Agitation in the older adult with traumatic brain injury

Improvements in medical care and health have resulted in an increase in life expectancy and with it a steady increase in the number of older adults, which has resulted in an increasing number of brain-injured older adults. There is limited information available however, which specifically defines the incidence, management and outcome of behavioral sequelae, specifically agitation, in the older adult with TBI. The vast majority of the available literature addressing interventions in the agitated older adult, focuses on the individual with a psychiatric or dementing process who is a resident of a long-term care facility. Agitated behavior in the older adult with acute brain injury differs from this patient population and therefore management must also differ. Management includes behavioral strategies, environmental modifications, structured therapy sessions, appropriate medical management and neuropharmacologic interventions. There are no controlled studies which utilize standardized measures and examine the efficacy of these behavioral, environmental, therapeutical and pharmacological interventions for agitation in the older adult following TBI. In general, considerable care must be taken when using medications in the older adult. Alterations in absorption, pharmacokinetics, liver and renal metabolism, receptor sensitivity, side-effect tolerance, and compliance must all be considered. This article aims to present available information and provide a practical and clinically effective guide for the management of agitation in the older adult with brain injury.