The agitated older adult in the emergency department: a narrative review of common causes and management strategies

Agitation and aggression are common in older emergency department (ED) patients, can impede the expedient diagnosis of potentially life‐threatening conditions, and can adversely impact ED functioning and efficiency. Agitation and aggression in older adults may be due to multiple causes, but chief am...

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Published inJournal of the American College of Emergency Physicians Open Vol. 1; no. 5; pp. 812 - 823
Main Authors Kennedy, Maura, Koehl, Jennifer, Shenvi, Christina L., Greenberg, Allyson, Zurek, Olivia, LaMantia, Michael, Lo, Alexander X.
Format Journal Article
LanguageEnglish
Published Hoboken John Wiley and Sons Inc 01.10.2020
Wiley
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Summary:Agitation and aggression are common in older emergency department (ED) patients, can impede the expedient diagnosis of potentially life‐threatening conditions, and can adversely impact ED functioning and efficiency. Agitation and aggression in older adults may be due to multiple causes, but chief among them are primary psychiatric disorders, substance use, hyperactive delirium, and symptoms of dementia. Understanding the etiology of agitation in an older adult is critical to proper management. Effective non‐pharmacologic modalities are available for the management of mild to moderate agitation and aggression in patients with dementia. Pharmacologic management is indicated for agitation related to a psychiatric condition, severe agitation where a patient is at risk to harm self or others, and to facilitate time‐sensitive diagnostic imaging, procedures, and treatment. Emergency physicians have several pharmacologic agents at their disposal, including opioid and non‐opioid analgesics, antipsychotics, benzodiazepines, ketamine, and combination agents. Emergency physicians should be familiar with geriatric‐specific dosing, contraindications, and common adverse effects of these agents. This review article discusses the common causes and non‐pharmacologic and pharmacologic management of agitation in older adults, with a specific focus on dementia, delirium, and pain.
Bibliography:JACEP Open
The authors have stated that no such relationships exist.
policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see
By
Supervising Editor: Catherine A. Marco, MD.
www.icmje.org
“The Agitated and Combative Older Patient in the Emergency Department: Management Strategies and Potential Pitfalls,” presented at the Annual Meeting of the Society of Academic Emergency Medicine, May 17, 2018, in Indianapolis, Indiana by Alexander Lo, MD, PhD, Maura Kennedy, MD, MPH, and Michael LaMantia, MD, MPH.
Funding and support
Funding and support: ByJACEP Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.
ISSN:2688-1152
2688-1152
DOI:10.1002/emp2.12110