Editorial

Abstract

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Between 2020 and 2022, the coronavirus disease 2019 (COVID-19) pandemic had devastating impacts worldwide. Countries adopted various policies to curtail these impacts: ranging from full lockdown with "dynamic zero" policy in China to policy of living with the virus in Western countries. Strategies were selected based on geopolitical situations. Nonetheless, older adults universally experienced the most adverse effects, with worse functional recovery and higher case fatality rates. In Hong Kong, the overall case fatality rate among older patients (16.8%) was associated with baseline Clinical Frailty Scale (CFS) score; the highest rate was 40% among patients with a CFS score ≥7. 1 In the current issue of the Asian Journal of Gerontology and Geriatrics, Chen et al 2 shared their experience from Singapore. They found that patients with greater frailty or more functional limitations had higher mortality rates, worse functional recovery, and longer hospital stays. They suggested that risk factors for longer length of stay should be identified to guide medical decisions and optimise healthcare resource utilisation. However, resources should not be the primary determinant of clinical management decisions, and ageism should be avoided. Optimal clinical care and management should consider biological status or frailty status. For robust individuals with adequate functional recovery, the goal of intervention should be restorative to achieve good health-related quality of life. For individuals near the end of life, the goal of intervention may be to achieve good quality of dying through an end-of-life care programme, 3 which is cost-effective without shortening the median survival. Nonetheless, the challenge is to identify older adults who are near the end of life and would benefit from optimised quality of dying (rather than restorative intervention). Mo et al 4 suggested possible solutions for this challenge. The use of Hospital Admission Risk Reduction Program for the Elderly score and/or CFS score can help guide management, not for medical resource allocation, but for optimising care towards restoration/maintenance of health-related quality of life or towards quality of dying. Although the impact of COVID-19 has diminished, its resurgence or the emergence of new infectious diseases will inevitably occur. It is time to plan ahead and initiate studies that can guide future clinical practice.