agitation
Meaning of agitation: New restlessness in an older adult points more often to a physical illness than to a psychiatric one, which is where the search starts.
Definition of agitation
Agitation is a state of excessive restlessness and irritability combined with purposeless physical or verbal activity. A person may pace, fidget, pull at clothing or lines, talk rapidly or loudly, and flare at small provocations. It runs from mild unease to severe distress, and it is a symptom produced by many different conditions rather than a diagnosis in itself.
What causes it?
| Group | Examples |
|---|---|
| Brain conditions | Delirium, dementia, head injury, stroke, the period after a seizure |
| Problems elsewhere in the body | Infection, low blood oxygen, low blood sugar, disturbed sodium or calcium, untreated pain, a full bladder, constipation, overactive thyroid |
| Substances | Withdrawal from alcohol or sedatives, stimulant use, and some prescribed medicines including those that block dopamine |
| Psychiatric conditions | Anxiety, mania, psychosis, agitated depression |
The list is long because agitation is a final common expression of distress. A brain deprived of oxygen, a bladder that cannot empty and a manic episode all produce it, and the behavior alone does not distinguish them.
Why does the timing matter?
Onset carries more information than the agitation itself. Restlessness that develops over hours or days, alongside a wavering level of attention and a person who drifts in and out of clarity, describes delirium, and delirium nearly always has a physical trigger. Agitation that has been present for years in someone with a known psychiatric diagnosis follows a different pattern and usually a different cause. In dementia, agitation often intensifies in the late afternoon and evening, a pattern given the name sundowning, and it can be set off by noise, unfamiliar surroundings, or a need the person can no longer put into words.
What is it confused with?
Akathisia is the most important look alike. It is an inner sense of restlessness with a compulsion to move, usually the legs, brought on by medicines that block dopamine, including some antipsychotics and some anti-nausea drugs. It is easily read as worsening agitation, and increasing the dose of the causative drug makes it worse rather than better. Anxiety is another. Anxiety is a felt emotion and can be present in someone sitting perfectly still, whereas agitation is defined by the visible, aimless activity that accompanies it.
Used in a sentence
The nursing staff documented increasing agitation overnight, prompting further evaluation.
Good to know
Agitation that appears suddenly, particularly in an older adult with no psychiatric history, most often reflects delirium, and delirium points toward a physical trigger such as infection, a drug effect or a metabolic disturbance.