The DeFRID trial is a multicentre Indian randomised trial of a structured deprescribing intervention for adults aged 60 or over taking fall risk-increasing drugs. This paper, combining a narrative review with the trial's process data, describes the barriers the investigators met and sets them against the global evidence.
They group the problems into four categories: the ethical difficulty of withdrawing drugs when clinicians are unsure it is safe, recruitment and retention, the difficulty of measuring falls reliably, and constraints particular to Indian practice. Those include few local deprescribing guidelines, polypharmacy that is seen as normal, fragmented care across prescribers, and hierarchical decision-making in which junior doctors or patients rarely question a senior's prescription. Trials elsewhere show low clinician adherence, short follow-up and exclusion of the frailest patients.
This is not an efficacy result. Its value for clinicians in India is recognising the barriers in their own practice: a patient seeing several specialists, each adding drugs, with no one owning the whole list.
- Take ownership of the complete medication list for older patients seeing several prescribers.
- Ask about every fall and review fall risk-increasing drugs at that visit.
- Involve patients and families in decisions to stop drugs, explaining the reason.
- Write a clear plan for tapering and follow-up when stopping a drug.
Why it matters
In fragmented care, no one stops the drugs because no one sees them all.
Don't overread it
This paper reports implementation barriers, not whether deprescribing reduced falls.
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