Rationing care by frailty during the COVID-19 pandemic.

Area of Science:

• Gerontology
• Critical Care Medicine
• Public Health Policy

Background:

• The COVID-19 pandemic disproportionately affects older adults and those with comorbidities.
• Limited critical care resources necessitate clear clinical decision-making guidelines.
• The National Institute for Health and Care Excellence (NICE) guidance utilizes the Clinical Frailty Scale (CFS) for critical care suitability assessments.

Purpose of the Study:

• To critically evaluate the limitations and potential unintended consequences of using the CFS in critical care resource allocation during the COVID-19 pandemic.
• To highlight the need for further research into the CFS's predictive accuracy for COVID-19 critical care outcomes.
• To call for a review of the CFS's impact and acceptability as a rationing strategy for older adults.

Main Methods:

• Commentary and critical analysis of existing NICE guidance on CFS use.
• Discussion of the implications of widespread CFS implementation with limited oversight.
• Identification of research gaps concerning CFS predictive validity and impact.

Main Results:

• The CFS is being widely implemented for critical care rationing in COVID-19 patients, often with inadequate training.
• Potential exists for the CFS to reduce access to critical care for older, frail individuals and exacerbate health inequalities.
• The predictive accuracy of CFS for COVID-19 outcomes is not well-established.

Conclusions:

• The current application of the CFS in critical care decision-making during the pandemic warrants caution due to potential biases and inequities.
• Further research is essential to validate the CFS's role in predicting critical care outcomes for COVID-19 patients.
• A thorough review is needed to assess the ethical implications and patient acceptability of using CFS for resource allocation.