Older adults in behavioural emergencies were more often sedated and less often restrained by EMS than younger adults

Design

Cross-sectional analysis of a national convenience sample of EMS encounters, 2023

Population

1,468,697 behavioural health emergency encounters handled by ALS units; 238,754 involved adults aged 65 or older

Primary outcome

Use of physical restraint or chemical sedation by age group

Effect

Sedated 69.2% vs 61.3%; restrained 39.7% vs 52.7% (older vs younger adults)

This US cross-sectional study used a national convenience sample of 1,468,697 emergency medical service encounters for behavioural health emergencies in 2023 handled by advanced life support units. Of these, 238,754 (16.3%) involved adults aged 65 or older.

Among 65,088 encounters where sedation or restraint was used (5,915 older adults, 9.1%), older adults were more likely to be sedated (69.2% vs 61.3%) and less likely to be restrained (39.7% vs 52.7%) than younger adults. Benzodiazepines were used more often in older adults (52.8% vs 45.3%), antipsychotics at similar rates (15.4% vs 14.9%) and ketamine slightly less (5.5% vs 6.6%).

The authors call for evidence-based protocols and training specific to older adults, since agitation in older people is often delirium or dementia-related and sedatives carry particular risks.

• Consider delirium, pain, retention, infection and drug effects as causes of agitation in an older person before sedating.
• Use non-drug de-escalation first where it is safe.
• Use the lowest effective sedative dose and monitor breathing and blood pressure afterwards.
• Be cautious with benzodiazepines in older adults, where falls and delirium risks are higher.
• Support local EMS and emergency teams in adopting age-specific protocols.

Why it matters

Agitation in an older adult usually has a medical cause, and sedating first can mask it.

Don't overread it

A descriptive US study of EMS records; it does not show harm or define the right drug, and practice elsewhere may differ.

The statistics, in plain English

The comparisons are percentages within those who were restrained or sedated, so they do not give the rate in all older adults. A convenience sample may not represent all services, and descriptive data cannot show appropriateness or harm.

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