Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital

Daniel Simpkins,1 Carmelle Peisah,2,3 Irene Boyatzis1 1Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, 2School of Psychiatry, University of New South Wales, 3Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia Aim: The management of severely agitated elde...

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Autores principales:	Simpkins D, Peisah C, Boyatzis I
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Aged aggression delirium dementia antipsychotic agents benzodiazepines Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/679b5ee45c9c4ea485fa9134b5123056
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spelling	oai:doaj.org-article:679b5ee45c9c4ea485fa9134b51230562021-12-02T06:10:57ZBehavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital1178-1998https://doaj.org/article/679b5ee45c9c4ea485fa9134b51230562016-10-01T00:00:00Zhttps://www.dovepress.com/behavioral-emergency-in-the-elderly-a-descriptive-study-of-patients-re-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Daniel Simpkins,1 Carmelle Peisah,2,3 Irene Boyatzis1 1Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, 2School of Psychiatry, University of New South Wales, 3Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia Aim: 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. Conclusion: 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. Keywords: aged, aggression, delirium, dementia, antipsychotic agents, benzodiazepinesSimpkins DPeisah CBoyatzis IDove Medical PressarticleAgedaggressiondeliriumdementiaantipsychotic agentsbenzodiazepinesGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 11, Pp 1559-1565 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Aged aggression delirium dementia antipsychotic agents benzodiazepines Geriatrics RC952-954.6
spellingShingle	Aged aggression delirium dementia antipsychotic agents benzodiazepines Geriatrics RC952-954.6 Simpkins D Peisah C Boyatzis I Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital
description	Daniel Simpkins,1 Carmelle Peisah,2,3 Irene Boyatzis1 1Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, 2School of Psychiatry, University of New South Wales, 3Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia Aim: 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. Conclusion: 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. Keywords: aged, aggression, delirium, dementia, antipsychotic agents, benzodiazepines
format	article
author	Simpkins D Peisah C Boyatzis I
author_facet	Simpkins D Peisah C Boyatzis I
author_sort	Simpkins D
title	Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital
title_short	Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital
title_full	Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital
title_fullStr	Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital
title_full_unstemmed	Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital
title_sort	behavioral emergency in the elderly: a descriptive study of patients referred to an aggression response team in an acute hospital
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/679b5ee45c9c4ea485fa9134b5123056
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Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital

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