Potential harms of pharmacological management for acute behavioural disturbance in older people
Pharmacological management for older people with acute behavioural disturbance can be associated with potential harms. If pharmacological management is used, consider seeking expert advice, and always monitor the patient closely for adverse drug effects; see Principles of monitoring patients with acute behavioural disturbance for more information.
Potential harms that are associated with sedative drugs include:
- oversedation
- falls
- complications of immobility (eg pressure injury)
- airway obstruction
- loss of airway tone and protective reflexes
- laryngospasm
- respiratory depression
- aspiration
- QT-interval prolongation and arrhythmias
- hypotension
- extrapyramidal adverse effects of antipsychotic drugs
- anticholinergic adverse effects of antipsychotic drugs
- paradoxical agitation.
Oversedation, causing unconsciousness and loss of protective airway reflexes, is an emergency—if this occurs, seek expert assistance to manage the airway and breathing urgently according to advanced life support protocols1.
Some older people have a higher risk of adverse effects after sedative drug administration, including older people with:
- severely limiting systemic disease
- high levels of frailty
- morbid obesity
- obstructive sleep apnoea
- known or suspected difficult endotracheal intubation
- severe anaemia
- increased risk of aspiration of stomach contents
- previous adverse events associated with sedation, analgesia or anaesthesia
- cognitive impairment—people with cognitive impairment have a higher risk of falls and injuries after sedation
- concomitant sedative use.