Division of Geriatrics, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
VA SLC Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, USA.
J Am Geriatr Soc. 2020 Jun;68(6):1143-1149. doi: 10.1111/jgs.16539.
Coronavirus disease 2019 (COVID-19) continues to impact older adults disproportionately with respect to serious consequences ranging from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these issues have focused attention on how these resources are ultimately allocated and used. Some strategies, for example, misguidedly use age as an arbitrary criterion that disfavors older adults in resource allocation decisions. This is a companion article to the American Geriatrics Society (AGS) position statement, "Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond." It is intended to inform stakeholders including hospitals, health systems, and policymakers about ethical considerations that should be considered when developing strategies for allocation of scarce resources during an emergency involving older adults. This review presents the legal and ethical background for the position statement and discusses these issues that informed the development of the AGS positions: (1) age as a determining factor, (2) age as a tiebreaker, (3) criteria with a differential impact on older adults, (4) individual choices and advance directives, (5) racial/ethnic disparities and resource allocation, and (6) scoring systems and their impact on older adults. It also considers the role of advance directives as expressions of individual preferences in pandemics. J Am Geriatr Soc 68:1143-1149, 2020.
2019 年冠状病毒病（COVID-19）继续对老年人造成不成比例的严重影响，从严重疾病和住院到增加死亡风险等后果不一。同时，人们对医疗保健专业人员和卫生用品潜在短缺的担忧，使得人们关注如何最终分配和使用这些资源。例如，一些策略错误地将年龄作为一种任意标准，在资源分配决策中对老年人不利。这是美国老年医学会（AGS）立场声明“COVID-19 时代及以后的资源分配策略和与年龄相关的考虑因素”的姊妹篇。其目的是告知利益攸关方，包括医院、卫生系统和决策者，在制定涉及老年人的紧急情况下稀缺资源分配策略时应考虑的道德考虑因素。这篇综述介绍了该立场声明的法律和伦理背景，并讨论了这些问题，这些问题为 AGS 立场的制定提供了信息：（1）年龄作为决定因素，（2）年龄作为决胜因素，（3）对老年人有差异影响的标准，（4）个人选择和预先指示，（5）种族/族裔差异和资源分配，以及（6）评分系统及其对老年人的影响。它还考虑了预先指示在大流行中作为个人偏好表达的作用。J Am Geriatr Soc 68:1143-1149, 2020。
