Acute agitation in an older patient in the emergency department often has a simple, treatable driver. Urinary retention, faecal impaction, pain, hypoxia, hypoglycaemia and drug withdrawal or toxicity are common, quick to check and easily missed once a sedative has been given.
A bladder scan, a glucose, saturation and a look at the drug chart take minutes. Sedation can hide the signal and add falls and aspiration risk.
- Check capillary glucose and oxygen saturation in every acutely agitated older patient.
- Scan the bladder or examine for retention before giving a sedative.
- Assess and treat pain, including in patients who cannot describe it.
- Review recent medication changes, especially anticholinergics, opioids and benzodiazepine withdrawal.
Why it matters
Sedation treats the behaviour and can hide the cause.
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