scholarly journals Age Alone is not Adequate to Determine Healthcare Resource Allocation during the COVID-19 Pandemic

2020 ◽  
Vol 23 (1) ◽  
pp. 152-154 ◽  
Author(s):  
Manuel Montero-Odasso ◽  
David B. Hogan ◽  
Robert Lam ◽  
Kenneth Madden ◽  
Christopher MacKnight ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Resource Allocation ◽  
Critical Care ◽  
Critical Care Unit ◽  
Geriatric Medicine ◽  
Well Being ◽  
Health Care Resource ◽  
Clinical Frailty Scale ◽  
Sole Criterion

Background The Canadian Geriatrics Society (CGS) fosters the health and well-being of older Canadians and older adults worldwide. Although severe COVID-19 illness and significant mortality occur across the lifespan, the fatality rate increases with age, especially for people over 65 years of age. The dichotomization of COVID-19 patients by age has been proposed as a way to decide who will receive intensive care admission when critical care unit beds or ventilators are limited. We provide perspectives and evidence why alternatives approaches should be used Methods   Practitioners and researchers in geriatric medicine and gerontology have led in the development of alternative approaches to using chronological age as the sole criterion for allocating medical resources. Evidence and ethical based recommendations are provided. Results Age alone should not drive decisions for health-care resource allocation during the COVID-19 pandemic. Decisions on health-care resource allocation should take into consideration the preferences of the patient and their goals of care, as well as patient factors like the Clinical Frailty Scale score based on their status two weeks before the onset of symptoms. Conclusions Age alone does not accurately capture the variability of functional capacities and physiological reserve seen in older adults. A threshold of 5 or greater on the Clinical Frailty Scale is recommended if this scale is utilized in helping to decide on access to limited health-care resources such as admission to a critical care unit and/or intubation during the COVID-19 pandemic.

scholarly journals Bedside Ultrasound Measures of Muscle Mass and Frailty Measures in Community-Dwelling Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 269-269
Author(s):  
Kenneth Madden ◽  
Boris Feldman ◽  
Shane Arishenkoff ◽  
Graydon Meneilly
Keyword(s):  
Older Adults ◽  
Muscle Mass ◽  
Frailty Index ◽  
Geriatric Medicine ◽  
Muscle Thickness ◽  
Vancouver General Hospital ◽  
Community Dwelling ◽  
Point Of Care Ultrasound ◽  
Clinical Frailty Scale ◽  
Community Dwelling Older Adults

Abstract The age-associated loss of muscle mass and strength in older adults is called sarcopenia, and it is associated with increased rates of falls, fractures, hospitalizations and death. Sarcopenia is one of the most common physical etiologies for increased frailty in older adults, and some recent work has suggested the use of Point-of care ultrasound (PoCUS) measures as a potential measure of muscle mass. The objective of this study was to examine the association of PoCUS measures of muscle thickness (MT) with measures of frailty in community-dwelling older adults. We recruited 150 older adults (age >= 65; mean age 80.0±0.5 years, 66 women, 84 men) sequentially from 5 geriatric medicine clinics (Vancouver General Hospital). We measured lean muscle mass (LMM, by bioimpedance assay) and an ultrasonic measure of muscle quantity (MT, vastus medialis muscle thickness) in all subjects, as well as two outcome measures of frailty (FFI, Fried Frailty Index; RCFS, Rockwood Clinical Frailty Scale). In our models, MT showed an inverse correlation with the FFI (Standardized β=-0.2320±0.107, p=0.032) but no significant correlation with the RCFS (Standardized β = -0.025±0.086, p=0.776). LMM showed no significant association with either FFI (Standardized β=-0.232±0.120, p=0.055) or RCFS (Standardized β = -0.043±0.119, p=0.719). Our findings indicate that PoCUS measures show potential as a way to screen for physical manifestations of frailty and might be superior to other bedside methods such as bioimpedance assay. However, PoCUS measures of muscle thickness will likely miss patients showing frailty in the much broader context captured by the RCFS.

Older adults’ philanthropic crafting of face masks during COVID-19

2021 ◽  
Vol 12 (2) ◽  
pp. 223-245 ◽  
Author(s):  
Christine Guy Schnittka
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Social Media ◽  
Virtual Community ◽  
Well Being ◽  
Moral Values ◽  
Lessons Learned ◽  
Front Line ◽  
Social Media Platforms ◽  
Front Line Workers

During the early months of the COVID-19 pandemic, people of all ages began sewing fabric face masks. Organized through separate grassroots movements, oftentimes using social media platforms, people pooled their resources to make masks for front line workers and others in desperate need. While some people sold these face masks, many participated in philanthropic crafting, donating them to hospitals and other health care centres. Older adults were identified early on as being particularly vulnerable to the effects of the virus, and so their response to mitigate the impacts of the pandemic through crafting was salient. This study investigated the experience of philanthropic hand crafting by older adults who were living through the COVID-19 pandemic. Twenty-seven older adults of age 60–87 who sewed masks for others were interviewed. A comprehensive data analysis of these interviews yielded 39 descriptive codes that were collapsed into eight themes: emotions, engagement, meaning, relationships, accomplishment, intellect, moral values and agency. One finding was that there were psychological, relational and existential benefits for the crafters. Making masks allowed participants to help other people, and it gave the participants a feeling of value, worthiness and purpose. Additionally, participants felt more in control in a chaotic world as they made masks to protect themselves, their loved ones, as well as strangers. The philanthropic crafting enhanced older adults’ well-being in many ways, and lessons learned from this study could be extended into ‘normal times’. For example, more older adults would be able to participate in craft-based philanthropy if they had access to the tools and materials. They would be more motivated if they received thank you notes and pictures of the recipients using their handmade gifts, and if they could express their creativity more. Finally, creating a physical or virtual community for older adults around craft philanthropy would help older adults feel more connected to and supported by their peers, and the community at large.

scholarly journals The Role of Immigration in the Health of Lesbian, Gay, Bisexual, and Transgender Older Adults in the United States

2019 ◽  
Vol 89 (1) ◽  
pp. 3-21
Author(s):  
Jane J. Lee ◽  
Hyun-Jun Kim ◽  
Karen Fredriksen Goldsen
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Behaviors ◽  
Health Outcomes ◽  
Health Care Access ◽  
Well Being ◽  
The United States ◽  
Foreign Born ◽  
Care Access ◽  
Bisexual And Transgender

Lesbian, gay, bisexual, and transgender (LGBT) aging research is growing around the globe. Yet, few studies have examined the interconnectedness of different populations and cultures. This study examines whether LGBT foreign-born older adults experience greater health disparities than their U.S.-born counterparts. We conducted a cross-sectional analysis of the National Health, Aging, and Sexuality/Gender Study: Aging with Pride from 2014, which assessed measures of health and well-being among LGBT adults aged 50 years and older ( n = 2,441). We compared sociodemographic characteristics, health-care access, health behaviors, and health outcomes between foreign-born and U.S.-born participants. Foreign-born LGBT older adults reported greater socioeconomic disadvantage and higher levels of experiencing barriers to health-care access than U.S.-born LGBT older adults. Groups did not significantly differ in health behaviors and health outcomes when controlling for sociodemographic factors. Greater understanding of the mechanisms that shape the relationship between migration and health among the LGBT population is warranted.

scholarly journals Contextualizing the COVID-19 Era in Puerto Rico: Compounding Disasters and Parallel Pandemics

2020 ◽  
Author(s):  
Catherine García ◽  
Fernando I Rivera ◽  
Marc A Garcia ◽  
Giovani Burgos ◽  
María P Aranda
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Puerto Rico ◽  
Puerto Rican ◽  
Debt Crisis ◽  
Wealth Inequality ◽  
Well Being ◽  
Research Report ◽  
The Impact ◽  
Health And Well Being

Abstract Objectives The COVID-19 outbreak has worsened the ongoing economic crisis in Puerto Rico by creating “parallel pandemics” that exacerbate socioeconomic and health inequalities experienced by its most vulnerable residents. Unfortunately, conditions on the island have been largely overlooked by national media outlets and the mainland U.S. population. Thus, this research report aims to draw attention to the disparate burden multiple and compounding disasters have on older island-dwelling Puerto Rican adults’ health and well-being. Methods We characterize the lived experiences of the older population in Puerto Rico by incorporating data from multiple sources and contextualizing the effects of compounding disasters, the fiscal pandemic, and health care challenges to provide a more nuanced portrait of existing compounding factors that negatively affect the health and well-being of older adults in the era of COVID-19. Results We highlight 2 main factors that exacerbate pre-pandemic inequities experienced by the older adult population amid the COVID-19 pandemic in Puerto Rico: (a) the impact of multiple and compounding disasters; and (b) health care challenges. Discussion The human suffering of the Puerto Rican population is compounded by the consequences of fiscal austerity, increasing levels of income and wealth inequality, the debt crisis, significant emigration, and a dysfunctional health care system. Future governmental actions are required to lessen the burden of parallel pandemics on older adults in Puerto Rico.

Social values and cancer funding priorities: Empirical evidence for cancer policy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18352-e18352
Author(s):  
Avram Denburg
Keyword(s):  
Health Care ◽  
Resource Allocation ◽  
Moral Reasoning ◽  
Cancer Care ◽  
Stated Preference ◽  
Population Based ◽  
Health Care Resource ◽  
Ethical Principles ◽  
Public Values ◽  
Stated Preference Survey

e18352 Background: Achieving value in health care requires knowledge of public values and priorities. To better understand public values for resource allocation on cancer care, we conducted a population-based stated preference survey with a nested randomized controlled moral reasoning intervention. Our objective was to generate evidence to inform economic evaluation and policymaking on cancer care priority-setting and payment reform in developed health systems. Methods: We conducted a population-based stated preference survey of societal views on the prioritization of health resources between children and adults, administered to a nationally representative sample (n = 1,556) of Canadian adults. Allocative preferences were elicited across a range of hypothetical treatment scenarios and scored on a visual analogue scale. Participants were randomized to a moral reasoning intervention (n = 773) or a control group (n = 783). Those randomized to the intervention group were exposed to a moral reasoning exercise prior to each choice task. The exercise presented participants with a list of ethical principles relevant to health care resource allocation and tasked them to select the top principles guiding their choice. The main outcomes were the difference in mean preference scores by group, scenario, and participant demographics. Results: Multiple regression analyses demonstrated a consistent aggregate preference by participants to allocate scarce health system resources to children. Exposure to the moral reasoning exercise weakened but did not eliminate allocative preference for children, as compared to control (difference 0.72, SE 0.14, p < 0.0001). Younger respondent age (-0.71, SE 0.14, p < 0.0001) and parenthood (-0.40, SE 0.11, p < 0.0002) were associated with greater preference for children. The top three principles guiding participants’ allocative decisions were treat equally (54.3-63.9%), relieve suffering (39.6-66.1%), and rescue those at risk of dying (37-40.8%). Conclusions: Our results demonstrate a significant preference by participants to allocate health care resources to children, but one attenuated by exposure to a range of ethical principles to guide decision-making. It also evinced strong support for humanitarian principles to guide health care resource allocation. Definitions of value in health care based primarily on the magnitude of clinical benefit and cost-effectiveness may exclude moral considerations that the public values.

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