Department of Medicine, Dunedin School of Medicine, University of Otago, c/o Older People's Health, Dunedin Hospital, Private Bag 1921, Dunedin 9054, New Zealand.
Age Ageing. 2020 Apr 27;49(3):334-336. doi: 10.1093/ageing/afz170.
The phrase 'not safe for discharge home' is often heard in relation to an older person in hospital, commonly due to functional limitations or risk of falls. But it remains unclear how such a standard of safety should be set in this context, or who should set it. In addition, labelling someone 'unsafe' to return to their own home has significant practical and ethical implications. After briefly exploring these issues, this Commentary suggests that a holistic approach and shared decision-making is required in this setting. Instead of simply declaring someone safe or unsafe for discharge home, specific 'safety concerns' (or 'hazards') should be identified and addressed as able. Ongoing specific concerns can then be discussed in conjunction with a patient's values and perceived benefits of returning home, in comparison with potential pros and cons of other discharge options. Overall, this paper suggests that paying attention to our words and values can enhance discharge planning and person-centred care.
“不适合出院回家”这句话在与住院的老年人有关时经常听到，通常是由于功能限制或跌倒风险。但目前尚不清楚在这种情况下应如何设定这种安全标准，或者应由谁来设定。此外，将某人标记为“不安全”返回自己的家会产生重大的实际和伦理影响。在简要探讨这些问题后，本评论建议在这种情况下需要采取整体方法和共同决策。与其简单地宣布某人出院回家安全或不安全，不如确定并尽可能解决具体的“安全问题”（或“危险”）。然后，可以根据患者的价值观和对返回家中的好处，与其他出院选择的潜在利弊进行比较，讨论持续存在的具体问题。总的来说，本文认为，关注我们的语言和价值观可以增强出院计划和以患者为中心的护理。
