Raghu Srikanti
Department of Pulmonary Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India; Superintendent of Government Hospital for Chest and Communicable Diseases, Guntur, Andhra Pradesh, India.
Indian J Tuberc. 2022;69 Suppl 2:S225-S231. doi: 10.1016/j.ijtb.2022.10.008. Epub 2022 Oct 29.
Tuberculosis (TB) epidemic is most prevalent in the India with increase in mortality and morbidity. Ongoing elderly population as a result of increase in health care facilities are at high risk of TB. Elderly people are four-fold more prone to TB. Most cases of TB in the elderly result from reactivation of latent TB due to immunosenescence. Major challenge in dealing with therapeutic aspects of elderly patients is recognising frailty to prevent loss of independence. Challenges facing with elderly TB are difficult to reach out to hospital because of poor health seeking behaviour especially elderly female either due to ignorance or neglected by the family members, atypical presentation mimicking other disorders leading to diagnostic delay, if at all diagnosed impoverished tolerance and adherence to treatment due to various factors like associated comorbidities leading to pill load, impaired renal and hepatic functions with aging and stigma. Emerging resistance with usage of non-standard treatment regimens lead to unpropitious outcomes and increases mortality. The mortality rate is six times higher in elderly compared to younger individuals. Hence elderly people need tertiary level health care facilities for enhancing the diagnosis and appropriate management of tuberculosis and its complications. New set of guidelines to be made for elderly to increase adherence and tolerance thereby decreasing drug interactions and adverse drug reactions. With the increased prevalence of TB in the elderly, it is the need of the hour for India, to focus on this vulnerable population as they are a potential source of infection in the community. Awareness to be created among the elderly community regarding this deadly disease and its outcomes to increase their health consciousness and medical attention. Priming the special focus on females coterie as they are the most neglected population in our society.
结核病疫情在印度最为普遍，死亡率和发病率都在上升。由于医疗保健设施的增加，老年人口不断增加，他们感染结核病的风险很高。老年人患结核病的几率是其他人的四倍。老年人的大多数结核病病例是由于免疫衰老导致潜伏性结核病重新激活所致。在处理老年患者的治疗问题时，主要挑战是认识到虚弱，以防止失去独立能力。老年结核病患者面临的挑战包括：由于健康寻求行为不佳，尤其是老年女性，要么由于无知，要么被家庭成员忽视，难以前往医院就诊；临床表现不典型，类似其他疾病，导致诊断延迟；如果被诊断出来，由于各种因素，如合并症导致用药负担加重、肾功能和肝功能随着年龄增长而受损以及耻辱感等，耐受性差且难以坚持治疗。使用非标准治疗方案导致的耐药性增加会导致不良后果并增加死亡率。老年人的死亡率比年轻人高六倍。因此，老年人需要三级医疗保健设施，以加强结核病及其并发症的诊断和适当管理。需要为老年人制定一套新的指南，以提高依从性和耐受性，从而减少药物相互作用和药物不良反应。随着老年人结核病患病率的上升，印度现在需要关注这一弱势群体，因为他们是社区中潜在的传染源。需要在老年人群体中提高对这种致命疾病及其后果的认识，以增强他们的健康意识并促使他们寻求医疗关注。尤其要特别关注女性群体，因为她们是我们社会中最被忽视的人群。
