This set of clinical practice guidelines from the Canadian Geriatrics Society (CGS) addresses methods for scarce resource allocation during a public health emergency, concluding that age alone is an inappropriate basis for rationing decisions because it fails to accurately capture variability of functional capacities and physiological reserve among older adults.
The guidelines recommend allocation decisions consider patient preferences and goals of care, as well as factors such as Clinical Frailty Scale (CFS) score. Regarding use of CFS scores, the guidelines recommend that scores be based on status two weeks prior to onset of symptoms (not at presentation to an acute care facility) and that a threshold CFS score of 5 or greater be used if the score is to be assist in allocation decisions. However, the guidelines note that only trained clinicians should provide CFS scores to ensure accuracy of the assessment, ideally in consultation with a geriatrician or other specialist in use of CFS.
According to the guidelines, chronological age should not be the sole determining factor for resource allocation decisions; rather, such decisions should be based on clinically relevant facts about individual patients and their likelihood of benefitting from possible interventions. The guidelines advise against automatic prioritization of younger patients over older ones.