Bleeding risk in elderly patients receiving anticoagulant therapy: Should dosage be reduced?

I worry a great deal when I prescribe anticoagulant or antiplatelet agents to an older, thin patient who appears to be somewhat frail. Most of these patients are elderly women in their mid 80s, living alone and having been widowed some years earlier. Of course, I also worry about their nutritional status and their ability to adhere to the usually complex list of medications they are supposedly taking. Commonly, they are diabetic, have mild to moderate renal insufficiency, as well as reduced serum albumin levels.