From the Guidelines
The most appropriate initial agent to manage agitation in a long-term care facility resident is a non-pharmacological approach, with low-dose atypical antipsychotics like quetiapine or risperidone considered for short-term use if necessary, as recommended by recent guidelines 1. Before considering medications, staff should first attempt behavioral interventions such as:
- Reorientation
- Distraction
- Addressing unmet needs (pain, hunger, toileting)
- Maintaining a calm environment
- Using familiar objects or music If medications become necessary after these approaches fail, low-dose atypical antipsychotics like quetiapine (25mg) or risperidone (0.25-0.5mg) may be considered for short-term use. Benzodiazepines like lorazepam should generally be avoided in elderly patients due to increased fall risk, confusion, and paradoxical agitation, except in alcohol withdrawal cases, as noted in previous studies 1. For residents with dementia, medications should be used cautiously with the lowest effective dose for the shortest duration possible, as antipsychotics carry black box warnings for increased mortality in elderly patients with dementia. The underlying cause of agitation should always be investigated, as addressing issues like pain, infection, medication side effects, or environmental triggers is preferable to symptom suppression with medications. Regular reassessment is essential to determine if medications can be reduced or discontinued once the resident stabilizes, highlighting the importance of a patient-centered approach in managing agitation in long-term care facilities 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Agitation Management in Long-Term Care Facilities
The management of agitation in long-term care facilities is a complex issue that requires a comprehensive approach. When it comes to selecting an appropriate agent to manage agitation, several options are available, including:
- Haloperidol
- Alprazolam
- Olanzapine
- Lorazepam
Evidence-Based Recommendations
According to the available evidence, the most appropriate initial agent to manage agitation in a resident at a long-term care facility is not explicitly stated in one single study. However, the following points can be considered:
- A study published in 2021 2 found that lorazepam is a clinically effective means of treating acute agitation, although it may not be superior to other agents such as olanzapine.
- Another study published in 1998 3 discussed the role of atypical antipsychotics, such as olanzapine, in managing agitation in long-term care settings.
- A study published in 1999 4 emphasized the importance of identifying and treating underlying causes of agitation, rather than just managing the symptoms.
- Non-pharmacological interventions, such as behavioral approaches and nursing interventions, have also been shown to be effective in reducing agitation in long-term care facilities 5, 6.
Considerations for Agent Selection
When selecting an agent to manage agitation, the following factors should be considered:
- The underlying cause of the agitation
- The resident's medical history and current medications
- The potential side effects and risks associated with each agent
- The availability of non-pharmacological interventions and their potential effectiveness in managing agitation.