What’s the news?

• TB, which affects over 25 lakh Indians every year and kills at least 1,000 every day, As India is on the cusp of a demographic shift, with the elderly population set to comprise a substantial portion of society, it is imperative to invest in the health of our elderly population and pay attention to their unique needs.

Central idea

• Advances in healthcare and increased life expectancy are propelling India’s demographic transition, with the elderly projected to constitute 12.5% of the population by 2030, up from 9% in 2011. This underscores the urgent need for age-responsive healthcare systems to address the complexities of TB care among the elderly, aligning opportunity with responsibility.

What is tuberculosis (TB)?

• TB is an infectious disease caused by the bacterium Mycobacterium tuberculosis.
• It primarily affects the lungs but can also affect other parts of the body, such as the kidneys, spine, and brain.
• TB is transmitted through the air when an infected individual coughs, sneezes, or speaks, releasing tiny droplets containing the bacteria. When inhaled by others, these droplets can lead to infection.

The Burden of TB among the Elderly

• Recent findings from India’s National TB Prevalence Survey in 2021 reveal a concerning trend: the prevalence of TB among individuals aged 55 and above stands at 588 per one lakh population, significantly higher than the national average of 316.
• This alarming disparity necessitates a dedicated focus on TB among the elderly and the formulation of age-specific TB guidelines.

Challenges faced by elderly TB patients

• Delayed Diagnosis: TB symptoms, including cough, fatigue, and weight loss, are often misinterpreted as signs of old age or other illnesses. Consequently, TB diagnoses among the elderly are frequently delayed or overlooked.
• Comorbidities: Many elderly TB patients have multiple comorbidities, especially diabetes, which complicates TB management. This leads to a higher pill count and an increased likelihood of side effects, affecting treatment adherence and outcomes.
• Access to Healthcare: Elderly individuals, particularly those in rural and hilly areas, struggle to access healthcare facilities due to mobility challenges. This can lead to delays in seeking medical care.
• Limited Information: Older individuals may have restricted access to reliable health information, as their social networks tend to shrink with age. This lack of information hampers their ability to recognize TB symptoms and seek timely medical attention.
• Economic Dependence: Most individuals over the age of 60 are retired and financially dependent on savings or family. While there are some social welfare schemes for the elderly, they often have limitations and may not provide adequate financial support.
• Stigma and Mental Health: TB-related stigma is a concern among the elderly, contributing to social isolation. Many elderly TB patients experience loneliness, anxiety, and a sense of purposelessness, negatively impacting their mental health.

Strategies to address these challenges and provide elder-friendly TB care

• Holistic Care Models: Transition from disease-specific care to holistic models that reduce the need for elderly patients to interact with multiple healthcare providers and facilities.
• Health Professional Training: Build the capacity of healthcare professionals at all levels to better understand TB in the elderly and manage multiple comorbidities effectively.
• Improved Case-Finding: Enhance case-finding mechanisms through effective sputum collection and transportation systems, mobile diagnostic vans, and active case-finding at geriatric OPDs and residential homes.
• Technical Protocols: Develop technical and operational protocols that guide the diagnosis and treatment of TB in the elderly, including sample extraction, comorbidity assessment, and drug dosage adjustments.
• Socio-Economic Support: Design and implement support protocols in consultation with elderly TB patients, including community care models, doorstep medicine delivery, peer support, counseling, and assistance with accessing social support schemes.
• Data Collection and Analysis: Ensure rigorous gender and age-disaggregated data collection and analysis to identify TB trends among the elderly, with a dedicated age category in all TB reports.
• Strengthen Collaboration: Foster collaboration within the healthcare system to build elderly-friendly care systems effectively.
• Research Agenda: Promote research focused on TB in the elderly, exploring state-specific trends, substance use, drug resistance, co-morbidity patterns, TB preventive therapy uptake, and intersectionality with other equity aspects.

Conclusion

• On this International Day of Older Persons, India must reaffirm its commitment to the well-being of its elderly citizens. By implementing age-responsive TB care models, strengthening healthcare systems, and conducting focused research, we can pave the way for a healthier, more inclusive future for our aging population.

Also read:

India’s diabetes epidemic is making its widespread TB problem worse

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