Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital.
OBJECTIVE
The management of severely agitated elderly patients is not easy, and limited guidelines are available to assist practitioners. At a Sydney hospital, an Aggression Response Team (ART) comprising clinical and security staff can be alerted when a staff member has safety concerns. Our aims were to describe the patient population referred for ART calls, reasons for and interventions during ART calls, and complications following them.


METHODS
Patients 65 years and older referred for ART calls in the emergency department or wards during 2014 were identified using the Incident Information Management System database and medical records were reviewed. Demographic and clinical data were collected.


RESULTS
Of 43 elderly patients with ART calls, 30 had repeat ART calls. Thirty-one patients (72%) had underlying dementia, and 22 (51%) were agitated at the time of admission. The main reasons for ART calls were wandering and physical aggression. Pharmacological sedation was used in 88% of the ART calls, with a range of psychotropics, doses, and routes of administration, including intravenous (19%) and, most commonly, midazolam (53%). Complications were documented in 14% of cases where sedation was used.


CONCLUSIONS
We observed a high frequency of pharmacological sedation among the severely agitated elderly, with significant variance in the choice and dose of sedation and a high rate of complications arising from sedation, which may be an underestimate given the lack of post-sedation monitoring. We recommend the development of guidelines on the management of behavioral emergency in the elderly patients, including de-escalation strategies and standardized psychotropic guidelines.
Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital.
Daniel
D
Simpkins
School of Psychiatry, University of New South Wales; Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia.
Carmelle
C
Peisah
Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital.
Irene
I
Boyatzis
D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology*; D014150:Antipsychotic Agents / Q000008:administration & dosage; D003704:Dementia / Q000150:complications; D004333:Drug Administration Routes; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D055816:Wandering Behavior / Q000523:psychology*
D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives
aged; aggression; antipsychotic agents; benzodiazepines; delirium; dementia