Improve TB response for elderly people, says doctor

DESPITE an alarming tuberculosis (TB) burden among older people, the response to it has not been successful, a doctor says.
Dr Vijay Kumar Arora, chairman of the TB Association of India and of the International Union Against TB and Lung Disease (The Union) Southeast Asia region, said one in four people globally who had developed TB in 2021 was over 55 years of age as per the latest WHO (World Health Organisation) Global TB Report.
According to Dr Arora, over a million of these older people were missed by TB services.
“There is also a large number of elderly TB patients who remain undiagnosed,” he said.
“Such a high rate of TB necessitates concentrated efforts to control the condition effectively.
“Increased life expectancy, changes in the demographic profile and atypical presentation of the clinical features of TB pose many challenges in the management of TB in the elderly.”
Dr Surya Kant, from King George Medical University, said the elderly persons’ TB formed a vulnerable group showing high mortality.
“The diagnosis poses difficulties as they exhibit many typical features, and symptoms are often similar to other age-related diseases,” Dr Kant said.
“Many elderly patients are present with non-specific symptoms and the condition is missed for a long period of time, causing delay in correct diagnosis.”
Dr Arora added that treatment of elderly patients with TB was similar to that given to younger patients.
However, adverse reactions, such as hepatotoxicity, were more common in the elderly.
“Drug interactions are more frequent in them,” he said. It has been seen that 63 per cent of the elderly patients exhibit poor tolerance to anti-TB drugs, as compared to 54 per cent in younger patients.
Dr Arora said financial issues often became a hindrance in continuing treatment.
“Many are not able to take care of themselves. This results in poor adherence to treatment and failure to complete the prescribed course.”
He said other conditions such as diabetes, hypertension, disease of the internal organs made the elderly more susceptible to TB.
Immunity decline in old age, malnutrition, chronic alcoholism, pollution, unhygienic living and smoking were other factors.