This article comes from the European Cardiology Review: Released on 4/27/2020. Researchers detail the ethical decision-making issues when treating elderly patients with coronavirus disease globally and specifically in Madrid, Spain, an area hit particularly hard by COVID-19.

Prioritization, Ageism, and How COVID-19 Impacts the Elderly

• Prioritization for the distribution of limited resources is not specific to COVID-19, but the recent scarcity of resources has been at the forefront of concerns during the world pandemic.
• Ageism is the act of stereotyping, having prejudice and discrimination against others based on age.
• Risks of COVID-19 are higher for those in the elderly population when compared to the younger population. The authors argue for medical and political authorities to offer older adults strict preventative measures to limit the risk of exposure and infection. If a vaccine is made, priority should go to the elderly to maximize the number of lives saved.
• Allotting resources in the context of COVID-19 goes to those with the highest chance of survival, but a decision like this, if solely based on chronological age, is not justified.
• Other aspects of theoretical life expectancy must be considered, i.e. frailty scales, survival rates after discharge, number of years of life saved, stages of life and a comprehensive geriatric assessment should be used when distributing resources. In addition to this, at the time an elderly patient is admitted with a severe SARS-COV-2 infection, providers should establish a therapeutic adaptation plan, which contains details like whether a patient is a candidate for ventilation or when life-sustaining therapies should be withdrawn.

Off-Label Therapies, Confinement, and Family Matters

• While clinical trials for an effective therapy are underway, there have been many off-label therapies being used, but no therapies to this point have proven effective.
• Confinement can be an effective way to decrease SARS COV-2 transmission, and allow more time for vaccine development, but on the other hand it does have economic ramifications and physical/psychological effects to those diagnosed with COVID-19.
• Elderly patients dying in a confined/isolated space has disrupted process of mourning, and often adds to the trauma of the family surrounding the death of a loved one.

COVID-19 in Madrid, and Conclusion

• At Madrid’s outbreak peak, more than 2/3’s of beds of most hospitals were occupied by COVID-19 cases. Due to lack of space, operating rooms and libraries were used as ICUs, but prioritization still had to be applied to patients which triggered a debate around the rights of patients, especially the elderly, and access to healthcare.
• The authors conclude, while the ethical issues raised by COVID-19 in elderly patients are not new, the prioritization for allocation of resources should be based on multiple factors, not exclusively based on age.

Martínez-Sellés D, Martínez-Sellés H, Martinez-Sellés M. Ethical Issues in Decision-making Regarding the Elderly Affected by Coronavirus Disease 2019: An Expert Opinion. Eur Cardiol. 2020;15. doi:10.15420/ecr.2020.14

This review was posted on behalf of Spencer Hofschulte-Beck, medical student at Marian University, and approved by Dr. Kathleen Unroe, IU School of Medicine Associate Professor, geriatrician, and IU Center for Aging Research Scientist.