Due to the development of the COVID-19 pandemic, the Swiss Academy of Medical Sciences and the Swiss Society of Intensive Care Medicine have published and constantly updated guidelines for the triage of patients in case of resource scarcity in intensive care units. Alzheimer Switzerland and Swiss Memory Clinics have repeatedly intervened to defend the interests of people with dementia. Although some results have been achieved, the use of the Clinical Frailty Scale remains problematic for assessing the frailty of people with dementia. You can find more information on the Alzheimer Switzerland website in German, French or Italian.
A translation of the position has done into English, as follows:
Update of the guidelines on triage decisions in case of overcrowding in the intensive care units:
Dementia and Clinical Frailty Scale - an exception in sight?
Due to the development of the Covid 19 pandemic, the Swiss Academy of Medical Sciences (SAMS) and the Swiss Society of Intensive Care Medicine (SGI) published an updated version (version 4) of the guidelines on triage of intensive care unit treatments in the event of resource shortages on 23 September 2021.
Compared to the previous versions published since the onset of the Covid 19 pandemic, the fourth version of the guidelines represents another step in the right direction for people with dementia. The present version specifies that dementia "should not be used alone to automatically infer a negative short-term prognosis" and that specific risk factors for increased mortality must be given for a patient to be posterior. In our opinion, these two explanations remove any doubts regarding the possible consideration of dementia as an exclusion criterion that still existed on the basis of the previous versions of the guidelines.
As welcome as these improvements are, the assessment of prognosis using the Clinical Frailty Scale (CFS) remains problematic for people with dementia, as the mere presence of dementia generally leads to an increase of 1 to 2 points on the scale due to the dependence on third parties that can exist in people with dementia. We particularly regret that the new version of the Guidelines does not mention that the CFS is not validated for assessing frailty in people with dementia, as this is explicitly mentioned for people with disabilities (point III, paragraph 8). For these reasons, the guidelines should explicitly state that the CFS is not validated for assessing frailty in people with dementia and is therefore irrelevant in this respect.
Alzheimer Switzerland and the Swiss Memory Clinics are pleased to note that the SAMS and the SGI have partially taken their demands into account in the fourth edition of the guidelines and have recognised that certain passages on the use of the frailty scale were formulated too succinctly and led to misunderstandings (see FAQ). As a reminder, since the third version of the Guidelines, several passages concerning dementia have been partially supplemented, reworded or removed.
Bern, October 2021