Abstract
IntroductionAgitation, mental illness, and delirium are common reasons for older adults to seek care in the emergency department (ED). There are significant knowledge gaps in understanding how to best screen older adults for these conditions and how to manage them. In addition, in areas where research has been performed, implementation has been slow. A working group convened to develop a set of high-priority research questions that would advance the understanding of optimal management of older adults with acute behavioral changes in the ED. This manuscript is the product of a breakout session on “Special Populations: Agitation in the Elderly” from the 2016 Coalition on Psychiatric Emergencies’ first Research Consensus Conference on Acute Mental Illness.MethodsParticipants were identified with expertise in emergency medicine (EM), geriatric EM, and psychiatry. Background literature reviews were performed prior to the in-person meeting in four key areas: delirium; dementia; substance abuse or withdrawal; and mental illness in older adults. Input was solicited from all participants during the meeting, and questions were iteratively focused and revised, voted on, and ranked by importance.ResultsFourteen questions were identified by the group with high consensus for their importance related to the care of older adults with agitation in the ED. The questions were grouped into three topic areas: screening and identification; management strategies; and the approach to delirium.ConclusionIt is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes, have the tools to screen older adults for those causes, and employ methods to treat the underlying causes and ameliorate their symptoms. Answers to the identified research questions have great potential to improve the care of older adults presenting with behavioral changes.
Highlights
Agitation, mental illness, and delirium are common reasons for older adults to seek care in the emergency department (ED)
It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes, have the tools to screen older adults for those causes, and employ methods to treat the underlying causes and ameliorate their symptoms
Answers to the identified research questions have great potential to improve the care of older adults presenting with behavioral changes. [West J Emerg Med.2019;20(2)393-402.]
Summary
Research Agenda for Assessment and Management of Acute Behavioral Changes in Elderly ED Patients likely to have functional decline, medical complications, or a revisit, re-hospitalization, or death.[4] This is in part because of physiologic changes that occur with aging, underlying frailty or other geriatric syndromes, more medical co-morbidities, atypical presentations of symptoms, reduced physiologic reserve, and greater risk of medication complications or interactions. Despite the existence of ED-validated, rapid screening tools, emergency physicians find recognizing delirium in the majority of their patients challenging.[5] It has been shown that alcohol and substance use or withdrawal in older adults is underrecognized by physicians, which could lead to a delay in diagnosis.[6] hearing and vision impairments in older adults can make it difficult for physicians to obtain an accurate history and physical exam All of these challenges can impede the rapid identification of the causes of behavioral changes in older adults
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
