Pharmacological Management of Agitation in Hospitalized Elderly Patients: Evaluating Appropriateness and Standard Practices

Abstract

Background: Agitation in hospitalized older adults is common and can increase the risk of harm, mechanical ventilation duration, and prolonged hospital stays. Diagnosing and managing agitation in geriatric patients is especially complex due to overlapping symptoms with other conditions, altered pharmacokinetics, and increased sensitivity to adverse effects. This study aimed to evaluate the appropriateness of pharmacologic interventions for acute agitation in elderly inpatients and identify areas for improvement. Methods: A retrospective chart review was conducted at a public hospital in South Florida for patients ≥65 years old admitted between January 1 and June 30, 2024, who received medications for agitation management. Appropriateness was determined using Sedation-Agitation Scale (SAS) scores, medication administration patterns, and restraint use. Effectiveness, documentation quality, and adverse events were also assessed. Results: Among 72 encounters from 54 patients, 50% were classified as appropriate based on alignment with SAS scores and clinical restraint use. Effectiveness, defined as ≤1 as-needed dose per day, was observed in 68.1% of cases. Restraint use was significantly associated with appropriateness (χ² = 23.63, P < 0.0001), and although paradoxical, inappropriate regimens were more often effective (χ² = 5.39, P = 0.0203). Adverse effects were documented in only 6.9% of cases, and complete documentation was present in 27.8% of encounters. Conclusion: Findings reveal inconsistencies in agitation management and documentation, with frequent overtreatment and underreporting. There is a clear need for standardized, geriatric-focused treatment protocols and improved documentation practices to optimize safety and effectiveness.