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Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital
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...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096780/ https://www.ncbi.nlm.nih.gov/pubmed/27826189 http://dx.doi.org/10.2147/CIA.S116376 |
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author | Simpkins, Daniel Peisah, Carmelle Boyatzis, Irene |
author_facet | Simpkins, Daniel Peisah, Carmelle Boyatzis, Irene |
author_sort | Simpkins, Daniel |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5096780 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-50967802016-11-08 Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital Simpkins, Daniel Peisah, Carmelle Boyatzis, Irene Clin Interv Aging Original Research 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. Dove Medical Press 2016-10-31 /pmc/articles/PMC5096780/ /pubmed/27826189 http://dx.doi.org/10.2147/CIA.S116376 Text en © 2016 Simpkins et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Original Research Simpkins, Daniel Peisah, Carmelle Boyatzis, Irene Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital |
title | 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_short | 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 |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096780/ https://www.ncbi.nlm.nih.gov/pubmed/27826189 http://dx.doi.org/10.2147/CIA.S116376 |
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