Assessing rehabilitation eligibility of older patients: An ethical analysis of the impact of bias

Abstract

Hospitalized older patients are more vulnerable to physical or cognitive functional decline. Inpatient rehabilitation programs improve significantly their functional status and may prevent their admission to nursing homes. While inpatient rehabilitation institutions have established admission criteria that can be seen as objective, the risk of bias remains and raises the question of equitable access for more vulnerable populations such as older patients. This paper reviews some established eligibility criteria for inpatient rehabilitation by examining a framework used in Montreal, Québec, Canada for assessing rehabilitation eligibility and by applying this framework to a case study. It also highlights the unique ethical challenges presented by the assessment of older patients. We conclude that in order to appropriately protect the vulnerable population of older patients in the context of priority setting and allocation of scarce resources, there is a need to establish more specific criteria that can better guide the assessment of this particular population.