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Pharmacological Management of Agitation and Delirium in Older Adults: a Survey of Practices in Canadian Emergency Departments
Agitation is a common presenting symptom of delirium for older adults in the emergency department (ED). No medications have been found to reduce delirium severity, symptoms, or mortality, yet they may cause harm. Guidelines suggest using medications only when patients are posing a risk of harm, situ...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Canadian Geriatrics Society
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10444529/ https://www.ncbi.nlm.nih.gov/pubmed/37662063 http://dx.doi.org/10.5770/cgj.26.666 |
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author | Russek, Natanya S. Skappak, Christopher Scheuermeyer, Frank Brousseau, Audrey-Anne McLeod, Shelley L. Melady, Don Spencer, Martha |
author_facet | Russek, Natanya S. Skappak, Christopher Scheuermeyer, Frank Brousseau, Audrey-Anne McLeod, Shelley L. Melady, Don Spencer, Martha |
author_sort | Russek, Natanya S. |
collection | PubMed |
description | Agitation is a common presenting symptom of delirium for older adults in the emergency department (ED). No medications have been found to reduce delirium severity, symptoms, or mortality, yet they may cause harm. Guidelines suggest using medications only when patients are posing a risk of harm, situations which may arise frequently in the ED. We sought to characterize prescribing patterns of medications for agitation by ED physicians in Canadian hospitals. In this multicenter study, we surveyed physicians in Vancouver, Toronto, and Sherbrooke. Descriptive statistics were used to summarize group characteristics and starting doses were compared to order sets. Fisher exact tests were used for demographic comparison. Ordinal linear regression models were run to identify a relationship between starting dose of medications and location. Of the 137 physicians invited, 77 (56%) completed the survey. Use of order sets was greatest in Sherbrooke and least in Vancouver. The most common medications used across sites were haloperidol, lorazepam, and quetiapine. Benzodiazepines were used across all sites but were used significantly more frequently in Vancouver than the other sites. Practice location was a significant predictor of starting dose of haloperidol, with Sherbrooke and Toronto having a lower starting dose than Vancouver. Higher use of order sets correlated with lower and more consistent starting doses. Benzodiazepines are used across EDs in Canada despite little evidence for efficacy in delirium and risk of harm. Implementation of order sets may be a useful way to standardize ED management of older adults experiencing hyperactive delirium. |
format | Online Article Text |
id | pubmed-10444529 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Canadian Geriatrics Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-104445292023-09-01 Pharmacological Management of Agitation and Delirium in Older Adults: a Survey of Practices in Canadian Emergency Departments Russek, Natanya S. Skappak, Christopher Scheuermeyer, Frank Brousseau, Audrey-Anne McLeod, Shelley L. Melady, Don Spencer, Martha Can Geriatr J Short Reports Agitation is a common presenting symptom of delirium for older adults in the emergency department (ED). No medications have been found to reduce delirium severity, symptoms, or mortality, yet they may cause harm. Guidelines suggest using medications only when patients are posing a risk of harm, situations which may arise frequently in the ED. We sought to characterize prescribing patterns of medications for agitation by ED physicians in Canadian hospitals. In this multicenter study, we surveyed physicians in Vancouver, Toronto, and Sherbrooke. Descriptive statistics were used to summarize group characteristics and starting doses were compared to order sets. Fisher exact tests were used for demographic comparison. Ordinal linear regression models were run to identify a relationship between starting dose of medications and location. Of the 137 physicians invited, 77 (56%) completed the survey. Use of order sets was greatest in Sherbrooke and least in Vancouver. The most common medications used across sites were haloperidol, lorazepam, and quetiapine. Benzodiazepines were used across all sites but were used significantly more frequently in Vancouver than the other sites. Practice location was a significant predictor of starting dose of haloperidol, with Sherbrooke and Toronto having a lower starting dose than Vancouver. Higher use of order sets correlated with lower and more consistent starting doses. Benzodiazepines are used across EDs in Canada despite little evidence for efficacy in delirium and risk of harm. Implementation of order sets may be a useful way to standardize ED management of older adults experiencing hyperactive delirium. Canadian Geriatrics Society 2023-09-01 /pmc/articles/PMC10444529/ /pubmed/37662063 http://dx.doi.org/10.5770/cgj.26.666 Text en © 2023 Author(s). https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivative license (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use and distribution, provided the original work is properly cited. |
spellingShingle | Short Reports Russek, Natanya S. Skappak, Christopher Scheuermeyer, Frank Brousseau, Audrey-Anne McLeod, Shelley L. Melady, Don Spencer, Martha Pharmacological Management of Agitation and Delirium in Older Adults: a Survey of Practices in Canadian Emergency Departments |
title | Pharmacological Management of Agitation and Delirium in Older Adults: a Survey of Practices in Canadian Emergency Departments |
title_full | Pharmacological Management of Agitation and Delirium in Older Adults: a Survey of Practices in Canadian Emergency Departments |
title_fullStr | Pharmacological Management of Agitation and Delirium in Older Adults: a Survey of Practices in Canadian Emergency Departments |
title_full_unstemmed | Pharmacological Management of Agitation and Delirium in Older Adults: a Survey of Practices in Canadian Emergency Departments |
title_short | Pharmacological Management of Agitation and Delirium in Older Adults: a Survey of Practices in Canadian Emergency Departments |
title_sort | pharmacological management of agitation and delirium in older adults: a survey of practices in canadian emergency departments |
topic | Short Reports |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10444529/ https://www.ncbi.nlm.nih.gov/pubmed/37662063 http://dx.doi.org/10.5770/cgj.26.666 |
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