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. 2025 Aug:94:81-95.
doi: 10.1016/j.ajem.2025.04.019. Epub 2025 Apr 16.

Agitation management strategies for older adults in the emergency department or with emergency medical services: A scoping review

Fatima I Shah  1 , Grace Lew  2 , Zeeshan Chawdhry  3 , Krista Reich  2 , Kathryn Crowder  4 , Diane L Lorenzetti  5 , Margaret McGillivray  6 , Zahra Goodarzi  7
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Free article

Agitation management strategies for older adults in the emergency department or with emergency medical services: A scoping review

Fatima I Shah et al. Am J Emerg Med. 2025 Aug.
Free article

Abstract

Background: Agitation is common in the emergency department (ED) and with emergency medical services (EMS), which can pose significant challenges to safety and patient care. In older adults, agitation is a common symptom of dementia or delirium.

Rationale: Managing agitation in older adults is challenging in emergency care environments. A scoping review of literature for agitation management approaches for older adults in ED/EMS environments was completed.

Methods: We searched Medline, Embase, and APA PsycINFO, combining key words and subject headings for 3 concepts: "older adults, aged 65 and older," "agitation/dementia/delirium," and "ED/EMS." Studies which explored management strategies for older adults with agitation, dementia, or delirium in the ED or EMS were included. Studies with younger populations (<65 years old) and/or lacking patient data specifically from the ED or EMS were excluded.

Results: A total of 7113 studies were screened, of which 22 were included in this review: pharmacological (n = 8), non-pharmacological (n = 5), multi-component (n = 3) treatments, and recommendations (n = 6). Most were in the ED, and 5038 older adults were included across all studies. Antipsychotics and benzodiazepines to manage agitation were common. Non-pharmacological and multi-component interventions were less commonly evaluated and lacked exploration of patient outcomes. Recommendations stressed caution with pharmacological medications rather than prioritizing non-restraint strategies.

Discussion: Most studies identified use of pharmacological treatment for agitation amongst older adults in ED/EMS settings, however, are not found to be overly effective and are associated with patient harm. There is a significant gap in evidence specific to EMS settings and evaluation of effectiveness of non-pharmacological interventions, highlighting the need for further research.

Keywords: Agitation; Delirium; Dementia; Emergency department; Restraints.

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Conflict of interest statement

Declaration of competing interest We do not have any conflicts to report. ZG holds grants from the Canadian Institute of Health Research, Weston Foundation, Alberta Health, and the University of Calgary, as well as honoraria from the Canadian Coalition for Seniors' Mental Health and is on the boards for the Canadian Conference on Dementia, and the Canadian Association of Geriatric Psychiatry.

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