[The issue of tuberculosis in the elderly in Japan].Kekkaku 2010; 85(12):881-94K
Tuberculosis in the elderly remains a health burden in Japan. Most of the elderly aged more than 70 years in Japan had become infected with Mycobacterium tuberculosis in their youth, and the elderly represent a population at a special high risk for developing tuberculosis owing to comorbidity and age-related immunosuppression. The characteristics of tuberculosis in the elderly are different from young patients. To reduce active tuberculosis in the elderly, treatment of latent tuberculosis infection for compromised host could be strengthened, however its impact might be limited. Elderly tuberculosis patients have not only clinical problems but also socioeconomic problems. Major problems of elderly tuberculosis patients are concurrent diseases, bed ridden states, necessity of nursing care, undernourished, poor adherence, and poor performance status of patients. With this symposium, we focused on the issue of tuberculosis in the elderly in Japan. The speakers were invited from various areas, including tuberculosis surveillance center, public health center and national hospital organization medical center. (1) Current trend of elderly TB: Masako OHMORI (Tuberculosis Surveillance Center, Research Institute of Tuberculosis, JATA) Although the tuberculosis (TB) incidence rate in Japan reached 19.4 per 100,000 in 2008, the rates among the elderly (65 + yrs) were high, e.g., 29.5 of those aged 64-74 years, 64.2 of those aged 75-84 years and 97.3 of those aged 85 years and over. The proportion of those aged 65 years and over increased from 36.8% in 1987 to 56.7% in 2008. Regarding the delay of case detection among elderly TB patients, the patient's delay tended to be shorter but the doctor's delay was longer. Although most TB patients including elderly TB patients were detected upon visiting a medical institution with some symptoms, in the case of elderly TB more patients were detected as outpatients or inpatients for a disease other than TB. Among TB patients aged 65 years and over, 26.4% died within one year. (2) The issues of elderly tuberculosis--An outbreak of pulmonary tuberculosis at nursing home for the elderly: Michiaki OKUMURA (Public Health Division, Public Health and Welfare Bureau, City of Osaka) I experienced a mass outbreak of pulmonary tuberculosis with 8 patients (including the source of infection) and 6 latent tuberculosis infections. Five patients (including the source) of the 8, I underwent restriction fragment length polymorphism (RFLP) analysis of isolated from the sputum. Five patients showed an identical RFLP pattern. These results showed that the infection had arisen from one source. The disease of 4 patients (aged 74-103) seemed to be caused by exogenous reinfections. The elderly tend to have some complications and to be malnutrition. These factors may be risk factors of tuberculosis reinfection for elderly. (3) The community DOTS in the elderly: Yoko HASHIMOTO (Wakayama Prefecture Gobo Health Center) In Wakayama prefecture, we have established a standard assessment list of adherence for tuberculosis patients. To identify predictors of default in the elderly, we investigated assessment lists of tuberculosis patients registered in Gobo Health Center from 2004 to 2007. Factors associated with default were concurrent diseases, side effects, disability and no family support. We have developed a liaison critical pathway for tuberculosis in Gobo Health Center and Tanabe Health Center since 2007. Introducing the path, we could strengthen community medical cooperation and build a network to support adherence. Health center staff should expand the community DOTS in the elderly with establishing an effective community collaboration. (4) The clinical issue of tuberculosis in the elderly: Takeshi KAWASAKI (Department of Respirology, Graduate School of Medicine, Chiba University, Department of Thoracic Disease, National Hospital Organization Chiba-East National Hospital) To identify the clinical issue of TB in the elderly, 139 cases were studied. There were 63 elderly cases in the 139. In the elderly TB patients, there were many cases of death and moving out, so the clinical results were poor. Some cases take much time to move out. It is important to inform doctors and people who care for the elderly that the elderly are under high risk of tuberculosis, to consider treatment for latent tuberculosis infection of high risk groups of tuberculosis, and that experts in tuberculosis, local doctors, health care center and geriatric facilities have close relation. (5) Problems and measures of tuberculosis in elderly group: Masahiro ABE (National Hospital Organization Ehime National Hospital) The percentage of the aged is high among all of tuberculosis patients, especially in the country compared to the city. I reported problems concerning tuberculosis treatment and ward management for elderly patients. During the hospitalization, the management of underlying diseases and new complications besides tuberculosis treatment is critical. Dysphagia features particularly make difficult to take anti-TB drugs and nutritional state worse. The rehabilitation of swallowing functions is effective to improve these conditions. To make discharge support more helpful, the support system, including regional cooperation path is expected to advance more widely and deeply.