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Sedatives and sedation at the end of life: a nursing home retrospective cohort study
  1. Eva Schildmann,
  2. Anna Bolzani,
  3. Sophie Meesters,
  4. Bettina Grüne,
  5. Alina Marheineke,
  6. Constanze Remi and
  7. Claudia Bausewein
  1. Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
  1. Correspondence to Dr Eva Schildmann, Department of Palliative Medicine, University Hospital, LMU Munich, 81377 München, Germany; eva.schildmann{at}med.uni-muenchen.de

Abstract

Objectives Sedatives are frequently used at the end of life in specialist palliative care. There is scarce information about their use in nursing homes. Therefore, we aimed to assess the use of (1) sedatives generally and (2) ‘sedatives with continuous effect’, based on objective operational criteria, within the last week of life in a nursing home.

Methods This was a retrospective cohort study of residents who died in a German nursing home between 1/2015 and 12/2017, using the nursing home’s medical records, which contained drug sheets and nurses’ notes. Sedatives analysed were those recommended by guidelines for ‘palliative sedation’: benzodiazepines, levomepromazine, haloperidol (≥5 mg/day) and propofol. Exploratory statistical analysis was conducted using R V.3.6.1.

Results 46/165 (28%) deceased residents received a sedative during the last week of life, all without use of the term ‘sedation’. 26/165 residents (16%) received ‘sedatives with continuous effect’, for median 4 days (range 1–7). Oral lorazepam was used most frequently, mainly for agitation, anxiety and dyspnoea, but also due to palliative status and patients wish. The median total daily dose of lorazepam within the last week of life was 1.5 mg (range 0.5–7.5). The term ‘palliative’ was significantly more often used for residents receiving sedatives (p=0.001).

Conclusions Compared with published data on continuous deep sedation, moderate or deep sedation was less frequent in this nursing home and never labelled as ‘sedation’. Multicentre mixed-methods research is needed to gain representative and more detailed data on sedation practices at the end of life in nursing homes.

  • palliative sedation
  • hypnotics and sedatives
  • benzodiazepines
  • Nursing Home care
  • palliative care
  • cohort study

Data availability statement

Data are available upon request

http://dx.doi.org/10.1136/bmjspcare-2019-001984

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    Data availability statement

    Data are available upon request

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    Footnotes

    • Presented at Part of this work was presented at the Conference of the European Association of Palliative Care in Berlin, May 2019 (oral presentation).

    • Contributors Obtaining funding: ES with support of CB. Overall concept and design of the study: ES and CB with support of AB, SM, AM and CR. Definition of sedating doses and intervals of drug application which result in a continuous effect of the respective sedatives: AM and CR, then consented with ES and CB. Data collection and analysis: AB, SM and BG with support of ES and CB. Interpretation of data: all authors. Draft of the manuscript: ES. All authors critically commented on and contributed to the draft. All authors read and approved the final manuscript.

    • Funding This work was supported by the Federal Ministry of Education & Research (grant number 01GY1712, SedEol).

    • Disclaimer The funder was not involved in the study design, in the collection, analysis and interpretation of the data, in the writing of the report and in the decision to submit the paper for publication.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.