Continuous Deep Sedation Until Death in Nursing Home Residents with Dementia: A Case Series

ObjectivesTo describe the characteristics of continuous deep sedation until death and the prior decision-making process of nursing home residents dying with dementia and to evaluate this practice according to features reflecting sedation guideline recommendations. DesignEpidemiological retrospective study completed using a case series analysis. SettingFlemish nursing homes in 2010. ParticipantsFrom a representative sample of 69 nursing homes, all residents who had dementia and had been continuously and deeply sedated until death over a period of 3 months were selected. MeasurementsQuestionnaires to general practitioners (GPs), nurses, and relatives most involved in the care of the resident regarding the clinical characteristics of the resident, how sedation was decided upon and performed, quality of care, and dying. Advanced dementia was identified using the Global Deterioration and Cognitive Performance Scale. Whether this practice is in conformity with sedation guideline recommendations was also investigated. ResultsEleven of 117 deceased residents with dementia (9.4%, 95% confidence interval (CI)=4.0-14.8) and nine of 64 residents with advanced dementia (14.1%, 95% CI=5.3-22.8) were sedated. Two of the 11 sedated residents were not considered to be terminal. Sedation duration ranged from 1 to 8days. Two received artificial food and fluids during sedation. Five were partly or fully competent at admission and three in the last week. Four had expressed their wishes or had been involved in end-of-life decision-making; for eight residents, the GP discussed the resident's wishes with their relatives. Relatives reported that five of the residents had one or more symptoms while dying. Nurses of three residents reported that the dying process was a struggle. For two residents, sedation was effective. ConclusionContinuous deep sedation until death for nursing home residents does not always guarantee a dying process free of symptoms and might be amenable to improvement.