Safely Caring for the Agitated Older Adult in the Emergency Department
With Dr. Maura Kennedy
Dementia is highly prevalent among older adults. One in three older adults over the age of 85 have dementia, but only 50% of these cases are documented. Dementia also puts the patient at higher risk of developing delirium while in the Emergency Department. All this leads to a greater likelihood that older adults in our EDs may have some agitation whether due to confusion, delirium, pain, or an underlying dementia.
Dr. Christina Shenvi and Dr. Maura Kennedy sit down to answer the question: How can we safely and affectively manage patients who have agitation, delirium or at risk of hurting themselves or others?
Key points
- Identifying the underlying cause of the agitation and treat the cause rather than the symptom.
- Invest a bit of time getting a collateral history to determine if the agitated patient has dementia to save time in the long run.
- Dementia is highly prevalent (1 in 5 over 80 and 1 in 3 over 85) and under documented (only 50% of cases). Always get collateral history or screen for cognitive impairment with your older adult patients.
References
- JACEP open narrative summary of agitation in older adults https://pubmed.ncbi.nlm.nih.gov/33145525/
- Antipsychotic and sedative use in older adults: https://pubmed.ncbi.nlm.nih.gov/34820831/
- Delirium in COVID-19 – https://pubmed.ncbi.nlm.nih.gov/33211114/)