Outcome measures for Alzheimer's disease: A global inter-societal Delphi consensus.

Introduction: We aim to provide guidance on outcomes and measures for use in patients with Alzheimer's clinical syndrome.

Methods: A consensus group of 20 voting members nominated by 10 professional societies, and a non-voting chair, used a Delphi approach and modified GRADE criteria.

Results: Consensus was reached on priority outcomes (n = 66), measures (n = 49) and statements (n = 37) across nine domains.

The effects of ageing on female genital and sexual health.

This article will explore the impact of ageing on sexual function in older women and will reflect on the social influences on women's sexual ageing, identify the effects of ageing on sexual activity, particularly on genital skin, and consider the concerns from the perspective of older women. The article will then focus on vulval skin conditions and the functional aspects of living with these conditions. Finally, the article provides a starting point for nurses to consider their own knowledge, skills and attitudes through a series of reflective questions and recommendations for those working with older women to aid the identification of issues relating to older women's sexual health and vulval skin conditions, leading to further discussions to promote genital health.

Value of music.

Groups that engage residents in singing, dancing or music are becoming common in care homes, and are likely to have health and social benefits for many people.

Learning to speak up about hospital failures.

The recent Public Accounts Committee (PAC) report on discharging older people from acute hospitals in England revealed that rising numbers of patients are remaining in hospital when they are clinically ready to go home.

Incontinence and sexuality in later life.

This article explores the interrelated aspects of incontinence and sexuality in older age. It describes the physiological changes that may have an effect on sexual function and the genitourinary system as people age. The enduring importance of sexual intimacy is discussed.

Older people and skin: challenging perceptions.

In this article we set out to challenge perceptions about older people and skin. We examine current portrayals of older people and skin, both in the media and in the nursing literature. We describe the ‘normal’ process of skin ageing and highlight the importance of maintaining skin integrity and effective barrier function for health and wellbeing, particularly in older people.

Psychosocial barriers to sexual intimacy for older people.

A review of the literature relating to the psychosocial barriers to sexual intimacy in older people reveals wide-ranging influences on people aged 75-85 years. These influences include: a lack of positive social policy, a lack of research, partner availability, negative media portrayals, psychological factors, relationship factors, and difficulties in interactions with health professionals. Stereotypical attitudes about sexual intimacy and older people remain a cultural norm.

Practice question.

The term 'personalisation' has become increasingly common in the context of a movement that recognises the importance of people's individuality and their right to exercise choice in their daily lives. In the fields of health and social care, personalisation focuses on placing the individual at the centre of their care and an understanding that they know best what their needs are and how to meet them ( Carr 2008 ). Personalisation can be as significant as a direct payment or individual budget, or as small as supporting a resident in a care home to decide for themselves when they should go to bed.

Practice question.

In 2005 the National Service Framework for Long-term Conditions ( Department of Health 2005 ) set out policy aims for people living with chronic disease. These included.

Practice question.

Practice development (PD) is a common phrase in health and social care. It is defined by McCormack et al ( 1999 ) as: 'A continuous process of improvement towards increased effectiveness in person-centred care, through enabling teams to transform the culture and context of care.' Although definitions vary, most agree that PD should embrace the concepts of engagement, empowerment, enlightenment, evaluation and evolution.

Alcohol Is alcohol misuse only a problem in the younger generation?

The popular image of older people requesting a small sherry with their Christmas lunch and becoming tipsy is an erroneous view of their drinking habits. People do not stop drinking hazardously simply because they are older. Bereavement, isolation and pain are a potent mix when combined with the low cost and accessibility of alcohol.

Ask the experts.

Although UK healthcare spending is now close to the European average( Organisation for Economic Co-operation and Development 2008 ), older people still receive inadequate services ( Healthcare Commission 2008 ). The recession is a time of great peril and great opportunity: there is the risk of savage funding cuts and falling quality; but there is also the opportunity to integrate our fragmented healthcare system and harness the skills of nurses to drive up quality.