Agitation and Delirium: Can Alternative Therapies Help?

Agitation and delirium are common problems in the cognitively impaired elderly. Agitated individuals exhibit emotional distress along with excess motor activity, and verbal or physical aggression. More than 20% of patients in community or nursing home settings experience agitation.

Delirium is a fluctuating course of cognition change combined with attention and awareness disturbances. Occurring in approximately 20% of hospitalized patients, and 50% of older intensive care unit patients, delirium has been associated with increased morbidity, mortality, and financial burden.

Providers have used antipsychotic medications to treat agitation and delirium, but severe adverse effects limit their utility. Researchers have not studied enough non-pharmacological approaches to treatment, including reorientation, sensory therapy, and decreased restraint use.

The International Journal of Geriatric Psychiatry published a systematic review of complementary and alternative medicine (CAM) use for the treatment of agitation and delirium in their January 2017 issue. Researchers from the Bnai Zion Medical Center in Haifa, Israel queried common scientific databases and collected 40 articles detailing CAM therapies and their efficacies.

Of the 40 selected articles, 16 were randomized controlled trials, and 39 involved older patients with dementia. Assessing agitation-related factors such as cortisol level, chromogranin A level, and heart rate variability, 35 studies supported CAM use to alleviate agitation and delirium severity. No studies reported major adverse effects, but most did not investigate adverse events aggressively, according to the study authors.

Several types of pharmacological CAM therapies showed beneficial effects for agitation and delirium. Vitamin B₁₂ was effective in vitamin-deficient patients. Other options include apple juice, omega 3, sage, lemon balm, and Yi-Gan San (combination of several Chinese herbs).

Some evidence supported acupressure, aromatherapy, and massage as useful nonpharmacological CAM therapies for agitated elderly patients.

The authors concluded that although these therapies showed promise, larger-scale, more diverse studies are required to confirm their effectiveness. They also suggested exploring combination treatment with CAM and traditional medication to expand therapy options.

Reference

Levy I, Attias S, Ben-Arye E, Bloch B, Schiff E. Complementary medicine for treatment of agitation and delirium in older persons: a systematic review and narrative synthesis. Int J Geriatr Psychiatry. 2017; doi: 10.1002/gps.4685. [Epub ahead of print]