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We would like to commend the authors Vitic et al for their article [1] on the complexities of administration of medication in multimorbid older adults. This article raised useful points on how and when to administer medication in order to improve patient outcomes, and we anticipate referring to it as a valuable resource and teaching tool in the future.
We would also like to highlight another perspective that was not addressed in the case presented (Anna, a frail 81-year-old). Rather than ensuring that the administration of her medication (n=11) allows for best absorption, the question that should first be asked in a medication review for a frail older adult is whether these medications are required. Perhaps the assumption was that an assessment of the benefits and potential harms of the medications had already been conducted after dialogue with Anna and her daughter.
For example, we would suggest first discussing the following 7 medications given they are straightforward to deprescribe:
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• Discontinuing alendronate due to the recommendation of a drug holiday after 5 years. If it had been
started recently, there would be value in explaining the number needed to treat and time to benefit
(estimated to prevent one of 100 women from having a non-vertebral fracture after a year of taking
it) [2].
• Discontinuing calcium and vitamin D due to the limited evidence in reducing fracture risk in frail
o...Competing Interests: None declared.