Emergent and Non-Emergent Agitation in the Older Adult: Evaluation and Management

AbstractPurpose of ReviewThis paper aims to describe the heterogenous presentation of agitation in older adults. It will delve into semiology, diagnosis, classification, as well as treatment options available to address agitation.Recent FindingsAgitation is a common and distressing symptom that poses risk to patients and caregivers. In older adults, it is often a manifestation of medical and neuropsychiatric conditions such as dementia, stroke, delirium, psychiatric disorders, catatonia, substance intoxication or withdrawal. Agitation in dementia is defined as excessive motor behavior and verbal or physical aggressive behavior, causing significant disability. Several tools are used to describe it; most notably, the Cohen-Mansfield Agitation Inventory (CMAI). Its evaluation is most complete with the DICE (Describe, Investigate, Create, Evaluate) approach which allows for examination of precipitating factors such as delirium, psychiatric disorders, pain, polypharmacy, constipation, environmental elements, and others. Non-pharmacological management should be attempted first, tailoring the treatment to the precipitants. If these fail, pharmacological treatments, although inherently risky, include non-emergent and emergent options. The former are antidepressants and cognitive enhancers, and the latter include antipsychotics, trazodone, and electroconvulsive therapy (ECT). Benzodiazepine use should be limited to excited catatonia or alcohol withdrawal.SummaryAgitation management is...

Source: Current Geriatrics Reports - July 28, 2021 Category: Geriatrics Source Type: research