New form of TB Care in India
Context:
- A large section of India’s population will be elderly in the future, mostly as a result of improvements in health care and longer life expectancies. In 2011, the proportion of Indians over 60 was approximately 9%. By 2030, this is anticipated to rise to 12.5%.
- Elderly people are a treasure trove of knowledge, and society benefits from respecting their liberties and rights. We must make a commitment to support the health of our senior citizens and give consideration to their particular requirements on October 1, which is International Day of Older Persons. This is particularly true in the case of tuberculosis (TB), which kills at least 1,000 people each day and affects over 25 lakh Indians annually.
About TB (tuberculosis):
- It is an infectious disease that is typically brought on by the MTB bacteria. Although extra-pulmonary TB can affect other regions of the body, pulmonary TB mostly affects the lungs.
- Most infections are referred to be latent tuberculosis when no symptoms are present. Approximately 10% of dormant infections develop into active illnesses, which kill roughly 50% of victims if treatment is not received.
- Fever, night sweats, weight loss, and a persistent cough with blood-containing mucus are typical signs of active tuberculosis.
According to India’s National TB Prevalence Survey, 2021, the country’s overall TB prevalence was 316, while the prevalence of the disease among those over 55 was significantly higher at 588 cases (per lakh population).
The effects of TB on the elderly:
- Cough, exhaustion, and weight loss are common TB symptoms that are misdiagnosed as other illnesses or written off as indicators of ageing. Compared to other people, older adults are more likely to have a delayed or missing TB diagnosis.
- After a diagnosis, other comorbidities, especially diabetes, may make managing tuberculosis in the elderly more difficult.
- Obstacles to receiving healthcare: People find it difficult to get to medical facilities on their own in rural and hilly places.
- They also have less access to trustworthy health information because older people’s social networks naturally get smaller.
- Infrastructural issues that affect older people also include inadequate seats and a lack of accessible public spaces.
- Most importantly, they might not have access to wholesome, high-quality food, which is necessary for healing.
- The majority of persons over 60 are either entirely dependent on their relatives or live off of their savings. For the aged, there are a few social welfare programmes, although their reach and scope are constrained.
- Lack of social and emotional support systems: Many elderly individuals talk about their fragile mental health, which is exacerbated by loneliness brought on by the death of spouses or family members, a lack of purpose or connection, and fear that they are not “useful.”
- The World Health Organisation (WHO) has identified ageism as a factor in both ill health and social isolation.
The future: Developing care that is age-responsive:
- The following are the ways that we create and provide TB care that is elder-friendly:
- It is imperative that we shift from disease-specific, vertical care programmes to holistic care models that minimise the need for senior citizens to engage with various facilities and providers.
- Increase the ability of medical professionals at all levels to better treat numerous morbidities and have a better clinical understanding of tuberculosis in the elderly.
- Effective sputum collection, efficient transportation, availability to mobile diagnostic vans, and active case finding at geriatric OPDs, senior housing facilities, and other institutional settings are all ways to improve case discovery among the elderly.
- Technical and operational guidelines, such as sample extraction procedures, thorough comorbidity assessments, medication dosage modifications, etc., that offer precise instructions for detecting and treating tuberculosis in the elderly.
- We require support protocols, with participation from older TB patients, to address socioeconomic concerns. An elder-focused community care model with connections to nearby carers is one example. Other examples include (a) medicine delivery to patients’ homes; (b) age-responsive peer support and counselling for senior citizens and their families; (c) senior assistance desks at facilities; and (e) assistance with paperwork to access social assistance programmes.
- Macroeconomically, we have to make sure that data is rigorously collected and analysed based on gender and age, that TB trends are identified across age groups, and that all TB reports include the elderly as a distinct age group.
- Increasing cooperation within the healthcare system is a critical first step in creating systems that are accommodating to the elderly.
- In conclusion, a more robust research agenda concerning tuberculosis in the elderly is required. This will enable us to gain a deeper understanding of the following topics: (a) substance abuse; (b) drug resistance and comorbidity patterns across geographic regions; (c) drug resistance and comorbidity patterns; (d) elderly patients’ uptake of TB preventive therapy; and (e) intersectionality with other aspects of equity, such as gender, disability, class, and caste.
