Objectives <p>Worldwide, the elderly population is steadily growing. A new population of very elderly patients is emerging, with specific management requirements, particularly at the end of life. However, data is scarce concerning the end-of-life care in these patients. The territories where this population is growing rapidly, like overseas France, was therefore of the utmost interest, to describe how they are provided end-of-life care and die.&#xa0;The aim of the study was to describe end-of-life care and death in overseas France nonagenarians and over, and to compare them with the rest of the population in these territories.</p> Methods <p>A retrospective study of a representative sample of adult patients who died between March 2020 and February 2021 was conducted in overseas France. Physicians who certified the deaths were asked to describe end-of-life care and medical decisions in a questionnaire.</p> Results <p>A total of 1815 deaths were analysed over 8730 questionnaires sent, with a total of 1082 questionnaires collecting data on non-sudden informed deaths. The nonagenarians were mostly women (p&lt;0.0001) with cognitive impairment (p&lt;0.0001) and died at home (p &lt; 0.0001). Physicians were mostly experienced (p=0.0022) general practitioners (p&lt;0.0001). Nonagenarians were less provided with palliative care than the rest of the population (64.36% vs 74.83%), with a lower use of deep and continuous sedation maintained until death (2.84%&#xa0;vs 15.19%) and less intensification of treatments to relieve symptoms (23.45%&#xa0;vs 32.56%).</p> Conclusions <p>The population of nonagenarians was specific in causes of death and comorbidities. Improving end-of-life care for these patients can include a high access to specialist palliative care and symptoms management.</p>