- Design
- Narrative review with scoping elements, combining trial process data and global evidence
- Population
- Adults aged 60 or over prescribed fall risk-increasing drugs (DeFRID trial, India) and global trials
- Primary outcome
- Implementation challenges to deprescribing fall risk-increasing drugs
- Effect
- Four barrier categories: ethical-clinical, operational, methodological and context-specific
A narrative review with scoping elements combined global randomised trial evidence on deprescribing fall risk-increasing drugs with process data from DeFRID, an ongoing multicentre randomised trial in India of an ARMOR-based deprescribing approach in adults aged 60 or over. It reports barriers rather than a treatment effect.
DeFRID encountered four categories of difficulty: ethical and clinical problems establishing equipoise for withdrawing drugs, recruitment and retention barriers, complexity in measuring falls, and context-specific constraints, namely few deprescribing guidelines, normalised polypharmacy, fragmented care and hierarchical decision-making. Global trials shared low clinician adherence, short follow-up, exclusion of frail or cognitively impaired people, and resource-intensive interventions.
There is no efficacy result here. The practical value is a checklist for anyone starting a deprescribing programme: involve prescribers early, agree who owns each decision, and build shared decision-making with the patient and family.
- Review the medicines most linked to falls at every older patient's visit, and agree a plan to stop or reduce each.
- Involve the original prescriber before changing a long-standing drug.
- Name who owns follow-up after a drug is stopped.
- Include frail and cognitively impaired patients in plans, which trials often excluded.
Why it matters
It names why deprescribing stalls in practice, which is often implementation rather than evidence.
Don't overread it
A narrative review of implementation barriers; it does not show that deprescribing reduces falls.
The statistics, in plain English
This review reports no outcome numbers. Barriers described come from the authors' own trial experience and a narrative synthesis, so they are informed opinion from practice rather than measured effects.
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