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Multicenter Study
. 2025 Apr 10;25(1):241.
doi: 10.1186/s12877-025-05860-6.

Palliative use of midazolam in acute geriatric units: a multicenter ambispective study

Chloé Prod'homme  1 , Guillaume Deschasse  2   3 , Fabien Visade  2   4 , Camille Hennion  5 , Anne Charpentier  5 , Cedric Gaxatte  5 , Frederic Bloch  3 , Celine Delecluse  4 , François Puisieux  2   5 , Jean-Baptiste Beuscart  2   5
Affiliations
Multicenter Study

Palliative use of midazolam in acute geriatric units: a multicenter ambispective study

Chloé Prod'homme et al. BMC Geriatr. .

Abstract

Introduction: End-of-life management in acute geriatric units (AGUs) is frequent but complex. Midazolam is the drug of choice for the management of refractory symptoms (particularly in the context of sedation) at the end of life. The objective of the present ambispective analysis was to investigate the frequency and modalities of midazolam use for palliative care in AGUs in France.

Methods: We conducted a prospective study in four AGUs in France, in order to identify patients having received comfort care only and having been treated with midazolam. We then retrospectively documented the modalities of midazolam use, the indications, and the level of effectiveness.

Results: Of the 210 patients identified as having received comfort care only in the AGU, 68 (32.4% (95%CI, 26.1 to 39.2%)) had received midazolam. The indication for midazolam corresponded to sedation in 67.6% of cases. The modalities of midazolam use at the end -of -life were rarely personalized, with low dose levels (less than 0.5 mg/h), mainly subcutaneous administration, and little anticipatory prescribing or dose level titration. The modalities did not appear to vary with the indication (anxiolysis vs. sedation).

Discussion: The present study is one of the first to have described the frequency and characteristics of palliative midazolam use in the AGU. Our results showed that the end-of-life use of midazolam is rarely personalized, not explicitly documented, and often not compliant with the current guidelines on palliative sedation practices.

Clinical trials registration number: NCT02949635. Registration Date: 2016-09-07.

Keywords: Anti-anxiety agents; Comfort care only; Deep sedations; End-of-life care; Geriatrics; Midazolam; Palliative care.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The DAMAGE study was performed in compliance with the tenets of the Declaration of Helsinki and was approved by an institutional review board (CPP Nord-Ouest IV, Lille, France) on February 13th, 2015. An amendment was approved on January 21st, 2016 (reference: IDRCB 2014 A01670 47, CNIL. bxA15352514). The patients and their primary family caregivers or legal representatives were given detailed verbal and written information about the study, in order to ensure that the patients fully understood the potential risks and benefits of participation. In accordance with the French legislation on observational, non-interventional studies of routine clinical care, written consent was not required. The patients were informed that they could refuse to participate in the study and that refusal would not have any impact on their treatment in the AGU. If the patient was unable to refuse to participate in the DAMAGE study (notably because of severe neurocognitive disorders), the next of kin or legal representative could refuse participation. All participants were free to withdraw from the study at any time. This withdrawal had no impact on the care received. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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