ABSTRACT
Even before 2020, older Americans made up the majority of ICU admissions and deaths. In
2020, as a pandemic infiltrates every corner of the globe, older adults are disproportionately
impacted, facing greater morbidity and mortality from COVID-19 than any other segment of the
population. As a society we are tackling unsettled questions about how best to deploy limited
resources as we confront mass critical illness on a scale not seen for generations. These
questions strike at the core of our ethos as a nation, challenging us to craft policies to sort
through waves of patients, knowing that if crisis standards of care are enacted those policies will
determine who is allocated intensive care resources – and who is not.
In Aim 1 we propose to analyze states’ scarce resource allocation policies through an anti-
discrimination lens, seeking to characterize the ways in which policies explicitly or implicitly
disadvantage older or disabled persons. These may include consideration of advanced age or
disability as an initial exclusion or deprioritization criterion, or as a tiebreaker among patients
presenting with similar severity of illness. We then seek in Aim 2 to measure the size of the
American population at highest risk to suffer from such criteria, Medicare beneficiaries with two
or more comorbid conditions living in jurisdictions that factor age and disability into allocation
decisions. In Aim 3 we will contextualize our findings with in-depth interviews with policy authors
from states with varied approaches to age and disability in triage.
This pilot research will lay evidentiary groundwork for future policy reform, characterizing the
permutations and pervasiveness of discriminatory policies against older adults and persons
living with disability. During the award period the principal investigator, who is a critical care
physician, will acquire skills in qualitative methods and layer policy findings over summary
claims data, a methodology she intends to further explore in future career development
mechanisms. The proposed projects will serve as a first step in the candidate’s trajectory toward
an independent research career at the intersection of bioethics, critical care, health policy and
aging research.
