Aging is associated with impairments in maintaining homeostasis in response to physiologic and environmental disturbances. These age-associated impairments include alterations in metabolic and neuroendocrine function. Leptin is a hormone mainly produced in and secreted by adipose tissue, and mutations in the leptin gene are associated with extreme obesity and neuroendocrine impairments, including impaired reproduction and low sex hormones, low thyroid hormone, low growth hormone, and elevated glucocorticoids. Leptin replacement reversed many of the phenotypes of leptin-deficient mice. Fasting reduces leptin gene expression and fasting-induced neuroendocrine alterations are also reversed by leptin injection. However, it was quickly apparent that leptin is highly correlated with total fat mass, and obesity is associated with elevated, rather than reduced, leptin levels in both rodents and humans. Thus, increased adiposity is associated with leptin resistance. Since aging is associated with dramatic changes in adiposity and neuroendocrine impairments similar to those observed in leptin-deficient and leptin-resistant animals, leptin resistance and/or insufficiency might contribute to some of these age-related metabolic impairments.

There is growing support for characterizing human aging from a life-course perspective, in terms of recognizing important influences operating from conception to death, and this approach provides a framework for understanding aging processes operating at the individual level. Kirkwood's disposable soma theory proposes that aging is a manifestation of imperfect somatic maintenance and repair processes. We can therefore predict that differing exposure to the determinants of somatic damage across the life-course, and variable capacity to respond in terms of repair are likely to underlie the wide variation in rates of aging between individuals.

Older people in residential or nursing care may have needs comparable with those of a healthy person living in the community, compounded by additional health-care needs. Sexual needs can be ignored or pushed into the background, with barriers created to their expression and satisfaction.

Diuretics are commonly prescribed in older people and are often used for prolonged periods. Indications for their use include heart failure and hypertension. They are also used to empirically treat complaints such as swollen ankles and shortness of breath. The aging body is particularly susceptible to the adverse effects of diuretic therapy. Many of the problems are a result of intravascular and extravascular fluid imbalance. It is therefore important that diuretics are prescribed rationally and with good reason. Most major clinical trials do not include older people with multiple co-morbidities. This review will consider whether trials involving diuretics are any different, through an evaluation of what evidence there is to support diuretic use in older people. We will also evaluate the evidence which implicates diuretics as a cause of common clinical problems such as falls, postural hypotension and incontinence. Finally, a rational approach to the use of diuretics in older people will be suggested so that the benefits of diuretic therapy can be maximized and potential adverse effects minimized.

Coeliac disease (CD) is a chronic enteropathy caused by intolerance to gluten in genetically susceptible people. The first description of the coeliac lesion was provided in 1954 by Paulley et al, who examined full-thickness biopsy specimens taken at laparotomy from a patient with CD. They referred to broad flat villi and a dense chronic inflammatory cell infiltrate in the small intestinal mucosa. Following this, the use of unguided suction biopsy devices, such as the Crosby capsule, allowed the study of patients with malabsorption. The advent of fibreoptic endoscopy as a diagnostic tool has led to extensive study of the duodenal mucosa in less florid forms of CD.

The involvement of service users as active participants is a stated aim of many current developments within health and social care, and self-assessment has been identified as a key mechanism. For over 15 years, the UK Department of Health has referred to the importance of the service user's views in assessment, and this has been re-emphasized recently in guidance issued to both local authorities social services and the NHS. The concept of the expert patient and the promotion of self-care amongst people with long-term conditions are also highlighted as central to current NHS development. Although not specified as such, self-assessment is an important component of these person-centred initiatives which encourage self-diagnosis, self-monitoring and self-management.