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. A number of outcomes and measurement instruments were ranked for: Cognitive abilities; Functional abilities/dependency; Behavioural and neuropsychiatric symptoms; Patient quality of life (QoL); Caregiver QoL; Healthcare and treatment-related outcomes; Medical investigations; Disease-related life events; and Global outcomes. DISCUSSION: This work provides indications on the domains and ideal pertinent measurement instruments that clinicians may wish to use to follow patients with cognitive impairment. More work is needed to develop instruments that are more feasible in the context of the constraints of clinical routine.

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.

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. Treatments for incontinence and to improve sexual function are explored. The authors conclude that nurses, particularly those involved in continence management, have a role in ensuring sensitive assessment and access to treatment, which can support many older people to maintain fulfilling sexual activity.

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. A high value is placed on a gold standard of sexual performance, which can reinforce negative esteem and set unrealistic expectations and measures for older people. This article focuses on the majority of the older population who do not require residential care. It examines major influences emerging from a review of the literature from 1995 to 2013, which informs a working definition for sexual intimacy in people over the age of 75 years. The article concludes with key recommendations for nurses working with older adults.

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. One element of maintaining skin integrity is ensuring that personal hygiene and emollient needs are met. Effective skin hygiene and emollient care will reduce the risk of breakdown, with all its burdensome and costly consequences. We therefore offer a summary of the current evidence base for skin-hygiene practice. We make a case for nurses considering skin health from a wider societal and human perspective, and identify opportunities to enhance nursing practice through skin-care advice and health education for all older people.

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.

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.

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. It is likely therefore that there will be an increase in the need for alcohol services for older people.

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.

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.

A national abhorrence of physical restraint.

Publications such as those from the RCN and the CSCI, together with media scrutiny and the increased involvement of the legal system, are highlighting what has been a long-standing issue for many health and social care staff. The difficulties still facing staff are that every situation is unique and staff members are themselves individuals.