The edition · Geriatrics
Agitation in Alzheimer's dementia: an expert panel puts function and safety ahead of sedation
A consensus panel sets out a primary-care pathway: assess, look for reversible causes, try non-drug measures first, and choose any drug on its safety profile. Plus end-of-life decisions in dementia, bright light for delirium, and robotic surgery in older adults.
The edition in brief
An expert consensus panel convened in April 2026 advised that agitation in Alzheimer's dementia be managed to reduce distress and preserve function rather than to sedate, starting with a structured behavioural assessment using validated tools, a search for reversible causes and non-drug interventions, and choosing any medicine on comparative safety given the known harms of off-label antipsychotic use. It is expert opinion, not a systematic guideline. In 5,389 US decedents, those with dementia more often had an advance directive (81.3% vs 69.1%) but were far more often unable to take part in end-of-life decisions (78.9% vs 48.0%), with children usually deciding. A meta-analysis of eight studies found bright light therapy's effect on delirium in hospital uncertain (RR 0.64, 0.38 to 1.07), with very low certainty. A review of 41 observational studies found robotic surgery in older adults associated with fewer colorectal conversions (OR 0.36) but no clear difference in complications, and no randomised trials.
An advance directive is not the end of decision-making in dementia
Treat an advance directive in dementia as the start of an ongoing conversation with the family, not a substitute for it.
Bright light for delirium prevention: a hopeful but uncertain signal
Support day-night rhythm on the ward as part of multicomponent delirium prevention; dedicated bright light therapy remains unproven.
Robotic surgery in older adults: fewer colorectal conversions, no proven recovery benefit
Base preoperative advice for older adults on frailty and function, not on whether surgery is robotic.
Screen for delirium in every older adult admitted acutely
Screen every acutely admitted older adult for delirium, and search for causes when positive.
Agitation in Alzheimer's: assess and treat causes before reaching for sedation
In Alzheimer's agitation, assess and treat reversible causes and try non-drug measures before medicines, and choose any drug on its safety.
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