What can be done for a 74-year-old female presenting to the Emergency Room (ER) with increased anxiety and feelings of being overwhelmed?

From the Guidelines

For a 74-year-old female presenting with anxiety and feeling overwhelmed, I recommend starting with a brief assessment to rule out medical causes while providing immediate support, and consider lorazepam 0.5mg orally as a first-line option for acute anxiety relief in elderly patients, with careful monitoring for side effects, as suggested by the Annals of Emergency Medicine 1.

Initial Assessment and Support

Begin with non-pharmacological interventions including:

• Validation of her concerns
• Deep breathing exercises
• Grounding techniques in a quiet area of the ER This approach is crucial in establishing trust and reducing anxiety levels immediately.

Medication Considerations

For medication, consider lorazepam 0.5mg orally as it is recommended for acute anxiety relief in elderly patients, with careful monitoring for side effects such as fall risk, cognitive impairment, and dependence concerns in older adults, as noted in the study published in the Annals of Emergency Medicine 1.

Follow-Up and Ongoing Care

Before discharge, arrange follow-up with a primary care provider or mental health specialist within 1-2 weeks, provide education about anxiety management techniques, and consider referral to senior support services. This approach balances immediate symptom relief with safety considerations specific to geriatric patients, addressing both the acute presentation and establishing a path for ongoing care, as emphasized in the Journal of Clinical Oncology 1 and further supported by the importance of screening and managing anxiety in women as discussed in the Annals of Internal Medicine 1.

Key Considerations

• Avoid benzodiazepines for long-term use due to potential risks
• Monitor for side effects and adjust treatment as necessary
• Emphasize the importance of follow-up care for ongoing management and support This comprehensive approach prioritizes the patient's immediate relief, safety, and long-term well-being, aligning with the principles of managing anxiety and its impact on quality of life, as highlighted across the referenced studies 1.

From the FDA Drug Label

Lorazepam Oral Concentrate is a prescription medicine used: to treat anxiety disorders for the short-term relief of the symptoms of anxiety or anxiety that can happen with symptoms of depression

For a 74-year-old female presenting to the Emergency Room (ER) with increased anxiety and feelings of being overwhelmed, lorazepam oral concentrate may be considered for the short-term relief of anxiety symptoms. However, it is crucial to weigh the potential benefits against the risks, particularly given the patient's age and potential for abuse, misuse, and addiction 2.

• The patient's medical history, including any history of drug or alcohol abuse or addiction, depression, mood problems, or suicidal thoughts or behavior, should be carefully evaluated.
• The patient should be closely monitored for serious side effects, including respiratory depression, coma, and death, especially when taking lorazepam with opioids or other central nervous system depressants.
• The patient should be advised not to drive or operate heavy machinery until the effects of lorazepam are known.
• It is essential to follow the prescribed dosage and not take more than prescribed to minimize the risk of physical dependence and withdrawal reactions.

From the Research

Assessment and Treatment Options

For a 74-year-old female presenting to the Emergency Room (ER) with increased anxiety and feelings of being overwhelmed, several treatment options can be considered:

• The patient's symptoms should be thoroughly assessed to determine the underlying cause of anxiety, as it may be related to an underlying medical condition or a psychiatric disorder 3.
• Benzodiazepines may be considered for short-term use, but their long-term use is generally not recommended due to the risk of dependence, rebound symptoms, and cognitive impairment 4, 5.
• Selective serotonin reuptake inhibitors (SSRIs) are often recommended as a first-line treatment for anxiety disorders in older adults, as they are generally well-tolerated and effective 3, 6.
• Cognitive behavioral therapy (CBT) is also a recommended treatment option for anxiety disorders in older adults, as it can be an effective and non-pharmacological approach 3, 6.

Considerations for Treatment

When selecting a treatment option, several factors should be considered:

• The patient's medical history and current medications should be reviewed to ensure that any potential interactions or contraindications are identified 7, 5.
• The patient's preferences and values should be taken into account when selecting a treatment option 6.
• The potential risks and benefits of each treatment option should be carefully weighed, and the patient should be closely monitored for any adverse effects 7, 5.

Alternative Therapies

Several alternative therapies may be considered for treating anxiety in older adults:

• Non-pharmacological approaches, such as sleep restriction-sleep compression therapy and CBT, may be effective for treating insomnia and anxiety 5.
• Alternative pharmacological agents, such as buspirone, may be considered for treating anxiety in older adults 4.