[Clinical investigation among elderly patients with tuberculosis].
OBJECTIVE
We discussed the factors which may confuse diagnosis and treatment of tuberculosis (TB) in elderly patients, in order to improve the situation.


METHODS
414 patients who were hospitalized for active tuberculosis in Tokyo National Hospital were divided into three groups according to their ages (in years): less than 65, 65 to 74, and greater than 75. The three groups were compared in terms of performance status (PS), serum albumin level (whether over 3 g/dl or not), underlying diseases, symptoms at onset, sputum smear findings for acid-fast bacilli, presence or absence of cavitary lesion, regimen of treatment, adverse reaction to medications, and treatment outcome.


RESULTS
The older group had significantly poorer PS (3 or 4), lower albumin level, more complications, a larger proportion of non-respiratory to respiratory symptoms, less cavity formation, less likelihood of continuing to take drugs regularly and higher mortality. It is supposed that these characteristics are mostly due to the aging itself.


CONCLUSIONS
Diagnosing and treating active tuberculosis among elderly people is difficult because of nonspecific and thus confusing findings due to other diseases or aging. Delay in diagnosis and start of treatment makes prognosis of their TB poorer. To improve this situation we should keep a high index to TB and make better use of novel diagnostic technologies. For satisfactory treatment that allows maintenance of a high level of activity of daily life, it is necessary to pay more attention to such aspects as nutrition and rehabilitation and to offer appropriate supports.
Toyota
Emiko
E
Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, 3-1-1, Takeoka, Kiyose-shi, Tokyo 204-8585, Japan. etoyota-in@tokyo-hosp.jp
Machida
Kazuko
K
Nagayama
Naohiro
N
Yamane
Akira
A
Komiya
Kosaku
K
Ito
Saburo
S
Suzuki
Junichi
J
Kashizaki
Fumihiro
F
Shimada
Masahiro
M
Matsui
Yoshinori
Y
Kawashima
Masahiro
M
Ohshima
Nobuharu
N
Suzuki
Junko
J
Ariga
Haruyuki
H
Masuda
Kimihiko
K
Matsui
Hirotoshi
H
Tamura
Atsuhisa
A
Teramoto
Shinji
S
Nagai
Hideaki
H
Akagawa
Shinobu
S
Shoji
Shunsuke
S
Hebisawa
Akira
A
Nakajima
Yutsuki
Y
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014376:Tuberculosis / Q000401:mortality / Q000503:physiopathology