{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T22:29:06Z","timestamp":1793917746801,"version":"4.8.0"},"reference-count":61,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Safe and Rational Use of Medicines"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Deprescribing fall risk-increasing drugs (FRIDs) is essential for reducing polypharmacy and falls in older adults, yet randomized controlled trials (RCTs) face unique implementation challenges. The DeFRID study is an ongoing multi-center RCT evaluating an Assess, Review, Minimize, Optimize, and Reassess-based deprescribing intervention versus usual care in adults aged \u226560\u2009years prescribed FRIDs. The objectives of this review are threefold: (1) to describe practical challenges encountered during a multi-center deprescribing RCT in India; (2) to propose a conceptual framework for categorizing these barriers; and (3) to contextualize DeFRID\u2019s experience within the broader deprescribing research landscape.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a narrative review with systematic scoping elements, synthesizing global RCT evidence from PubMed, OpenAlex, and Google Scholar (inception-December 2025) with DeFRID process evaluation data. DeFRID barriers and facilitators were identified via mixed-methods (clinician KAP questionnaire and qualitative interviews), team meetings, retention logs, and Phase II RCT implementation data, thematically categorized, and then compared with global RCT challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>DeFRID implementation revealed four challenge categories: ethical-clinical difficulties establishing equipoise for FRID withdrawal; operational barriers to recruitment and retention; methodological complexities in fall outcome ascertainment; and context-specific constraints unique to the Indian low- and middle-income countries setting\u2014limited deprescribing guidelines, polypharmacy normalization, fragmented care coordination, and hierarchical decision-making. Global RCTs revealed substantial implementation challenges: low clinician adherence, short follow-up periods, restrictive eligibility excluding frail or cognitively impaired older adults, and resource-intensive interventions limiting scalability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Deprescribing FRIDs in older adults is impeded by ethical, operational, methodological, and provider-patient challenges, necessitating multilevel strategies integrating training, shared decision-making, context-specific guidelines, and stakeholder engagement for scalable implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration number<\/jats:title>\n                    <jats:p>The DeFRID trial is registered with the Clinical Trials Registry of India (CTRI\/2023\/12\/060516) [https:\/\/ctri.nic.in\/Clinicaltrials\/pmaindet2.php?EncHid=ODg1NjM=&amp;Enc=&amp;userName=].<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/gerona\/glag248","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T11:50:32Z","timestamp":1791460232000},"source":"Crossref","is-referenced-by-count":0,"title":["Deprescribing fall risk-increasing drugs in older adults: implementation challenges and a conceptual framework from the DeFRID trial and global evidence"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2049-8163","authenticated-orcid":false,"given":"Madhavi","family":"Eerike","sequence":"first","affiliation":[{"name":"Department of Pharmacology, AIIMS Bibinagar , Hyderabad, Telangana,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5691-670X","authenticated-orcid":false,"given":"Sakthivadivel","family":"Varatharajan","sequence":"additional","affiliation":[{"name":"Department of General Medicine, AIIMS Bibinagar , Hyderabad, Telangana,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3538-6444","authenticated-orcid":false,"given":"Priyadharsini","family":"Rajendran","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, JIPMER , Puducherry,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0286-4705","authenticated-orcid":false,"given":"Paul","family":"Mathai","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Malabar Medical College , Calicut, Kerala,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9372-2680","authenticated-orcid":false,"given":"Veena","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Kasturba Medical College, Manipal Academy of Higher Education , Manipal, Karnataka,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1559-4454","authenticated-orcid":false,"given":"Vijaya Kumar","family":"Karra","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, AIIMS Bibinagar , Hyderabad, Telangana,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7637-0292","authenticated-orcid":false,"given":"Gomathi","family":"Ramaswamy","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Family Medicine, AIIMS Bibinagar , Hyderabad, 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