• Cara Kiernan Fallon and Madison K Kilbride.
• Jackson Institute for Global Affairs, Yale University, Horchow Hall, 55 Hillhouse Avenue, New Haven, CT 06511, USA. Electronic address: cara.fallon@yale.edu.
• Prev Med. 2021 Apr 1; 145: 106409.

AbstractDespite the increased burden of Covid-19 on older adults, ethical and public health frameworks lack adequate guidance for elderly patients who manage severe, even fatal, illness at home. The U.S. Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) recognize the heightened risks of Covid-19 for older adults; however, both organizations presuppose that most cases of Covid-19 will be mild to moderate and recoverable at home. Yet, older adults are least likely to follow this trajectory. Older patients are more susceptible to experiencing severe illness at home from which they may not recover; and if they do seek medical care, they tend to suffer worse outcomes than younger patients in intensive care settings. Given their likelihood of severe illness, worse outcomes in intensive care settings, and potential difficulty accessing resources, frail, disabled, and otherwise vulnerable older patients may face Covid-19 at home without adequate resources, information, or support for home-based care. This editorial proposes three approaches to prevent needless suffering and ensure that this vulnerable population continues to receive needed care.Copyright © 2021 Elsevier Inc. All rights reserved.

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