The Decision-Making Process of Selection in the Clinical Pathway for COVID-19: The Recommendations for Older Patients

Abstract

Older people are at a higher risk of serious illness and death from the COVID-19 disease due to physiological changes of ageing and potential underlying health conditions. In the last years, there has been an increase in the elderly population admitted to the intensive care unit (ICU) and the proportion of the very old (85 years or over) critically ill patients is very high especially during the COVID-19 crisis. The care of older patients often determines ethical and practical challenges both before and during admission to intensive care. Therefore a decision-making process of selection in the clinical pathway is necessary. This decision-making process requires some skills like remarkable knowledge of ageing and its consequences on the normal function of organs, competence in comprehensive geriatric assessment and good communication ability with the family and other caregivers. For these reasons, an approach based on comprehensive geriatric assessment (CGA) and the identification of levels of “frailty” becomes essential in the decision-making process to guarantee the most appropriate levels of care both in a critical area and in the long-term or palliative care in accordance, when it is possible, with the wishes and individual needs of the older patient. The mission of Geriatrics is to identify and to treat older patients maximally benefiting of goal-oriented, tailored, multidisciplinary interventions and to identify patients at risk of poor outcomes such as the “very frail” elderly to guarantee the best possible quality of life and avoid unnecessary treatment. When no benefit of treatments can be obtained, palliative care should be considered.