0856 Correcting Sleep/Wake Cycle and Reducing Combativeness in an 84-year-old Patient

Abstract

Abstract Introduction Sleep disruption is a common occurrence in hospitalized geriatric patients. Such patients frequently arrive at the emergency department for behavioral changes due to delirium, which can often be mistaken for, or compounded by, underlying dementia. Behavioral symptoms may vary, including disinhibition, aggression, distress during care, mood disturbance, and paranoia, affecting approximately 90% of patients. Effectively treating these patients is challenging; antipsychotic use is a commonly implemented treatment in hospitalized settings, but is complicated by adverse side effects and an increased risk of CVA. In this case report, we discuss the use of an antipsychotic, olanzapine, to treat an 84 year old hospitalized patient presenting with sleep disruption and changes in mental status. Report of Cases: An 84 year old gentleman with a history of Alzheimer’s dementia with worsening behavioral changes was admitted for urinary tract infection, humeral fracture secondary to mechanical fall, and increasing aggression toward his caretaker. At home the patient was sleeping during the day and more was active and combative at night. While hospitalized, he had become aggressive with hospital staff due to his distress and was minimally oriented at baseline. We trialed the patient on olanzapine 5mg at night to facilitate sleep and reduce his aggression, in addition to environmental changes to reorient day and night. After a few days of this treatment, this patient was much more pleasant and oriented, able to hold conversation, and no longer aggressive. His initial disposition was to be transferred to a memory care facility, given increasing safety concerns expressed by the caretaker. However, following these changes, he was able to return home in the comfort of his family and caretaker. Conclusion Antipsychotic use in the elderly for sleep disruption and behavioral disturbances is heavily debated, though there may be some benefit to their use. The CATIE-AD trial and a Cochrane Review suggest Olanzapine may reduce aggression, particularly in Alzheimer’s disease, and has the added benefit of sedation which aids in establishing sleep cycles. However, many patients discontinue antipsychotic treatment due to side effects and routine use is discouraged. When in use, regular monitoring should take place to evaluate for side effects associated with pharmacotherapy and continued therapeutic benefit should be reassessed. Support (If Any)