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Mortality from coronavirus disease 2019 (COVID-19) increases with age, and those over 80 are particularly vulnerable (Verity et al., 2020). Most national data on COVID-19 will underestimate mortality in older people. Triage and resource allocation protocols (Truog et al., 2020), and our understanding that it is often in the best interests of the frail older person to remain in their usual place of residence, may result in many deaths occurring outside of hospitals, particularly in care homes where these data may not be routinely collected.

However, the nature of COVID-19 is changing how people die. Patients can experience a sudden deterioration with rapid onset of respiratory failure. Frail older people and their families may have to make very quick decisions under highly stressful circumstances and decide whether to go to the hospital (where they risk iatrogenic harm, have proven worse outcomes, and will be separated …