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The facts speak for themselves: Where we can treat the over-90s out of hospital, we should do so

I have been treating many older patients who might have coronavirus, and some who do. I’ve spent much of my 31 years as an NHS doctor looking after acutely ill older people. I have campaigned against ageist attitudes and discrimination. I don't like labels like "burden" or "bed blocker". But I'll defend Professor Sir David King's remarks, if not the tone.

Older citizens have the same right to acute hospital services as younger ones. We should not ordinarily deny them a trip to A&E or an in-patient bed or procedure if they might benefit. And generally, we don't.

Around half of hospital admissions and two thirds of bed days are in people over 75. But Sir David's remarks were specific to our current unprecedented pandemic, with the effects of the Covid-19 virus threatening to overwhelm hospital services, and they focused on people in extreme old age who might have been infected. These are exceptional circumstances.

The Imperial College predictive model for Coronavirus tells a tale. For people over 80 (let alone 90) with the virus and symptoms, an anticipated 27.3 per cent might require hospital admission, 70.9 per cent need intensive care (assuming we had sufficient capacity to admit them all) and 9.3 per cent would die. We don't yet know how healthy or permanently damaged the survivors might be.

Clearly, not all over-90s are in poor health. Many remain active and independent. But the odds are stacked against them compared to younger people. 

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