What medication can be given acutely to an agitated elderly woman in her 80s with agitation?

From the Guidelines

For an agitated elderly woman in her 80s, low-dose risperidone (0.25 mg per day at bedtime) or quetiapine (12.5 mg twice daily) can be given acutely, as these atypical antipsychotics have a diminished risk of developing extrapyramidal symptoms and tardive dyskinesia compared to typical antipsychotic agents 1. When considering medication, it's essential to identify and address potential underlying causes of agitation, such as pain, urinary retention, constipation, or delirium. Non-pharmacological approaches should be tried first, including reorientation, creating a calm environment, and having familiar people present. Some key points to consider when administering medication to an agitated elderly woman include:

• Starting with the lowest effective dose to minimize side effects, as elderly patients are more sensitive to medications and at higher risk for adverse effects like sedation, falls, and paradoxical reactions 1.
• Being aware that antipsychotics carry a black box warning for increased mortality in elderly patients with dementia, so they should be used at the lowest dose for the shortest duration possible 1.
• Regular reassessment is crucial to determine if the medication can be discontinued once the acute agitation resolves. Other medication options, such as lorazepam (0.5-1mg orally or intramuscularly), may also be effective, especially if anxiety is contributing to the agitation, but should be used with caution due to the risk of tolerance, addiction, depression, and cognitive impairment 1. It's also important to note that the American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia recommends that decisions about treatment should balance the potential benefits and harms of a particular intervention as compared to other therapeutic options for the individual patient 1.

From the Research

Medication Options for Agitated Elderly Women

• For an agitated elderly woman in her 80s, several medication options can be considered acutely, including:
  • Anti-depressants, such as citalopram or escitalopram, which have been shown to be effective in treating agitation in Alzheimer's disease dementia 2
  • Anti-psychotics, such as risperidone or quetiapine, which can be effective in treating agitation, but require careful consideration of potential adverse effects 3
  • Benzodiazepines, which can be used in the emergency department to manage acute agitation, but may have a higher risk of adverse events, such as respiratory depression or falls 4
• The choice of medication depends on the patient's comorbidities, specific symptoms, and tolerance of medications 5
• It is essential to identify and address underlying medical and environmental precipitants of agitation, and to use non-pharmacological management strategies before initiating medication 6, 3

Considerations for Medication Use

• When using medications to treat agitation in elderly women, it is crucial to consider the potential risks and benefits, as well as patient-specific factors that may increase the risk of adverse effects or treatment failure 4
• Regular monitoring of the patient's response to medication and adjustment of the treatment plan as needed is essential to ensure effective and safe management of agitation 3
• The use of medications, such as antipsychotics, should be carefully considered, and alternative options, such as anti-depressants or benzodiazepines, may be preferred in certain situations 2, 4