Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Intern Med J. 2011 Sep;41(9):651-7. doi: 10.1111/j.1445-5994.2011.02560.x.
The vulnerability of older people to serious underlying medical illness and adverse effects of psychotropics means that the safe and effective treatment of severe agitation can be lifesaving, the primary management goals being to create a safe environment for the patient and others, and to facilitate assessment and treatment. We review the literature on acute sedation and provide practical guidelines for the management of this problem addressing a range of issues, including aetiology, assessment, pharmacological and non-pharmacological strategies, restraint and consent. The assessment of the agitated older patient must include concurrent assessment of the likely aetiology of, the risks posed by, and the risks/benefits of management options for, the agitation. A range of environmental modifications and non-pharmacological strategies might be implemented to maximize the safety of the patient and others. Physical restraints should only be considered after appropriate assessment and trial of alternative management and if the risk of restraint is less than the risk of the behaviour. Limited evidence supports a range of pharmacological options from traditional antipsychotics to atypical antipsychotics and benzodiazepines. It is advised to start low and go slow, using small increments of dose increase. Medical staff are frequently called to sedate agitated older patients in hospital settings, often after hours, with limited access to relevant medical information and history. Safe and effective management necessitates adequate assessment of the aetiology of the agitation, exhausting all non-pharmacological strategies, and resorting to pharmacological and/or physical restraint only when necessary, judiciously and for a short-term period, with frequent review and the obtaining of consent as soon as possible.
老年人易患严重基础疾病和精神药物不良反应，因此，严重激越的安全有效治疗可能挽救生命，主要管理目标是为患者和他人创造安全的环境，并促进评估和治疗。我们回顾了关于急性镇静的文献，并为解决一系列问题提供了管理这一问题的实用指南，包括病因、评估、药物和非药物策略、约束和同意。评估激越的老年患者必须包括对激越的可能病因、对患者和他人构成的风险以及管理选择的风险/益处的同时评估。可以实施一系列环境改变和非药物策略，以最大限度地提高患者和他人的安全性。只有在适当评估替代管理方法并在约束风险小于行为风险的情况下，才应考虑使用身体约束。有限的证据支持从传统抗精神病药到非典型抗精神病药和苯二氮䓬类药物的一系列药物选择。建议低剂量起始，缓慢增加剂量，逐渐增加。医务人员经常在医院环境中为激越的老年患者镇静，通常在非工作时间，并且只能有限地获得相关医疗信息和病史。安全有效的管理需要充分评估激越的病因，用尽所有非药物策略，仅在必要时才使用药物和/或身体约束，并且要明智地、短期地进行，并经常进行评估并尽快获得同意。
