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

  • Geriatric Psychiatry (S Lehmann, Section Editor)
  • Published:
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Abstract

Purpose of Review

This 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 Findings

Agitation 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.

Summary

Agitation management is as much about addressing unmet needs as it is about treatment of underlying etiologies. A careful and systematic approach is imperative to successful treatment. It allows the clinician to uncover what the patient is unable to convey and minimizes the risk that polypharmacy may bring. More research is needed into methods to quantify, anticipate, and safely treat agitation in older adults.

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Authors and Affiliations

  1. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Shobana Subramanian, Mario Fahed, Ebony Dix & Kirsten M. Wilkins

  2. Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA

    Mario Fahed

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  1. Shobana Subramanian
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Subramanian, S., Fahed, M., Dix, E. et al. Emergent and Non-Emergent Agitation in the Older Adult: Evaluation and Management. Curr Geri Rep 10, 73–81 (2021). https://doi.org/10.1007/s13670-021-00358-6

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