You are reviewing an 82-year-old lady with an established diagnosis of HFrEF. Medications include ramipril 1.25mg bd, dapagliflozin 10mg od, furosemide 40mg od, and bisoprolol 1.25mg od. Spironolactone was withdrawn due to symptomatic hypotension. The resting heart rate is 62 bpm (sinus rhythm), blood pressure is 88/60 mmHg, and there is no clinical congestion. Co-morbidities include COPD, CKD (eGFR 40), type II diabetes, and anaemia (Hb 95 g/dl, microcytosis, and transferrin 
saturation 10%). She is less independent than 1 year ago and recently has had a carer visiting once a day. There is evidence of mild frailty but no incontinence. The serum albumin is 28 g/L (reference range 32–38 g/L). On further enquiry you learn of poor sleep, low mood, and constipation. What should you consider in your consultation?