Mental Age: From 2 Different Sources
A measurement of the intellectual development of a person, with regard to the normal age at which that level of achievement is attained.
For example, a 13 year-old child with learning difficulties may have a mental age of 5.
a measure of the intellectual level at which an individual functions; for example, someone described as having a mental age of six years would be functioning at the level of an average six-year-old child. This measure has largely been replaced by a comparison of the functioning of persons of the same age group (see intelligence quotient; intelligence test).
All forms of illness in which psychological, emotional or behavioural disturbances are the dominating feature. The term is relative and variable in different cultures, schools of thought and definitions. It includes a wide range of types and severities.... mental illness
Agenesis means incomplete development, or the failure of any part or organ of the body to develop normally.... agenesis
See LEARNING DISABILITY.... mental handicap
A substance, living or inanimate, or a force, sometimes rather intangible, the excessive presence or relative lack of which is the immediate or proximal cause of a particular disease.... agent
Chelating agents are compounds that will render an ion (usually a metal) biologically inactive by incorporating it into an inner ring structure in the molecule. (Hence the name, from the Greek chele = claw.) When the complex formed in this way is harmless to the body and is excreted in the urine, such an agent is an e?ective way of ridding the body of toxic metals such as mercury. The main chelating agents are DIMERCAPROL, PENICILLAMINE, desferrioxamine and sodium calciumedetate, used for example, in iron poisoning.... chelating agents
A disorder characterized by the display of an intellectual defect, as manifested by diminished cognitive, interpersonal, social and vocational effectiveness and quantitatively evaluated by psychological examination and assessment.... mental impairment
See Learning difficulties.... mental retardation
The process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age.... active ageing
An agent pertaining to aetiology.... aetiologic agent
The state of being old. A person may be defined as aged on a number of criteria including chronological age, functional assessment, legislation or cultural considerations.... aged
Services provided to people deemed to be aged or elderly.... aged care
Multidisciplinary team of health professionals that is responsible for comprehensive assessments of the needs of older persons, including their suitability for hospital, home or institutional care.... aged care assessment team
The lifelong process of growing older at cellular, organ or whole-body level throughout the life span.... ageing / aging
Meeting the desire and ability of people, through the provision of appropriate services and assistance, to remain living relatively independently in the community in his or her current home or an appropriate level of housing. Ageing in place is designed to prevent or delay more traumatic moves to a dependent facility, such as a nursing home.... ageing / aging in place
See “population ageing”.... ageing of the population
The negative stereotyping or discrimination of people on the basis of age.... ageism
A factor, such as a micro-organism, chemical substance, form of radiation, or excessive cold or heat, which is essential for the occurrence of a disease. A disease may be caused by more than one agent acting together or, in the case of deficiency diseases, by the absence of an agent.... agent (of disease)
An entity which provides comprehensive mental health services (principally ambulatory), primarily to individuals residing or employed in a defined catchment area.... community mental health centre
An independent agency recently set up by the UK government. The aim is for the agency to protect consumers’ interests in every aspect of food safety and nutrition. The agency advises ministers and the food industry, conducts research and surveillance, and monitors enforcement of food safety and hygiene laws.... food standards agency
An approach which recognizes that growing older is a part of living; recognizes the interdependence of generations; recognizes that everyone has a responsibility to be fair in their demands on other generations; fosters a positive attitude throughout life to growing older; eliminates age as a reason to exclude any person from participating fully in community life; promotes a commitment to activities which enhance well-being and health, choice and independence, and quality of life for all ages; encourages communities to value and listen to older people and to cater for the diverse preferences, motivations, characteristics and circumstances of older persons in a variety of ways.... healthy ageing
Intended as a key part of the NHS’s local comprehensive mental health services serving populations of around 50,000, these multidisciplinary, multi-agency teams have been less e?ective than expected, in part due to varying modes of operation in di?erent districts. Some experts argue that the services they provide – for example, crisis intervention, liaison with primary care services and continuing care for long-term clients – could be delivered more e?ectively by several specialist teams rather than a single, large generic one comprising psychiatrists, psychologists, community mental health nurses, occupational therapists, support and (sometimes) social workers.... community mental health teams
See “residential care”; “assisted living facility”; “high dependency care facility”.... home for the aged
A public or private organization that provides home health services supervised by a licensed health professional in a person’s home, either directly or through arrangements with other organizations.... home health agency (hha) / home health care agency
An organization offering advice and practical assistance to older people who need to repair, improve or adapt their homes.... home improvement agency
An organism, chiefly a microorganism but including helminths, that is capable of producing infection or infectious disease.... infectious agent
A range of health care, personal care and social services provided to individuals who, due to frailty or level of physical or intellectual disability, are no longer able to live independently. Services may be for varying periods of time and may be provided in a person’s home, in the community or in residential facilities (e.g. nursing homes or assisted living facilities). These people have relatively stable medical conditions and are unlikely to greatly improve their level of functioning through medical intervention.... long-term care (ltc) / long-term aged care
An executive agency of the Department of Health in the UK. Set up in 1994, it is responsible for regulating and advising on the sale or use of any product, other than a medicine, used in the health-care environment for the diagnosis, prevention, monitoring or treatment of illness or disease. Equipment ranges from pacemakers (see CARDIAC PACEMAKER) to prostheses (see PROSTHESIS), and from syringes to magnetic resonance imaging (see (MRI).... medical devices agency
An executive agency of the Department of Health with the prime function of safeguarding the public health. It ensures that branded and non-branded MEDICINES on the UK market meet appropriate standards of safety, quality and e?cacy. The agency applies the strict standards set by the UK Medicines Act (1968) and relevant European Community legislation.... medicines control agency
These oral agents reduce the excessive amounts of GLUCOSE in the blood (HYPERGLYCAEMIA) in people with type 2 (INSULIN-resistant) diabetes (see DIABETES MELLITUS). Although the various drugs act di?erently, most depend on a supply of endogenous (secreted by the PANCREAS) insulin. Thus they are of no value in treating patients with type 1 diabetes (insulin-dependent diabetes mellitus (IDDM), in which the pancreas produces little or no insulin and the patient’s condition is stabilised using insulin injections). The traditional oral hypoglycaemic drugs have been the sulphonylureas and biguanides; new agents are now available – for example, thiazolidine-diones (insulin-enhancing agents) and alpha-glucosidase inhibitors, which delay the digestion of CARBOHYDRATE and the absorption of glucose. Hypoglycaemic agents should not be prescribed until diabetic patients have been shown not to respond adequately to at least three months’ restriction of energy and carbohydrate intake.
Sulphonylureas The main group of hypoglycaemic agents, these act on the beta cells to stimulate insulin release; consequently they are e?ective only when there is some residual pancreatic beta-cell activity (see INSULIN). They also act on peripheral tissues to increase sensitivity, although this is less important. All sulphonylureas may lead to HYPOGLYCAEMIA four hours or more after food, but this is relatively uncommon, and usually an indication of overdose.
There are several di?erent sulphonylureas; apart from some di?erences in their duration or action (and hence in their suitability for individual patients) there is little di?erence in their e?ectiveness. Only chlorpropamide has appreciably more side-effects – mainly because of its prolonged duration of action and consequent risk of hypoglycaemia. There is also the common and unpleasant chlorpropamide/ alcohol-?ush phenomenon when the patient takes alcohol. Selection of an individual sulphonylurea depends on the patient’s age and renal function, and often just on personal preference. Elderly patients are particularly prone to the risks of hypoglycaemia when long-acting drugs are used. In these patients chlorpropamide, and preferably glibenclamide, should be avoided and replaced by others such as gliclazide or tolbutamide.
These drugs may cause weight gain and are indicated only if poor control persists despite adequate attempts at dieting. They should not be used during breast feeding, and caution is necessary in the elderly and in those with renal or hepatic insu?ciency. They should also be avoided in porphyria (see PORPHYRIAS). During surgery and intercurrent illness (such as myocardial infarction, COMA, infection and trauma), insulin therapy should be temporarily substituted. Insulin is generally used during pregnancy and should be used in the presence of ketoacidosis.
Side-effects Chie?y gastrointestinal disturbances and headache; these are generally mild and infrequent. After drinking alcohol, chlorpropamide may cause facial ?ushing. It also may enhance the action of antidiuretic hormone (see VASOPRESSIN), very rarely causing HYPONATRAEMIA.
Sensitivity reactions are very rare, usually occurring in the ?rst six to eight weeks of therapy. They include transient rashes which rarely progress to erythema multiforme (see under ERYTHEMA) and exfoliate DERMATITIS, fever and jaundice; chlorpropamide may also occasionally result in photosensitivity. Rare blood disorders include THROMBOCYTOPENIA, AGRANULOCYTOSIS and aplastic ANAEMIA.
Biguanides Metformin, the only available member of this group, acts by reducing GLUCONEOGENESIS and by increasing peripheral utilisation of glucose. It can act only if there is some residual insulin activity, hence it is only of value in the treatment of non-insulin dependent (type 2) diabetics. It may be used alone or with a sulphonylurea, and is indicated when strict dieting and sulphonylurea treatment have failed to control the diabetes. It is particularly valuable in overweight patients, in whom it may be used ?rst. Metformin has several advantages: hypoglycaemia is not usually a problem; weight gain is uncommon; and plasma insulin levels are lowered. Gastrointestinal side-effects are initially common and persistent in some patients, especially when high doses are being taken. Lactic acidosis is a rarely seen hazard occurring in patients with renal impairment, in whom metformin should not be used.
Other antidiabetics Acarbose is an inhibitor of intestinal alpha glucosidases (enzymes that process GLUCOSIDES), delaying the digestion of starch and sucrose, and hence the increase in blood glucose concentrations after a meal containing carbohydrate. It has been introduced for the treatment of type 2 patients inadequately controlled by diet or diet with oral hypoglycaemics.
Guar gum, if taken in adequate doses, acts by delaying carbohydrate absorption, and therefore reducing the postprandial blood glucose levels. It is also used to relieve symptoms of the DUMPING SYNDROME.... hypoglycaemic agents
The absence of psychiatric disorders or traits. It can be influenced by biological, environmental, emotional and cultural factors. This term is highly variable in definition, depending on time and place.... mental health
A National Health Service body intended to combat the increasing threat from infectious diseases and biological, chemical and radiological hazards. Covering England, the agency includes the Public Health Laboratory Service, the National Radiological Protection Board, the Centre for Applied Microbiology and Research, and the National Focus Group for Chemical Incidents.... national infection control and health protection agency
See “healthy ageing”.... optimal ageing
The increase over time in the proportion of the population of a specified older age.... population ageing
See “healthy ageing”.... positive ageing
Diseases developing during a person’s lifetime may be the result of his or her lifestyle, environment, genetic factors and natural AGEING factors.
Lifestyle While this may change as people grow older – for instance, physical activity is commonly reduced – some lifestyle factors are unchanged: for example, cigarette smoking, commonly started in adolescence, may be continued as an adult, resulting in smoker’s cough and eventually chronic BRONCHITIS and EMPHYSEMA; widespread ATHEROSCLEROSIS causing heart attacks and STROKE; osteoporosis (see BONE, DISORDERS OF) producing bony fractures; and cancer affecting the lungs and bladder.
Genetic factors can cause sickle cell disease (see ANAEMIA), HUNTINGTON’S CHOREA and polycystic disease of the kidney.
Ageing process This is associated with the MENOPAUSE in women and, in both sexes, with a reduction in the body’s tissue elasticity and often a deterioration in mental and physical capabilities. When compared with illnesses described in much younger people, similar illnesses in old age present in an atypical manner
– for example, confusion and changed behaviour due to otherwise asymptomatic heart failure, causing a reduced supply of oxygen to the brain. Social adversity in old age may result from the combined effects of reduced body reserve, atypical presentation of illness, multiple disorders and POLYPHARMACY.
Age-related change in the presentation of illnesses This was ?rst recognised by the specialty of geriatric medicine (also called the medicine of ageing) which is concerned with the medical and social management of advanced age. The aim is to assess, treat and rehabilitate such patients. The number of institutional beds has been steadily cut, while availability of day-treatment centres and respite facilities has been boosted – although still inadequate to cope with the growing number of people over 65.
These developments, along with day social centres, provide relatives and carers with a break from the often demanding task of looking after the frail or ill elderly. As the proportion of elderly people in the population rises, along with the cost of hospital inpatient care, close cooperation between hospitals, COMMUNITY CARE services and primary care trusts (see under GENERAL PRACTITIONER (GP)) becomes increasingly important if senior citizens are not to suffer from the consequences of the tight operating budgets of the various medical and social agencies with responsibilities for the care of the elderly. Private or voluntary nursing and residential homes have expanded in the past 15 years and now care for many elderly people who previously would have been occupying NHS facilities. This trend has been accelerated by a tightening of the bene?t rules for funding such care. Local authorities are now responsible for assessing the needs of elderly people in the community and deciding whether they are eligible for ?nancial support (in full or in part) for nursing-home care.
With a substantial proportion of hospital inpatients in the United Kingdom being over 60, it is sometimes argued that all health professionals should be skilled in the care of the elderly; thus the need for doctors and nurses trained in the specialty of geriatrics is diminishing. Even so, as more people are reaching their 80s, there seems to be a reasonable case for training sta? in the type of care these individuals need and to facilitate research into illness at this stage of life.... medicine of ageing
Emotional and behavioural problems are common in children and adolescents, affecting up to one-?fth at any one time. But these problems are often not clear-cut, and they may come and go as the child develops and meets new challenges in life. If a child or teenager has an emotional problem that persists for weeks rather than days and is associated with disturbed behaviour, he or she may have a recognisable mental health disorder.
Anxiety, phobias and depression are fairly common. For instance, surveys show that up to
2.5 per cent of children and 8 per cent of adolescents are depressed at any one time, and by the age of 18 a quarter will have been depressed at least once. Problems such as OBSESSIVE COMPULSIVE DISORDER, ATTENTION DEFICIT DISORDER (HYPERACTIVITY SYNDROME), AUTISM, ASPERGER’S SYNDROME and SCHIZOPHRENIA are rare.
Mental-health problems may not be obvious at ?rst, because children often express distress through irritability, poor concentration, dif?cult behaviour, or physical symptoms. Physical symptoms of distress, such as unexplained headache and stomach ache, may persuade parents to keep children at home on school days. This may be appropriate occasionally, but regularly avoiding school can lead to a persistent phobia called school refusal.
If a parent, teacher or other person is worried that a child or teenager may have a mental-health problem, the ?rst thing to do is to ask the child gently if he or she is worried about anything. Listening, reassuring and helping the child to solve any speci?c problems may well be enough to help the child feel settled again. Serious problems such as bullying and child abuse need urgent professional involvement.
Children with emotional problems will usually feel most comfortable talking to their parents, while adolescents may prefer to talk to friends, counsellors, or other mentors. If this doesn’t work, and if the symptoms persist for weeks rather than days, it may be necessary to seek additional help through school or the family’s general practitioner. This may lead to the child and family being assessed and helped by a psychologist, or, less commonly, by a child psychiatrist. Again, listening and counselling will be the main forms of help o?ered. For outright depression, COGNITIVE BEHAVIOUR THERAPY and, rarely, antidepressant drugs may be used.... mental health problems in children
Any human beings, animals, arthropods, plants, soil, or inanimate matter in which an infectious agent normally lives and multiplies and on which it depends primarily for survival, reproducing itself in such manner that it can be transmitted to a susceptible host.... reservoir of infectious agent
See “residential care”; “assisted living facility”.... residential aged care facility
Involves care designed to improve the physical wellbeing and restore the health of older people to an optimum level following a serious illness.... short-term aged care
People or groups who have an involvement or interest in the aged care system, including beneficiaries, providers and funders.... stakeholders (in aged care)
These are compounds with the property of breaking up blood clots in the circulatory system (see BLOOD CLOT; THROMBUS; THROMBOSIS; FIBRINOLYTIC DRUGS).... thrombolytic agents
Comprehensive mental health services, as generally defined under some national (or state) laws and statutes, include: inpatient care, outpatient care, day care and other partial hospitalization and emergency services; specialized services for the mental health of the elderly; consultation and education services and specialized programmes for the prevention, treatment and rehabilitation of alcohol and drug abusers. They generally include a variety of services provided to people of all ages, including counselling, psychotherapy, psychiatric services, crisis intervention and support groups. Issues addressed include depression, grief, anxiety and stress, as well as severe mental illnesses.... mental health services
An agent which assists constructive metabolism and assimilation: Saw Palmetto, Sarsaparilla. ... anabolic agent
The lack or an impairment of the sense of taste (see taste, loss of).... ageusia
a factor associated with the definitive onset of an illness (or other response, including an accident). Examples are bacteria and trauma. The relationship is more direct than in the case of a *risk factor; in general, the ill health only occurs if the agent is a precursor.... causal agent
a chemical compound whose molecules form complexes by binding metal ions. Some chelating agents, including *desferrioxamine and *penicillamine, are drugs used to treat metal poisoning: the metal is bound to the drug and excreted safely. Chelating agents often form the active centres of enzymes. The chelating agent ethylenediaminetetraacetic acid (EDTA) is used in dentistry to remove the *smear layer before root canal filling.... chelating agent
(CMHT) a multidisciplinary team consisting of psychiatrists, psychiatric nurses, psychologists, social workers, and occupational therapists who treat patients with severe mental illness in the community.... community mental health team
items that help to improve contact between the two paddles of a manual *defibrillator and the chest wall of the patient, thus reducing the *transthoracic impedance and the risk of contact burns. The most common agents are defibrillation gel pads, thin pads of electrically conductive material placed between the patient’s skin and the defibrillation paddles. The two pads must not touch during defibrillation or a short circuit will form between the paddles. Liquid gels can also be used, but there is a greater risk of short-circuiting as the gel can spread between the two paddles.... coupling agents
see DSM.... diagnostic and statistical manual of mental disorders
(HPA) formerly, a nondepartmental public body set up as a special health authority in 2003 to protect the health of the UK population via advice and support to the NHS, local authorities, the Department of Health, emergency services, and others. The HPA was abolished in April 2013; its responsibilities were largely passed to *Public Health England. See Consultant in Health Protection.... health protection agency
HPV (two doses)... girls aged 12–13 years
(IMCA) a person who must, by virtue of the *Mental Capacity Act 2005, be contacted to represent the *best interests of a patient who lacks *capacity and has no family or friends while acting as a proxy in medical decision-making. IMCAs are available via the local Independent Mental Capacity Advocacy Service.... independent mental capacity advocate
legislation for England and Wales, which came into force in October 2007, to govern the treatment of people who lack *capacity to make decisions. It gives legal force to the importance of *autonomy in health care and to *advance directives, decisions, or statements. It also provides statutory legislation for medical and social decision-makers to act in the patient’s best interests should he or she lose capacity (see Independent Mental Capacity Advocate). It allows proportionate force to implement decisions made in a patient’s best interests. For Scotland the current legislation is the Adults with Incapacity (Scotland) Act 2000.... mental capacity act 2005
a regulating body in England and Wales, governed by the Mental Health Act 2007, that was responsible for regularly visiting psychiatric hospitals, reviewing psychiatric care, giving second opinions on the need for certain psychiatric treatments, and acting as a forum for the discussion of psychiatric issues. It was subsumed under the *Care Quality Commission in April 2009.... mental health act commission
(MHRT) a tribunal, established under the Mental Health Act 1959 and now operating under the Mental Health Act 2007, to which applications may be made for the discharge from hospital of a person compulsorily detained there under provisions of the Act (see compulsory admission). When a patient is subject to a restriction order an application may only be made after his or her first six months of detention. The powers of the tribunal, which comprises both legally and medically qualified members, include reclassifying unrestricted patients, recommending leave of absence for a patient, delaying discharge, and transferring patients to other hospitals. Detained patients may also apply to have a managers hearing to review their detention. The powers of the managers hearing are slightly different from those of the MHRT, but both are defined in the Mental Health Act 2007 and both can discharge a patient from a section of the Mental Health Act.... mental health review tribunal
(MSE) a full psychiatric examination of signs and symptoms, which takes place during a psychiatric interview and should apply only to signs and symptoms elicited at that time; it should not take into account historical information. The examination is usually divided into the following subheadings: appearance and behaviour, speech, mood, *affect, thought and perception, *insight, and orientation. Usually it also includes a *risk assessment.... mental state examination
(MMSE) a brief 30-point questionnaire that is used to screen for cognitive impairment in the diagnosis of dementia. It is also used to estimate the severity of cognitive impairment and to follow the course of cognitive changes in an individual over time, thus making it an effective way to document response to treatment. It tests functions including arithmetic, memory, and orientation.... mini-mental state examination
the ability to make moral judgments and to take responsibility for choices and actions.... moral agency
(NPSA) formerly, a special health authority that led and coordinated work to improve all aspects of patient safety in England. The NPSA comprised three divisions: the National Reporting and Learning Service, the National Research Ethics Service, and the National Clinical Assessment Service. It closed in 2012, with its key functions transferred to *NHS England. In 2016 the same functions were transferred from NHS England to the newly formed *NHS Improvement.... national patient safety agency
(prokinetic) an agent (e.g. *domperidone) that stimulates intestinal peristalsis, thus increasing gastrointestinal motility.... prokinetic agent
(caudal regression syndrome) a severe neural tube defect specific to diabetic pregnancies. The risk may be correlated with the *glycated haemoglobin (HbA1c) level.... sacral agenesis
congenital absence of part or all of the vagina. See Mayer–Rokitansky–Küster–Hauser syndrome.... vaginal agenesis
(targeted therapy) a drug that interferes with specific molecular targets in the pathways involved in cancer cell growth and signalling, in contrast to *cytotoxic drugs that act primarily on rapidly dividing cells. It typically requires prolonged courses of treatment, and the anticancer action can be synergistic with *chemotherapy. Many new drugs are being developed and are undergoing trials to determine optimal use. The *tyrosine kinase inhibitors include imatinib and *epidermal growth factor receptor inhibitors; multitargeted agents include *sorafenib and *sunitinib. The monoclonal antibodies include *rituximab, *trastuzumab, *cetuximab, and *bevacizumab.... targeted agent
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