• Eva Schildmann, Sophie Meesters, Bettina Grüne, Anna Bolzani, Basel Habboub, Alina Hermann, Constanze Remi, and Claudia Bausewein.
• Department of Palliative Medicine, LMU Klinikum, Munich, Germany. Electronic address: eva.schildmann@med.uni-muenchen.de.
• J Am Med Dir Assoc. 2021 Jan 1; 22 (1): 109-116.e1.

ObjectivesThere is scarce information about sedation in nursing homes at the end of life. We aimed to assess (1) the use of sedatives generally and "sedatives with continuous effect," based on objective operational criteria, within the last week of life in nursing homes and (2) factors associated with this treatment.DesignRetrospective cohort study, using the nursing homes' medical records.Setting And ParticipantsResidents who died in 4 German nursing homes from January 2015 to December 2017 and whose medical records were available (n = 512).MethodsSedatives analyzed were those recommended by guidelines for "palliative sedation": benzodiazepines, levomepromazine, haloperidol (≥5 mg/d), and propofol. The definition of "sedatives with continuous effect" and doses judged as at least moderately sedating were consented by palliative care clinicians and pharmacists, based on the literature. Descriptive statistics and multivariate logistic regression analysis were performed (R version 3.6.1).ResultsOverall, 110/512 (21%) deceased residents received a sedative at least once during the last week of life, 46/512 (9%) "sedatives with continuous effect." Oral lorazepam was used most frequently. Eleven of 512 (2%) residents received doses judged as at least moderately sedating. The term sedation was not used. Most frequent indications were agitation (58/110; 53%) and anxiety (35/110; 32%); no indication was noted for 36/110 (33%) residents. The resident's involvement in the decision for sedatives was documented in 3/110 (3%). Multivariate logistic regression analysis showed significant associations between use of sedatives and age (OR = 0.94, P < .001) as well as institution (P < .001).Conclusions And ImplicationsOur data indicate a lower prevalence of sedation compared to international data and considerable differences regarding prevalence between institutions. These differences, potential setting-specific challenges, and need for support measures for consistent best practice of sedation in nursing homes should be further explored.Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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