How Should We Interpret “Abnormal” Lab Results in Older Patients? Ethical and Practical Challenges of Establishing and Verifying Laboratory Reference Intervals in the United States

Laboratory reference intervals (RIs) are useful tools that assist healthcare workers with medical decision-making. With current laboratory establishment and verification techniques, older patients can be systematically excluded from the RI process. This in turn can lead to use of improper RIs that may not accurately reflect the normal physiologic variance of aging. Ethically, the use of improper RIs in older patients conflicts with the principles of justice and beneficence. By excluding older patients from laboratory RIs, any effects in this population's healthcare outcomes would reflect the intrinsic ageist structure of the current RI system. Ways to address this issue include active inclusion of older patients in establishment studies, or establishment of population specific RIs, though each solution has limitations. Use of artificial intelligence and informatics techniques also could prove useful in this endeavor. It is critical that healthcare providers understand these challenges when treating this population.