Montero-Odasso Manuel, Hogan David B, Lam Robert, Madden Kenneth, MacKnight Christopher, Molnar Frank, Rockwood Kenneth
Schulich School of Medicine and Dentistry, Department of Medicine and Division of Geriatric Medicine, The University of Western Ontario, London, ON.
Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON.
Can Geriatr J. 2020 Mar 1;23(1):152-154. doi: 10.5770/cgj.23.452. eCollection 2020 Mar.
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.
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.
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.
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.
加拿大老年医学会（CGS）致力于促进加拿大老年人以及全球老年人的健康与福祉。尽管在整个生命周期中都会出现严重的 COVID-19 疾病和显著的死亡率，但病死率会随着年龄的增长而上升，尤其是对于 65 岁以上的人群。当重症监护病房床位或呼吸机有限时，有人提议根据年龄对 COVID-19 患者进行二分法，以此来决定谁将获得重症监护病房的收治。我们阐述了为何应采用其他方法的观点和证据。
老年医学和老年学领域的从业者及研究人员率先开发了替代方法，不再将实足年龄作为分配医疗资源的唯一标准。提供了基于证据和伦理的建议。
在 COVID-19 大流行期间，仅年龄因素不应成为医疗资源分配决策的驱动因素。医疗资源分配决策应考虑患者的偏好及其护理目标，以及诸如基于症状出现前两周状态的临床衰弱量表评分等患者因素。
仅年龄因素无法准确反映老年人功能能力和生理储备的变异性。如果在 COVID-19 大流行期间利用临床衰弱量表来帮助决定是否能够获得有限的医疗资源，如入住重症监护病房和/或进行插管，建议该量表的阈值为 5 或更高。
