@article{8b522ddb16044d5381642d3feccb7e5f,
title = "AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond",
abstract = "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.",
keywords = "COVID-19, aging, bioethics, pandemic, rationing",
author = "Farrell, {Timothy W.} and Ferrante, {Lauren E.} and Teneille Brown and Leslie Francis and Eric Widera and Ramona Rhodes and Tony Rosen and Ula Hwang and Witt, {Leah J.} and Niranjan Thothala and Liu, {Shan W.} and Vitale, {Caroline A.} and Braun, {Ursula K.} and Caroline Stephens and Debra Saliba",
note = "Funding Information: The authors wish to acknowledge Nancy Lundebjerg, MPA, CEO of the American Geriatrics Society (AGS), for her editing and input during manuscript preparation. The authors also wish to acknowledge Mary Jordan Samuel, associate director for governance and operations; Dan Trucil, MA, MPH, associate director, communication; and Aimee Cegelka, MA, senior manager of education and special projects, of the AGS, for their assistance with manuscript formatting, copy editing, and submission. The AGS Executive, Ethics, Ethnogeriatrics, and Clinical Practice and Models of Care Committees reviewed and provided feedback on the manuscript. The following expert reviewers provided feedback on the manuscript: Mary Mulcare, MD, FACEP, and Michael Stern, MD, from the Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital; Chakravarthy Reddy, MD, from the University of Utah School of Medicine and Huntsman Cancer Institute; and Douglas B. White, MD, MAS, from the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, and Program on Ethics and Decision Making in Critical Illness. Tony Rosen, MD, MPH, appreciates the generosity of the Razak family in allowing him to live in their home during the COVID-19 pandemic. We dedicate this manuscript to the memory of AGS Ethics Committee member Jeffrey Escher, MD, a geriatrician and tireless advocate for older adults, who died on April 26, 2020, of complications from COVID-19. The participation of Lauren E. Ferrante (K76 057023), Tony Rosen (K76 AG054866), and Caroline Stephens (K76 AG054862) was supported by Paul B. Beeson Emerging Leaders in Aging Career Development Awards from the National Institute on Aging. The participation of Leah J. Witt (K01HP33446) was supported by a Geriatrics Academic Career Award from the Health Resources and Services Administration, an operating division of the U.S. Department of Health and Human Services. This article is the position of the American Geriatrics Society and does not represent the official views of any sponsor. Concept and design: Farrell, Ferrante, Brown, Francis, Widera, Rhodes, Vitale, and Saliba. Analysis and interpretation of data: All authors. Manuscript preparation: Farrell, Ferrante, Brown, Francis, and Saliba. Funding Information: The participation of Lauren E. Ferrante (K76 057023), Tony Rosen (K76 AG054866), and Caroline Stephens (K76 AG054862) was supported by Paul B. Beeson Emerging Leaders in Aging Career Development Awards from the National Institute on Aging. The participation of Leah J. Witt (K01HP33446) was supported by a Geriatrics Academic Career Award from the Health Resources and Services Administration, an operating division of the U.S. Department of Health and Human Services. This article is the position of the American Geriatrics Society and does not represent the official views of any sponsor. Publisher Copyright: {\textcopyright} 2020 The American Geriatrics Society",
year = "2020",
month = jun,
day = "1",
doi = "10.1111/jgs.16537",
language = "English",
volume = "68",
pages = "1136--1142",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "6",
}