Approach to managing acute agitation in palliative care

Acute agitation may represent an emergency for both patients with palliative care needs and their family and carers. Agitation may be a manifestation of delirium and its causes (eg pain, panic, constipation, urinary retention, hypercalcaemia, hypoglycaemia, hyponatraemia, drug toxicity or withdrawal), anxiety, panic or severe depression. In some patients, acute agitation is a sign that the patient is progressing (eg to the last days of life).

Management of acute agitation in palliative care is challenging, and focuses on ensuring the safety of the patient, staff and others.

Management depends on the cause and always includes nonpharmacological strategies. Pharmacological management may be required.

For information on acute behavioural disturbance (including assessment and nonpharmacological strategies), see Approach to managing acute behavioural disturbance in the Psychotropic guidelines.

For management of agitation in the last days of life, see Agitation and restlessness in the last days of life.