NEW

A national point-prevalence audit across major trauma centres and trauma units in England, Wales and Scotland finds only 41% of older major trauma patients had a documented treatment escalation plan, and only a fifth of those were on a palliative or end-of-life care pathway.

A systematic review of 75 studies finds fall-circumstance reporting is highly inconsistent and proposes a standardised '6 W's' interview and reporting framework for community-dwelling older adults.

A systematic review of 46 studies finds digital health technologies for post-discharge follow-up of older adults are feasible, well-engaged with and liked by patients, but evidence on whether they reduce rehospitalisation or improve mental health is mixed.

A Cochrane review of eight randomised trials finds lumbar supports offer little to no benefit alone for chronic low back pain, a small short-term pain reduction only when added to anti-inflammatory drugs, and no eligible evidence exists at all for other mobility or gait assistive devices.

A Japanese multicentre prospective study of 65 older adults finds apathy severity after ward transfer independently predicts poorer functional recovery following hip-fracture surgery, distinct from delirium or behavioural and psychological symptoms of dementia.

A national study comparing four spatial-accessibility methods across 295 German inpatient hospices finds 90.3% of the population can reach a hospice within 30 minutes by car, but accessibility declines sharply in rural areas once distance-decay is accounted for.

A large real-world cohort study of 887 patients over nearly five years finds very high patient satisfaction and perceived safety in a telemedicine-based, virtual-first hospital-at-home programme.

A US research letter finds rural hospice patients are more likely to die in nursing homes, rely more heavily on unpaid family caregiving, and receive less intensive paid hospice support than urban patients.

This week's evidence across five domains converges on one mechanism for extending admission-avoidance and home-based care to rural and deprived populations: redesigning how often, not how much, care reaches the patient.

A double-blind placebo-controlled trial in the Netherlands finds no significant difference in xerostomia symptoms between pilocarpine drops and placebo in frail or life-limited patients, though the trial was underpowered.

A scoping review of 21 studies covering roughly 681,000 participants finds people with opioid use disorder have palliative care needs equivalent to the general population but face fragmented care, unmet pain management and stigma-driven access barriers.

A scoping review of 15 international Hospital-at-Home admission-avoidance models finds just four used a validated frailty measure, and communication practice between professionals, patients and carers varied widely.

A multidisciplinary clinical consensus sets out age-adjusted opioid selection, dosing and route-of-administration standards for treating chronic pain safely in older adults.

The first large pragmatic English trial of Open Dialogue crisis care finds no difference in relapse rates but significantly lower psychiatric admission and re-referral, with better patient-rated recovery and satisfaction.

A consensus of 16 international experts concludes that delivery and implementation capacity — not the underlying evidence for high-dose, high-intensity rehabilitation — is the primary barrier to delivering it, and names home- and community-based hybrid delivery as essential to closing the gap.

A retrospective cohort study of over 8,000 emergency department attendances finds that comprehensive geriatric assessment embedded at first contact converts most encounters into home discharge with hospital-at-home support, rather than admission.

A scoping review of 18 studies covering over 5,000 patients finds outpatient parenteral antimicrobial therapy readmission risk tracks whether a competent team member performs the initial patient assessment, not how many quality indicators a service reports.

A meta-analysis finds the Clinical Frailty Scale is a validated prognostic tool specifically in elderly heart failure populations, though the finding should not be generalised to non-cardiac frailty pathways.

A quasi-experimental stewardship intervention for patients receiving outpatient parenteral antibiotic therapy for urinary tract infection raised appropriate-duration prescribing from 44% to 83% and cut 90-day recurrence, without increasing readmissions.

A randomised controlled trial finds adjunctive neuromuscular electrical stimulation produces significantly faster recovery of functional oral intake than swallowing therapy alone in acute and subacute post-stroke dysphagia.

A systematic review of four randomised trials finds telerehabilitation is non-inferior to conventional in-person stroke rehabilitation for arm motor recovery only in the one trial that matched therapy dose between arms, with smaller, non-dose-matched trials showing mixed results.

A realist review of 126 studies identifies six mechanisms through which mobile health interventions improve home-based palliative care outcomes, and cautions that mHealth must be tailored to local infrastructure and technology competence rather than treated as a substitute for workforce capacity.

A mixed-methods systematic review of 34 studies finds rural palliative care access breaks down cumulatively across recognition, entry, reach and continuity stages, with distance, workforce shortages and weak specialist-generalist referral links driving the biggest barrier.

This week's evidence answers a question earlier weeks left open: not whether earlier, community-facing care reduces avoidable hospital use, but what makes that model actually work — and a national dataset supplies the clearest quantified evidence yet that the workforce needed to deliver it is under strain.