Sedatives and Sedation at the End of Life in Nursing Homes: A Retrospective Multicenter Cohort Study

ObjectivesThere is scarce information about sedation in nursing homes at the end of life. We aimed to assess (1) use sedatives generally and “sedatives with continuous effect,” based on objective operational criteria, within last week life (2) factors associated this treatment.DesignRetrospective cohort study, using homes' medical records.Setting ParticipantsResidents who died 4 German from January 2015 December 2017 whose records were available (n = 512).MethodsSedatives analyzed those recommended by guidelines for “palliative sedation”: benzodiazepines, levomepromazine, haloperidol (≥5 mg/d), propofol. The definition effect” doses judged as least moderately sedating consented palliative care clinicians pharmacists, literature. Descriptive statistics multivariate logistic regression analysis performed (R version 3.6.1).ResultsOverall, 110/512 (21%) deceased residents received a sedative once during life, 46/512 (9%) effect.” Oral lorazepam was used most frequently. Eleven 512 (2%) sedating. term not used. Most frequent indications agitation (58/110; 53%) anxiety (35/110; 32%); no indication noted 36/110 (33%) residents. resident's involvement decision documented 3/110 (3%). Multivariate showed significant associations between age (OR 0.94, P < .001) well institution (P .001).Conclusions ImplicationsOur data indicate lower prevalence compared international considerable differences regarding institutions. These differences, potential setting-specific challenges, need support measures consistent best practice should be further explored.