Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Management of Older Adults with Dementia in the ER

Int J Geriatr Psychiatry; ePub 2016 Oct 4; Silwanowicz, et al

There are significant differences in the management of dementia with and without neuropsychiatric symptoms (NPS) in an emergency room setting, a recent study found. Researchers conducted a retrospective cohort study that involved the medical and psychiatric emergency departments of a tertiary academic medical center. Participants included patients aged ≥65 years with dementia who presented between February 1, 2012, and July 16, 2014 (n=347). Subjects with documented NPS (n=78) were compared with a group of subjects without documented NPS (n=78) randomly selected from the overall group with dementia. They found:

  • Patients with NPS were more likely to have additional diagnostic testing performed and receive psychotropic medications.
  • Significantly fewer patients with NPS (59.0%) returned to their original setting from the emergency department than patients without NPS (76.9%).
  • Among patients with NPS, those who had a motor disturbance were more likely to receive psychotropic medications than patients who did not have a motor disturbance.
  • Patients with depression/dysphoria or anxiety were more likely to be psychiatrically hospitalized.


Silwanowicz RM, Maust DT, Seyfried LS, Chiang C, Stano C, Kales HC. Management of older adults with dementia who present to emergency services with neuropsychiatric symptoms. [Published online ahead of print October 3, 2016]. Int J Geriatr Psychiatry. doi:10.1002/gps.4599.

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