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Frequency, severity, and treatment of agitation in young versus elderly patients in the ICU
G L Fraser1, B S Prato, R R Riker
1University of Vermont College of Medicine, Burlington, USA.
Study Objective:
To study the frequency, duration, severity, and treatment of agitation in patients in the intensive care unit (ICU) to determine if the elderly represent a distinct population.
Design:
Prospective cohort study
Setting:
Tertiary care, 10-bed, multidisciplinary ICU.
Patients:
All patients older than 18 years of age admitted for longer than 24 hours during a 4-month period.
Interventions:
None.
Measurements And Main Results:
One hundred thirty patients were studied for 916 patient-days; 63 (48%) were elderly (> 65 yrs). Nurses and physicians described agitated behavior in 92 patients (70.8%) during 534 (58.3%) patient-days, and it was severe or dangerous in 60 patients (46.1%) during 273 (30%) patient-days. There were no age-related differences in frequency, severity, and duration of agitation. Opiates, benzodiazepines, and haloperidol were administered during 72%, 62%, and 29% of agitated patient-days, respectively. Haloperidol was administered more often to elderly patients (p=0.015); otherwise no between-group differences were noted. Daily dosing requirements were less in the elderly for intermittent intravenous lorazepam, haloperidol, and morphine but not for midazolam (p=0.15). When these dosages were corrected for body mass, no statistical differences between young and old were found.
Conclusion:
In the ICU, the elderly are not a distinct population for agitation.