As the COVID-19 pandemic continues, data is showing that while illness and mortality occur across the lifespan, the death rate increases significantly for those over 65 years of age.
Dr. Manuel Montero-Odasso, Professor at Western University’s Schulich School of Medicine & Dentistry and Scientist at Lawson Health Research Institute is the co-chair of the Canadian Geriatrics Society COVID-19 Working Group. He is available to media for comment on the allocation of health care resources for older adults, and also on recommendations specific to this population to help prevent transmission.
“Particularly for older adults, they need to know that they are the most vulnerable but that there is no need to panic. They should follow evidence-based recommendations if they become sick. Importantly, we also stress the role of caregivers and family members, and we have specific recommendations for them on how to connect with their loved ones,” he said.
Dr. Montero-Odasso has also co-authored a position statement on behalf of the Canadian Geriatrics Society arguing that it is not acceptable to ration critical care admission or life-saving ventilation solely on the basis of age, as has been seen in other epicentres of COVID-19 when health care resource become scarce. They point out that while an established body of evidence supports that mechanical ventilation would likely be futile in some frail older adults with multiple comorbidities, there is a critical ethical difference between decisions made on the basis of futility versus those based on age alone.
“It is a concern not only because of ageism, but because it’s important to understand that age is not the only variable. It is also key to understand previous wishes of patients. You could have a 30-year-old with a chronic neurodegenerative condition who doesn’t want to be intubated and also an 80-year-old who has a high functionality and quality-of-life who does want to use all means possible to survive,” he said. “Age itself should not be the main driver of these decisions; important variables include previous functional capabilities, and levels of frailty. There needs to be a very thoughtful and thorough evaluation.”
Dr. Montero-Odasso says one example of how the COVID-19 Working Group has been involved in policy decisions is related to feedback on the Ontario Health Association Clinical Triage Protocol for Major Surge in COVID Pandemic.
“This important Ontario document does not use age alone in their recommendations and, moreover, it recommends to use proper geriatric tools, such as the Clinical Frailty Scale, in their triage algorithms to guide resources allocation,” he said.
Since COVID-19 was declared a pandemic, the first evidence that emerged was that the older adult population was being hit the hardest. As part of the Canadian Geriatrics Society COVID-19 Working Group, Dr. Montero-Odasso and colleagues have created resources and recommendations such as global recommendations for older adults, evidence-based position statements on ageism and healthcare resource utilization, and how to support health care workers on the front lines, such as the doctors and nurses in healthcare facilities.
Commentary reflects the perspective and scholarly interest of Western faculty members and is not an articulation of official university policy on issues being addressed.
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