Why deprescribing fall-risk drugs stalls - lessons from an Indian trial

The team running DeFRID, a multicentre randomised trial in India testing a structured deprescribing intervention for adults aged 60 or over taking fall risk-increasing drugs, report the barriers they met alongside a review of global trials (Journals of Gerontology Series A, 8 October 2026).

They group the challenges into four kinds: clinical and ethical difficulty establishing equipoise for stopping a drug; recruitment and retention; measuring falls reliably; and context-specific problems - few deprescribing guidelines for Indian practice, polypharmacy seen as normal, fragmented care across several prescribers, and hierarchical decision-making that discourages one doctor from stopping another's drug. Trials elsewhere show low clinician adherence, short follow-up and exclusion of the frail and cognitively impaired patients who most need deprescribing.

This is a narrative account, not a trial result, but it names the practical obstacles a clinician meets. In India especially, a patient may carry prescriptions from several specialists, and no one feels permitted to stop any of them.

• Review sedatives, antihypertensives, antidepressants and anticholinergics after any fall
• Take ownership of the whole medication list, including drugs started by other specialists
• Explain to patients and families why a drug is being reduced, and agree a review date
• Taper sedatives and antidepressants gradually rather than stopping abruptly

Why it matters

Deprescribing fails less on evidence than on who feels entitled to stop a drug.

Don't overread it

A narrative review with process data from an ongoing trial - it does not report whether deprescribing reduced falls.

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