的建议。这种审查将支持修订战略，以确保政府和机构拥有公平的紧急资源分配战略，避免未来的歧视性语言和做法，并为制定紧急资源分配决定的国家框架提供适当指导。[J]中华医学杂志，2016,38(2):444 - 444。
Coronavirus disease 2019 (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, inappropriately disfavoring 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 deemphasizes 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 short-term (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 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. J Am Geriatr Soc 68:1136-1142, 2020.