For older people and frail people, the long-term benefit of medicines reduces and the potential for harm from adverse effects increases. When the benefit–risk balance changes in this way, medicine review and optimisation are important to simplify the therapeutic regimen, reduce inappropriate medicines and minimise risks. In this article, pharmacist prescriber Linda Bryant uses two case studies to illustrate important considerations during medicine reviews
The first time you talk about death and dying: Don’t assume it can wait
The first time you talk about death and dying: Don’t assume it can wait

GP Jo Scott-Jones discusses the importance of end-of-life care planning and how to raise the topic in conversation with your patients
Kia ora and welcome to New Zealand Doctor Rata Aotearoa
Not a subscriber? Unlock this article by subscribing here.
1. Detering KM, Hancock AD, Reade MC, et al. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ 2010;340:c1345.
2. Thomas K, Corner H, Stobbart-Rowlands M. National primary care audit in end of life care and ACP and recommendations for improvement. BMJ Supportive & Palliative Care 2012;2:192.
3. RACP. Pomegranate Health [podcast]. Ep1: Recognising Death. 29 June 2015. https://www.racp.edu.au/pomegranate/view/episode-1-recognising-death
4. Woelk C, Harlos M. Prognostic Scoring: The Karnofski, Palliative Performance Scale (PPS) and Palliative Prognostic Indicator (PPI). August 2005. https://bit.ly/3sGm1qW
5. British Geriatrics Society. End of Life Care in Frailty: Identification and prognostication. 12 May 2020. https://www.bgs.org.uk/resources/end-of-life-care-in-frailty-identification-and-prognostication
6. Brayne, AB, Brayne, RP, Fowler, AJ. Medical specialties and life expectancy: An analysis of doctors’ obituaries 1997–2019. Lifestyle Med 2021;2:e23.