Frequency, severity, and treatment of agitation in young versus elderly patients in the ICU

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 Lt-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.