AGITATION IN THE OLDER ADULT WITH TRAUMATIC BRAIN INJURY

Improvements in medical care and health have resulted in an increase i n life expectancy and with it a steady increase in the number of older adults, which has resulted in an increasing number of brain-injured o lder adults. There is limited information available however, which spe cifically defines the incidence, management and outcome of behavioral sequelae, specifically agitation, in the older adult with TBI. The vas t majority of the available literature addressing interventions in the agitated older adult, focuses on the individual with a psychiatric or dementing process who is a resident of a long-term care facility. Agi tated behavior in the older adult with acute brain injury differs from this patient population and therefore management must also differ. Ma nagement includes behavioral strategies, environmental modifications, structured therapy sessions, appropriate medical management and neurop harmacologic interventions. There are no controlled studies which util ize standardized measures and examine the efficacy of these behavioral , environmental, therapeutical and pharmacological interventions for a gitation in the older adult following TBI. In general, considerable ca re must be taken when using medications in the older adult. Alteration s in absorption, pharmacokinetics, liver and renal metabolism, recepto r sensitivity, side-effect tolerance, and compliance must all be consi dered. This article aims to present available information and provide a practical and clinically effective guide for the management of agita tion in the older adult with brain injury.