Final answer:
Switching from duloxetine to nortriptyline may not decrease and could increase the risk of falls in the elderly due to the side effects of tricyclic antidepressants like orthostatic hypotension and sedation. Other changes like stopping lorazepam or adjusting diuretics and antihyperglycemic medications can potentially reduce fall risk.
Step-by-step explanation:
The direct answer to the question is: b) Switching his antidepressant medication from duloxetine (Cymbalta®) to nortriptyline (Pamelor®) will likely not decrease the patient's fall risk and may actually increase it.
In a review of medications that could potentially increase a fall risk for an elderly patient, changing antidepressants from duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), to nortriptyline, a tricyclic antidepressant (TCA), might increase risk rather than decrease. TCAs can cause orthostatic hypotension, sedation, and even confusion, which are all risk factors for falls in the elderly. On the other hand, discontinuing lorazepam (Ativan®), a benzodiazepine, could decrease the risk of falls because benzodiazepines can cause sedation and cognitive impairment. Decreasing the diuretic dose can reduce the frequency of urination and thereby reduce the urgency and frequency of getting up, which can lower fall risk. Lastly, switching from a sulfonylurea to a DPP-4 inhibitor might be beneficial, as sulfonylureas can cause hypoglycemia, which can lead to falls, while DPP-4 inhibitors have a lower risk of hypoglycemia.