Agitation

Abstract

Agitation, a term that includes behaviour such as excessive motor activity, verbal and physical aggression, is common in people with dementia. The assessment and management of agitation in older people can be challenging in primary care. Agitation may be the initial presentation of an early dementia, with a differential diagnosis that includes delirium, agitated depression, late life psychoses and anxiety disorders. In persons with established dementia, factors that contribute to agitation include acute medical problems, physical discomfort, communication difficulties, misinterpretations, carer and environmental problems and psychiatric comorbidity. Prevention of agitation by appropriate training of carers to provide person-centred care and by adapting the physical environment to meet the needs of people with dementia is paramount. Interventions to manage agitation should focus on non-pharmacological strategies first including addressing physical needs (e.g. pain relief), providing individualized psychosocial activities (e.g. physical exercise, music therapy, aromatherapy) in a regular structured program, educating and supporting the carers and optimizing the environment. In general, pharmacotherapy with psychotropic medication should be reserved for the more severe forms of agitation not responding to non-pharmacological interventions or when safety is seriously compromised and initially be used in trials of up to three months duration.