Despite huge efforts to increase the capacity in Intensive Care Units (ICU), bring in more staff and build more ventilators, access will have to be rationed based on chance of good outcomes. Frailer, older people will rightly be cared for on general wards or, where possible, out of hospital.
ICU can be a distressing experience with long-term consequences for survivors. Overcrowded, pressurised A&E departments can also be very frightening places for older people to be and can leave them confused, vulnerable and dependent. Admission to in-patient wards, mid-pandemic, risk over-90s who don’t have the Covid-19 virus catching it from others.
Treatment of those with suspected Covid-19 isn’t just about ICU. Oxygen, antibiotics, fluids, regular monitoring, relief of symptoms like pain or breathlessness can help. So can rehabilitation. Sometimes there are no alternatives to hospital. If older people are dying, as many will, we need skilled palliative care to make death more dignified and peaceful.
I never want to see over-90s denied hospital care on the grounds of age alone. But where we can support and treat them out of hospital – including in nursing and residential homes, where many live – we should. For those who do come in, we should aim to get them home the moment they are stable.
If we present the realities to many nonagenarians and ask what they or their families want , then admission to an overstretched hospital is often not it. Saying so is not discriminatory or disrespectful. The facts speak for themselves.
- Professor David Oliver is an NHS consultant in geriatrics and general internal medicine, and was previously the government medical tsar for elderly care, president of the British Geriatrics Society and vice-president of the Royal College of Physicians