Which of the following changes will likely not decrease fall risk in an elderly patient?

Switching from duloxetine (Cymbalta®) to nortriptyline (Pamelor®) is the change that is least likely to decrease fall risk in an elderly patient. Duloxetine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI), is often prescribed for conditions like depression and anxiety, and it has been shown to have a favorable safety profile regarding falls in older adults. In contrast, nortriptyline is a tricyclic antidepressant (TCA) that is associated with more anticholinergic side effects, such as sedation, confusion, and hypotension, all of which can increase the risk of falls.

In addition, while patients with specific conditions may benefit from switching medications, in general, the switch to nortriptyline may expose the elderly patient to a higher chance of adverse effects that contribute to instability and fall risk. Therefore, this medication change does not align with strategies aimed at reducing fall risk, highlighting its potential to inadvertently worsen the patient's overall safety profile.