Age must not be used as primary criteria to deny treatment

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An employee chats with a woman at the Las Praderas care home for the elderly in Pozuelo de Alarcon near Madrid on April 15.

As we face a global pandemic, depictions of older people as frail, vulnerable, and burdensome have dominated the news. Chillingly, these stereotypes have made it acceptable for some governments and health systems in the U.S. and abroad to develop guidelines that permit providers to use age as a proxy to deny life-saving treatments, such as a ventilator, if there is a scarcity.

As advocates for aging populations, we have made great strides over the past several years to reframe the public’s understanding of what aging means and the many ways that older people contribute to our society. 

There is extraordinary heterogeneity across the older adult population. As we age, we become more different, not more alike. All people with underlying health conditions are at higher risk than the general population of facing severe health consequences if they become infected with COVID-19, not just those over the age of 65.

But many people 65+ are stepping up in meaningful ways to combat the virus. For example, when New York Governor Andrew Cuomo (D) put out the call for retired doctors, nurses, and other health professionals to come back to work, more than 50,000 responded. 

Societies across the globe are experiencing an unprecedented demand for supplies and health-care services. With shortages of ventilators and personal protective equipment, over-extended health care providers and emergency responders are being forced to make life-or-death decisions about who receives care. We have seen troubling reports that some governments and health systems are making triage decisions based mainly on age.

Widespread misunderstanding about the aging process is one of the main factors threatening to put older people at risk of being denied access to life-saving treatments. According to the World Health Organization, “there is no typical older person.” No two people age at the same rate or manner; rather, the rate is influenced by genetics, lifestyle, and diseases, as well as environmental and socioeconomic factors. 

Among individuals, the relationship between age and mortality is highly variable. Instead of denying or limiting treatment based on someone’s age, medical professionals need to consider multiple factors, such as a person’s overall health status, physiological reserve, and quality of life, in addition to life expectancy. 

New York’s protocol for rationing ventilators, for example, prohibits using advanced age as a triage criterion, noting that age “already factors indirectly into any criteria that assess the overall health of an individual.” Likewise, The National Institutes of Health (NIH) Inclusion Across the Lifespan policy prohibits the exclusion of older adults from clinical trials based solely on age. 

But some governments, such as Italy, have used age in guidelines for rationing ventilators and other essential medical equipment, giving preference to younger patients over older patients explicitly.

To prepare for a time when these unthinkable decisions may be necessary, we must come together to demand that age not be used as the sole criterion for rationing health care. We need to value people of all ages and remember that we are all in this together.

Nora Super is a senior director of the Milken Institute Center for the Future of Aging and a former executive director of the White House Conference on Aging. James Appleby is CEO of The Gerontological Society of America.

Tags Ageing Andrew Cuomo Coronavirus COVID-19 Gerontology health system

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