The aims of this thesis were to provide insight into current practice for acutely admitted older adults with palliative care needs and to evaluate the PalliSupport transmural palliative care pathway, which was developed to overcome barriers in current practice. The first part of this thesis focusses on current practice. We found that specialist palliative care teams are consulted most often for patients in the last weeks of their life, showing that consultations focus on care in the last days and weeks of life. Healthcare professionals acknowledge that the initiation of advance care planning and palliative care is less timely and less often than what is considered ideal. We also found that acutely admitted older patients with palliative care needs are often unaware of their preferred place of death, but are willing to consider their preferences. Patients often consider unplanned hospital admissions as unavoidable, and find it difficult to make decisions about future (unplanned) hospitalizations. In the second part of this thesis the evaluation and implementation of the PalliSupport care pathway are described. After implementation of the care pathway in one hospital, unplanned hospital admissions were not prevented, but more patients died at their preferred place. The large scale implementation of the care pathway was not as successful as was hoped. Factors that influenced the implementation were the complexity of transmural palliative care, the setting in which the care pathway started, the high number of involved professionals and organizations and the complexity of combining implementation with a stepped wedge randomized controlled trial.