Pediatrics vs. Geriatrics: How Hospitals Allocate Resources to Different Age Groups

Pediatrics and Geriatrics, what are they? Pediatrics is the speciality of medical science concerned with the physical, mental, and social health of children from birth to young adulthood; While, Geriatrics is a speciality focused on the high-quality, person-centered care’ for older individuals, typically those 65 and older. With the fertility rate for women rising to 1.67 births per woman in 2022, and projected growth of 65-and-older individuals from 58 million to around 82 million also in 2022, how do hospitals allocate resources to these groups?

According to the Cambridge Quarterly of Healthcare Ethics, some theorists or members of the public believe age plays a major role in allocating resources. One version is where medical professionals are faced with the decision to extend the life of a ‘young’ or ‘old patient; they should prioritize the younger patient and prioritize public health spending on these certain age groups for these life-extending treatments. This is often justified with the principle that extending the lives of older patients will produce ;less total good; than extending the lives of younger patients, where old patients can face lower chances of benefitting treatment and if they do they live for a low time period and with more health complications than the young.

Ethics aside, in situations such as the COVID-19 pandemic, resource allocation is heavily discussed, especially with scarcity. The American Geriatrics Society (AGS) focuses on providing care and treatment to all people equally, without placing all the weight on someone’s age. The AGS ethics committee had divides seven principles aimed at resource allocation when they are in short supply (summarized):

Age should not be used to exclude anyone from standard care or as a strict cutoff in resource allocation. Decision-makers must also consider how race, ethnicity, and social factors impact comorbidities, as these are often outside a person's control.

Allocation strategies should focus on short-term survival (within six months) by assessing the severity of comorbidities and hospital outcomes, avoiding long-term predictions that may disadvantage older adults. Biased criteria like "life years saved" or "long-term life expectancy" should not be used, as they unfairly impact aging individuals.

Triage committees should include experts in ethics and geriatrics, operating independently to ensure impartial decisions. Institutions must create transparent, uniform allocation policies with input from multiple disciplines and ensure frontline clinicians apply—not determine—rationing criteria.

Advance care planning (ACP) is crucial but should never be used to ration care or pressure individuals into decisions during a crisis. Effective ACP involves early, voluntary discussions focused on personal preferences, not external pressures.

Regardless of age, AGS and hospitals make it a priority to include multi-factor allocation strategies, communication surrounding rationing, and whether certain practices, such as age-based cutoffs can be considered discriminatory. Healthcare is surrounded by the ethics of how medical professionals can care and treat for all age groups, and not the if’s of the matter.

References

American Academy of Pediatrics. (2015). Definition of a pediatrician. Pediatrics, 135(4), 780-781. https://publications.aap.org/pediatrics/article/135/4/780/33636/Definition-of-a-Pediatrician

American Geriatrics Society (AGS). (n.d.). About geriatrics. https://www.americangeriatrics.org/geriatrics-profession/about-geriatrics

American Geriatrics Society (AGS). (2020). New AGS position statement addresses one of health care’s most difficult issues [Press release]. https://www.americangeriatrics.org/media-center/news/new-ags-position-statement-addresses-one-health-cares-most-difficult-issues

Kapp, M. B. (2004). Healthcare priorities: The young and the old. Cambridge Quarterly of Healthcare Ethics, 13(1), 13-22. https://www.cambridge.org/core/journals/cambridge-quarterly-of-healthcare-ethics/article/healthcare-priorities-the-young-and-the-old/8EB045BE9E3FF0E330DC192A9910448D