Aggressive behavior in the elderly is not synonymous with psychomotor agitation.
Agitation is a behavioral disorder characterized by exaggeration and abnormal psychomotor activity, leading to a loss of control of thoughts and actions. It is a behavioral disorder that originates in suffering.
It does not necessarily justify hospitalization, which must most often be avoided (except in the case of somatic illness or serious psychiatric disorder). The possible causes are multiple and sometimes interdependent.
Agitation can be verbal, physical, and associated with aggression or not
It can have severe consequences for the elderly subject and others around him. Approximately 15% of elderly subjects hospitalized in psychiatry are hospitalized for aggressive agitation.
The subject does not stay in place; he wanders and gesticulates. He can scream and cling to others.
He can sometimes have violent gestures accompanied by falls and traumatism.
Their comments may be abusive or repetitive, and he can refuse to cooperate. Agitation may be permanent or intermittent, alternating with prostration.
The causes of psychomotor agitation
Confusion
This common syndrome in the elderly can lead to behavioral disorders such as agitation.
Anxiety
It can cause more or less confused agitation in the elderly. Chronic anxiety can lead to ambulation, insomnia, and irritability, accompanied by bodily manifestations: oppression, tremors, palpitations, and abdominal pain.
Hypomania
The elderly subject presents a state of hypomanic excitement that is euphoric and satisfied but sometimes suspicious, even aggressive. A toxic cause or a brain tumor should be sought if there is no history of manic-depressive disorders.
Depression
Certain depressions in the elderly may include phases of agitation with anxiety disorders. The person is in a sad mood and has a loss of interest and a feeling of emptiness.
Late delirium
Settling gradually can lead to behavioral disorders marked by agitation.
The subject feels persecuted and is experiencing emotional reactions.
Hallucinations
In certain dementias, they can be distressing.
Dementia
Behavioral disorders related to dementia are potentially dangerous manifestations for the person or others.
These behaviors are frequently added to the cognitive symptoms observed in dementia.
Agitation and aggression in dementia of Alzheimer’s may occur in approximately half of the patients depending on the care setting.
A crisis
A relational crisis within a family or the entourage can generate psychomotor agitation in the elderly.
Mourning
The mourning of a loved one, the loss of an animal, or money can trigger agitation.
Medical and surgical causes
- Hypoglycemia
- Hyperthyroidism
- fecal impaction
- Urinary retention
- Hyponatremia
- Pulmonary, urinary, or dental infection
- Meningitis
- Iatrogenic pathologies: drugs that can cause confusion (e.g., anticholinergics), diuretics, corticosteroids, caffeine, etc.
- Drug withdrawal (especially benzodiazepine)
- Alcoholic withdrawal
- The appearance of a heart rhythm disorder
- Hemodynamic disorder
- Subdural hematoma after a fall on the buttocks gone unnoticed or minimized
- Cerebrovascular or tumor pathology
Diagnostic
It is done by contacting the person, who can sometimes play down the situation. It is also necessary to inquire about the patient’s entourage.
The circumstances that provoked the psychomotor agitation must be specified, as well as the possible pathological history and the previous treatments.
Suppose the cause is not a psychiatric origin. In that case, the doctor must have the patient undergo a clinical examination to look for somatic reasons: blood test, blood sugar, creatinine, calcium, sodium, blood pressure and temperature, cardiovascular, pulmonary, abdominal, and skin condition (search for bruises, for example). Spatial and temporal orientation and signs of hemiparesis are also checked.
Treatment
The doctor’s presence can sometimes have a soothing sedative effect.
If this is not the case, sedative therapy may be necessary:
- Antipsychotic for urgent action.
- Benzodiazepine with a short half-life.
- Mood stabilizer (e.g., Depamide).
- An antidepressant
Sensory capture is a technique of the Gineste-Marescotti care methodology
to prevent restless behavior.