CLINICAL DECISION MAKING IN OLDER ADULTS WITH COVID-19 IN DEVELOPING COUNTRIES: LOOKING BEYOND CHRONOLOGICAL AGE

Rev Invest Clin. 2020;72(3):127-134. doi: 10.24875/RIC.20000131.

Abstract

Background: The coronavirus disease 2019 (COVID-19) has been declared a global pandemic. Older adults have been found as a vulnerable group for developing severe forms of disease and increased mortality.

Objective: The objective of the study was to propose a pathway to assist the decision-making process for hospital resource allocation for older adults with COVID-19 using simple geriatric assessment-based tools.

Methods: We reviewed the available literature at this point of the COVID-19 outbreak, focusing in older adult care to extract key recommendations for those health-care professionals who will be treating older adults in the hospital emergency ward (HEW) in developing countries during the COVID-19 pandemic.

Results: We listed a series of easy recommendations for non-geriatrician doctors in the HEW and suggested simple tools for hospital resource allocation during critical care evaluation of older adults with COVID-19 in low- and middle-income countries.

Conclusions: Age must not be used as the sole criterion for resource allocation among older adults with COVID-19. Simple and efficient tools are available to identify components of the comprehensive geriatric assessment, which could be useful to predict outcomes and provide high-quality care that would fit the particular needs of older adults in resource-limited settings amidst this global pandemic.

Keywords: COVID-19; Emergency care; Ethics; Frailty; Resource-allocation.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Betacoronavirus*
  • Clinical Decision-Making*
  • Coronavirus Infections* / economics
  • Coronavirus Infections* / epidemiology
  • Developing Countries* / economics
  • Emergency Service, Hospital* / economics
  • Female
  • Frail Elderly
  • Geriatric Assessment / methods
  • Humans
  • Male
  • Pandemics* / economics
  • Patient Preference
  • Pneumonia, Viral* / economics
  • Pneumonia, Viral* / epidemiology
  • Prognosis
  • Resource Allocation / ethics
  • Resource Allocation / standards*
  • Triage
  • Vulnerable Populations

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2