404
LETTERS TO THE EDITOR
More whites than black Africans reported feeling depressed. Use of antidepressants and psycholeptics was higher in whites and coloreds, and both groups reported a higher number of comorbid conditions and medication use than black Africans. Of fallers with injuries, 23 (14%) reported having sustained a fracture at baseline (78% women) and 6% at follow-up (all women), of which six (26%) and two (20%) were of the hip, respectively. The baseline fractures distribution was coloreds nine (39.1%), whites eight (34.8%), blacks four (17.4%), and Indians two (8.7%).
DISCUSSION Marked differences in fall rates were found, with the highest rates reported in whites and the lowest in black Africans, with those in coloreds in between. Racial differences in fall rates have been studied in the United States, but findings are inconsistent. Some studies suggest a higher rate of falls in Caucasians than in African Americans and other racial groups.4,5 Differences in propensity to fall may be related to lifestyle factors and physical activity levels,6 comorbid conditions, and drug use. In South Africa, the majority of black Africans are socioeconomically disadvantaged and likely worked as unskilled laborers; in the study, 78% were so, compared with 8.6% of whites and 17.3% of coloreds. Differences in physical activity levels and lifestyles may thus be factors that modify peak bone and muscle mass and function7 and the rate of their decline, which will determine the maintenance of gait and balance and a propensity to fall in older age. Multigenerational co-residence, common in black Africans in this study, may protect older residents from risk-taking behavior that might predispose them to a fall. Differences in fracture rate in racial groups have been reported.8 A study in the United States found that fracture rates were lowest in African American and Asian women and highest in white and Hispanic women, with bone mineral density highest in African American women and lowest in Asian women.9 The differences in prevalence rates and incidence of falls in the racial subsamples were unexpected and may be partially explained by SES. Future investigation of factors that contribute to prevalence rates in different communities is likely to enhance an understanding of causality and risk factors, as well as inform intervention to prevent falls in older individuals. Sebastiana Z. Kalula, MB ChB, PhD Division of Geriatric Medicine, Albertina and Walter Sisulu Institute of Ageing in Africa, University of Cape Town, Cape Town, South Africa
FEBRUARY 2015–VOL. 63, NO. 2
JAGS
Motasim Badri, PhD Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
ACKNOWLEDGMENTS We wish to thank the field workers and the study participants for making this work possible. We are grateful to George Petros for coordinating field workers and for data capture. This study was funded by the Medical Research Council of South Africa, the University of Cape Town Research Office and Health Sciences Research Committee, the Harry Crossley Fund, and the National Research Foundation of South Africa. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: SZK: study concept and design, drafting the manuscript, acquisition of subjects. MF, GHS: study design, drafting the manuscript. MB: statistical analysis, drafting the manuscript. All authors read and approved the final manuscript. Sponsor’s Role: Sponsors had no role in the design, methods, subject recruitment, data collections, analysis, and preparation of paper.
REFERENCES 1. Aoyagi K, Ross PD, Davis JW et al. Falls among community-dwelling elderly in Japan. J Bone Miner Res 1998;13:1468–1474. 2. Chu L, Chi I, Chiu A. Incidence and predictors of falls in the Chinese elderly. Ann Acad Med Singapore 2005;34:60–72. 3. Yu PL, Qin ZH, Shi J et al. Prevalence and related factors of falls among the elderly in an urban community of Beijing. Biomed Environ Sci 2009;22:179–187. 4. Nevitt MC, Cummings SR, Kidd S et al. Risk factors for recurrent nonsyncopal falls: A prospective study. JAMA 1989;261:2663–2668. 5. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701–1707. 6. Dibba B, Prentice A, Laskey M et al. An investigation of ethnic differences in bone mineral, hip axis length, calcium metabolism and bone turnover between West African and Caucasian adults living in the United Kingdom. Ann Hum Biol 1999;26:229–242. 7. Sayer AA, Robinson SM, Patel HP et al. New horizons in the pathogenesis, diagnosis and management of sarcopenia. Age Ageing 2013;42:145– 150. 8. Moayyeri A, Soltani A, Larijani B et al. Epidemiology of hip fracture in Iran: Results from the Iranian Multicenter Study on Accidental Injuries. Osteoporos Int 2006;17:1252–1257. 9. Barrett-Connor E, Siris ES, Wehren LE et al. Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 2005;20:185–194.
Monica Ferreira, DPhil International Longevity Centre–South Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
TAKOTSUBO CARDIOMYOPATHY AND ELDERLY ADULTS: STILL A BENIGN CONDITION?
George H. Swingler, MB ChB, PhD Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
To the Editor: Takotsubo syndrome (TKS)1 mimics an acute coronary syndrome2–10 and has been deemed to be related to stressful situations. The prognosis is usually good,2,3 but data concerning TKS in elderly adults are lim-
JAGS
FEBRUARY 2015–VOL. 63, NO. 2
ited and mainly based on case reports and small case series. The aim of the current study was to examine TKS in elderly adults and to compare their baseline features, clinical presentation, natural history, and long-term prognosis with those of a cohort of contemporary younger adults with TKS as a control group. A prospective database2 of individuals with TKS (Mayo modified criteria)6 between January 2003 and April 2014 and the National Spanish Registry of TKS were reviewed.8 Three hundred forty-three individuals were analyzed, 235 of whom were classified as elderly (≥65) and the remaining 107 as younger (4.5 mIU/L, fT4 4.5 mIU/L, fT4 13–23 pmol/L; n = 35). Hemoglobin was measured on the day the blood sample was drawn using a fully automated system (Sysmex XE-2100, TOA Medical Electronics, Kobe, Japan). Anemia was defined according to the World Health Organization criteria (hemoglobin
LETTERS TO THE EDITOR
More whites than black Africans reported feeling depressed. Use of antidepressants and psycholeptics was higher in whites and coloreds, and both groups reported a higher number of comorbid conditions and medication use than black Africans. Of fallers with injuries, 23 (14%) reported having sustained a fracture at baseline (78% women) and 6% at follow-up (all women), of which six (26%) and two (20%) were of the hip, respectively. The baseline fractures distribution was coloreds nine (39.1%), whites eight (34.8%), blacks four (17.4%), and Indians two (8.7%).
DISCUSSION Marked differences in fall rates were found, with the highest rates reported in whites and the lowest in black Africans, with those in coloreds in between. Racial differences in fall rates have been studied in the United States, but findings are inconsistent. Some studies suggest a higher rate of falls in Caucasians than in African Americans and other racial groups.4,5 Differences in propensity to fall may be related to lifestyle factors and physical activity levels,6 comorbid conditions, and drug use. In South Africa, the majority of black Africans are socioeconomically disadvantaged and likely worked as unskilled laborers; in the study, 78% were so, compared with 8.6% of whites and 17.3% of coloreds. Differences in physical activity levels and lifestyles may thus be factors that modify peak bone and muscle mass and function7 and the rate of their decline, which will determine the maintenance of gait and balance and a propensity to fall in older age. Multigenerational co-residence, common in black Africans in this study, may protect older residents from risk-taking behavior that might predispose them to a fall. Differences in fracture rate in racial groups have been reported.8 A study in the United States found that fracture rates were lowest in African American and Asian women and highest in white and Hispanic women, with bone mineral density highest in African American women and lowest in Asian women.9 The differences in prevalence rates and incidence of falls in the racial subsamples were unexpected and may be partially explained by SES. Future investigation of factors that contribute to prevalence rates in different communities is likely to enhance an understanding of causality and risk factors, as well as inform intervention to prevent falls in older individuals. Sebastiana Z. Kalula, MB ChB, PhD Division of Geriatric Medicine, Albertina and Walter Sisulu Institute of Ageing in Africa, University of Cape Town, Cape Town, South Africa
FEBRUARY 2015–VOL. 63, NO. 2
JAGS
Motasim Badri, PhD Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
ACKNOWLEDGMENTS We wish to thank the field workers and the study participants for making this work possible. We are grateful to George Petros for coordinating field workers and for data capture. This study was funded by the Medical Research Council of South Africa, the University of Cape Town Research Office and Health Sciences Research Committee, the Harry Crossley Fund, and the National Research Foundation of South Africa. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: SZK: study concept and design, drafting the manuscript, acquisition of subjects. MF, GHS: study design, drafting the manuscript. MB: statistical analysis, drafting the manuscript. All authors read and approved the final manuscript. Sponsor’s Role: Sponsors had no role in the design, methods, subject recruitment, data collections, analysis, and preparation of paper.
REFERENCES 1. Aoyagi K, Ross PD, Davis JW et al. Falls among community-dwelling elderly in Japan. J Bone Miner Res 1998;13:1468–1474. 2. Chu L, Chi I, Chiu A. Incidence and predictors of falls in the Chinese elderly. Ann Acad Med Singapore 2005;34:60–72. 3. Yu PL, Qin ZH, Shi J et al. Prevalence and related factors of falls among the elderly in an urban community of Beijing. Biomed Environ Sci 2009;22:179–187. 4. Nevitt MC, Cummings SR, Kidd S et al. Risk factors for recurrent nonsyncopal falls: A prospective study. JAMA 1989;261:2663–2668. 5. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701–1707. 6. Dibba B, Prentice A, Laskey M et al. An investigation of ethnic differences in bone mineral, hip axis length, calcium metabolism and bone turnover between West African and Caucasian adults living in the United Kingdom. Ann Hum Biol 1999;26:229–242. 7. Sayer AA, Robinson SM, Patel HP et al. New horizons in the pathogenesis, diagnosis and management of sarcopenia. Age Ageing 2013;42:145– 150. 8. Moayyeri A, Soltani A, Larijani B et al. Epidemiology of hip fracture in Iran: Results from the Iranian Multicenter Study on Accidental Injuries. Osteoporos Int 2006;17:1252–1257. 9. Barrett-Connor E, Siris ES, Wehren LE et al. Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 2005;20:185–194.
Monica Ferreira, DPhil International Longevity Centre–South Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
TAKOTSUBO CARDIOMYOPATHY AND ELDERLY ADULTS: STILL A BENIGN CONDITION?
George H. Swingler, MB ChB, PhD Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
To the Editor: Takotsubo syndrome (TKS)1 mimics an acute coronary syndrome2–10 and has been deemed to be related to stressful situations. The prognosis is usually good,2,3 but data concerning TKS in elderly adults are lim-
JAGS
FEBRUARY 2015–VOL. 63, NO. 2
ited and mainly based on case reports and small case series. The aim of the current study was to examine TKS in elderly adults and to compare their baseline features, clinical presentation, natural history, and long-term prognosis with those of a cohort of contemporary younger adults with TKS as a control group. A prospective database2 of individuals with TKS (Mayo modified criteria)6 between January 2003 and April 2014 and the National Spanish Registry of TKS were reviewed.8 Three hundred forty-three individuals were analyzed, 235 of whom were classified as elderly (≥65) and the remaining 107 as younger (4.5 mIU/L, fT4 4.5 mIU/L, fT4 13–23 pmol/L; n = 35). Hemoglobin was measured on the day the blood sample was drawn using a fully automated system (Sysmex XE-2100, TOA Medical Electronics, Kobe, Japan). Anemia was defined according to the World Health Organization criteria (hemoglobin
