In spinal stenosis, a group programme cut use of controlled painkillers (opioids and gabapentinoids), and that helped explain fewer falls

The edition in brief

A secondary and mediation analysis of the BOOST randomised trial in 435 older people with neurogenic claudication found a physical and psychological group programme reduced use of controlled pain medicines at six months compared with best-practice advice (OR 0.62, 95% CI 0.40 to 0.96), and that this reduction was one of the factors mediating the programme's fall reduction at 12 months. A meta-analysis of 11 trials found esketamine-containing perioperative regimens were associated with less postoperative delirium in adults aged 60 or over (OR 0.57), with less nausea and no increase in psychiatric adverse events, on evidence of limited certainty. A meta-analysis of 27 trials (2034 participants) found mind-body exercise such as tai chi improved global cognition in mild cognitive impairment (Hedges g 0.67), with benefit at about 240 minutes a week needing at least 11 weeks. A Japanese cohort of 52 789 older adults found self-reported chewing difficulty and dysphagia each predicted mortality over about ten years. A Chinese longitudinal study found activities-of-daily-living difficulty after hip fracture remained 25% above baseline six years later. Today's pearl covers checking lying and standing blood pressure after a fall.