The problems of tuberculosis in the elderly.

A prospective study of tuberculosis notifications from 1976 to 1980 in the North Staffordshire Health District (NSHD), an area with only a small immigrant population, has been carried out. The notification rate for all new cases of tuberculosis in white patients over 55 years of age in the NSHD was twice that reported for England and Wales by the Medical Research Council (1980). Of 433 cases in all ethnic groups 52 (12 per cent) were diagnosed only at necropsy. In addition 48 (11 per cent) died before treatment was completed. Tuberculosis was the only cause of death in 39 of these 100 cases and contributed to death in a further 19 cases, the site of disease being thoracic in 86. Of those who died before completion of treatment, tuberculosis was the cause of death or contributory in 23 and 16 of the 23 (70 per cent) had been on treatment for less than 13 weeks. Death occurred more commonly before or during treatment with increasing age. In a retrospective study of treatment during 1979 and 1980, major unwanted drug-induced effects occurred in 40 per cent of all treated cases in the over-65 age group, mostly related to rifampicin. The survey highlighted the problems of tuberculosis in the elderly white population. They present with advanced disease, are diagnosed late and their course is complicated by other disease and a poor tolerance of therapy.