ReviewJournal of the American College of Emergency Physicians open2020
The agitated older adult in the emergency department: a narrative review of common causes and management strategies.
Review in Journal of the American College of Emergency Physicians open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Comparative Safety of Medications for Severe Agitation: A Geriatric Emergency Department Guidelines 2.0 Systematic Review.Journal of the American Geriatrics Society · 2025Pooled it
- Can we improve delirium prevention and treatment in the emergency department? A systematic review.Journal of the American Geriatrics Society · 2022Pooled it
- A retrospective cohort study on the association between antipsychotics prior to and in the emergency department and their longer-term impacts in older adults with acute agitation.Internal medicine journal · 2026Article
- Exploring Current Emergency Medical Services Approaches to Manage Agitated Older Adult Patients: An Analysis of Statewide Protocols.Journal of the American Geriatrics Society · 2026Article
- Prehospital pain management in older adults with proximal Femur fractures: current practices and implications for delirium prevention.SAGE open medicine · 2026Article
- Association of Antipsychotic Dose with Surrogate Efficacy and Safety Outcomes in Hospitalized Older Adults: A Retrospective Cohort Study.Drugs & aging · 2025Article
- "I know you didn't want to stay": emergency department conversations about disposition for people living with dementia.The Gerontologist · 2025Article
- Perceptions and Practices of Clinicians Undertaking Invasive Procedures With Patients Experiencing Delirium in Hospital: A Sequential Mixed Methods Study.Nursing & health sciences · 2025Article
- Delirium Prevention and Management in Older Adults in the Emergency Department.Emergency medicine clinics of North America · 2025Review
- Racial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department.The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry · 2025Article
- Optimizing older patient care in emergency departments: a comprehensive survey of current practices and challenges in Northern Italy.BMC emergency medicine · 2024Article
- How do emergency department staff respond to behaviour that challenges displayed by people living with dementia? A mixed-methods study.BMJ open · 2023Article
- Characterizing PRN Use of Psychotropic Medications for Acute Agitation in Canadian Long-Term Care Residents with Dementia Before and During COVID-19.Journal of Alzheimer's disease reports · 2023Article
- Emergency Psychiatry: Updates, Future Directions, and Core Concepts.Focus (American Psychiatric Publishing) · 2023Article
- Updates in the Assessment and Management of Agitation.Focus (American Psychiatric Publishing) · 2023Article
- Enhancing the quality of prescribing practices for older adults discharged from the emergency department in Rhode Island.Journal of the American Geriatrics Society · 2022Article
- Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review.Journal of the American Medical Directors Association · 2022Article
- Article
- Hospitalizations of older people in an emergency department related to potential medication-induced hyperactive delirium: a cross-sectional study.International journal of clinical pharmacy · 2022Article
- Evaluating older adults with cognitive dysfunction: A qualitative study with emergency clinicians.Journal of the American Geriatrics Society · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Agitation and aggression are common in older emergency department (ED) patients, can impede the expedient diagnosis of potentially life-threatening conditions, and can adversely impact ED functioning and efficiency. Agitation and aggression in older adults may be due to multiple causes, but chief among them are primary psychiatric disorders, substance use, hyperactive delirium, and symptoms of dementia. Understanding the etiology of agitation in an older adult is critical to proper management. Effective non-pharmacologic modalities are available for the management of mild to moderate agitation and aggression in patients with dementia. Pharmacologic management is indicated for agitation related to a psychiatric condition, severe agitation where a patient is at risk to harm self or others, and to facilitate time-sensitive diagnostic imaging, procedures, and treatment. Emergency physicians have several pharmacologic agents at their disposal, including opioid and non-opioid analgesics, antipsychotics, benzodiazepines, ketamine, and combination agents. Emergency physicians should be familiar with geriatric-specific dosing, contraindications, and common adverse effects of these agents. This review article discusses the common causes and non-pharmacologic and pharmacologic management of agitation in older adults, with a specific focus on dementia, delirium, and pain.
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Registered trials
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