Abstract
BackgroundThe demographic transition and increasing life expectancy in Africa has lead to a rising elderly population. In Nigeria, little is known about the profile of and treatment outcomes of tuberculosis (TB) in the elderly.MethodsRetrospective cohort study of adult TB patients treated between January 2011 and December 2012 in two large health facilities in Nigeria. The demographic, clinical and treatment outcomes of patients aged 60 and older were compared with those aged 15 to 59 years.ResultsElderly (≥60 years) TB patients accounted for 12.7% of all (1668) adult TB enrolled. Elderly patients had a higher proportion of men compared to non-elderly (64.2% vs 56.8%; p = 0.043); but a lower proportion of smear-positive TB at baseline (40.7% vs 65.8%; p<0.001). A higher proportion of elderly patients failed to smear convert after the intensive phase of treatment (23.7% vs 19.8%; p = 0.06), and overall elderly patients had lower treatment success rates (68.9% vs 77.1%; p = 0.009). Unsuccessful outcomes were mainly due to higher default and deaths in the elderly. The risk factors for unsuccessful outcomes in the elderly were: extrapulmonary TB case (adjusted odds ratio (aOR) 10.9; 95% confidence interval (CI) 1.1–108), and HIV co-infection (aOR 3.6; CI 1.1–11.7).ConclusionsTreatment outcomes of elderly TB patients were inferior to non-elderly adults with higher death and default rates being implicated. With the rising elderly population, specific strategies are needed to quickly address TB management in the elderly in resource-limited settings.
Highlights
The frequency of tuberculosis among elderly persons is about three times that observed in non-elderly adults [1]
A higher proportion of the elderly resided in a rural area (79.2% vs 69.5% among nonelderly; p = 0.003); but, a lower proportion of them were HIVpositive (7.1% vs 22.5%; p,0.001)
There were no differences in the proportion of elderly and non-elderly patients in terms of facility where care was given, treatment category, regimen received and type of TB (Table 1)
Summary
The frequency of tuberculosis among elderly persons is about three times that observed in non-elderly adults [1]. The increased risk of tuberculosis in persons aged 60 years and above is being driven by immunosuppression, malnutrition, poverty, reduced access to health services, and co-morbidities like diabetes mellitus [2,3]. With age-related physiological, psychological, physical disability and social changes compounded by chronic degenerative diseases, TB in elderly ($60 years) individuals is likely to follow a non-classical course [4]. To optimize healthcare services and TB control in resource-poor settings of Africa, detailed knowledge of the epidemiological features of TB and its treatment outcomes in the elderly in the region are needed. The demographic transition and increasing life expectancy in Africa has lead to a rising elderly population. In Nigeria, little is known about the profile of and treatment outcomes of tuberculosis (TB) in the elderly
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