Current Practice of Palliative Sedation in Dutch Nursing Homes

To evaluate current practices regarding palliative sedation in nursing homes. Despite being an essential component of palliative care, empirical data on its use are currently lacking. Understanding these practices can help improve care quality and support evidence-based policy development for end-of-life care.

Retrospective cohort study of prescriptions for midazolam, propofol, levomepromazine, phenobarbital, and morphine within 14 days before death, used as a proxy for palliative sedation and to gain insight into the occurrence.

A total of 672 nursing home residents from 10 different nursing homes who died between September 1, 2022, and August 31, 2024.

Medication prescriptions issued to these residents within 14 days before death were systematically evaluated. Analyses included medication type, prescription modality [fixed schedule vs pro re nata (PRN)], and dosage. Differences in prescribing patterns between residents in somatic and psychogeriatric (PG) wards were assessed using χ² tests and independent sample t tests.

A total of 2718 resident prescription records for midazolam, propofol, levomepromazine, phenobarbital, and morphine were identified and analyzed; 86.3% of residents were prescribed at least 1 of these medications within 14 days before death. Of these residents, 40.5% were prescribed midazolam as a fixed-schedule prescription and 64.6% received it as a PRN prescription. Morphine was prescribed frequently (fixed schedule 67.9%, PRN 74.3%). Few residents received a levomepromazine prescription (fixed-schedule 2.4%, PRN 0.7%). No residents were prescribed propofol or phenobarbital. Morphine was prescribed significantly more often to residents in PG wards compared with somatic wards (71.3% vs 62.9%, relative risk, 1.13; 95% CI, 1.02-1.26).

A substantial number of nursing home residents were prescribed midazolam and morphine within 14 days before death. Further research is needed to clarify the indications for initiating these medications, optimizing dosing strategies, and assessing the intended clinical effects.