Risky Discharges: Are We Too Cautious?

Abstract

Some elderly individuals choose to remain at home, despite considerable risks of injury or even death. We followed 19 patients who returned home despite all of the multidisciplinary team considering that they were extremely unsafe and at considerable risk. At six months, 10(53%) were still at home, 5(26%) were in rest homes, 1(5%) was in long stay hospital care and 3(16%) had died. The three patients who “failed to manage” at home, did so early (within one day), emphasising the importance of a “trial leave” period Patients who lived with a carer were more likely to remain at home than those who lived alone (p = 0.006), These findings suggest that very frail, “at risk”, elderly patients can often manage at home despite considerable dangers.

Stroke discharges from a rehabilitation unit: 1‐year and 5‐year domicile outcomes. Function is important

“…Function at discharge was a key predictor of early failed discharges (in this case lower functioning predicted early failure). A high rate of early failed discharges may indicate premature discharge whereas a very low ‘failure’ rate may indicate an unwillingness to take a risk 7 . Home is where most older people want to be, and so for patients who want to return home and the risks are manageable, they should be given the opportunity of trying again 25…”

“…Too many early failed discharges may indicate inadequate preparation. Too few may suggest that we are not taking enough risks for our patients 7 . Failure to take a chance can result in premature discharge to institutional care, without trying at home first.…”