Mortality trends of elderly people in Taiwan from 1974 to 1994

Challenges in treating tuberculosis in the elderly population in tertiary institute

Tuberculosis (TB) epidemic is most prevalent in the India with increase in mortality and morbidity. Ongoing elderly population as a result of increase in health care facilities are at high risk of TB. Elderly people are four-fold more prone to TB. Most cases of TB in the elderly result from reactivation of latent TB due to immunosenescence. Major challenge in dealing with therapeutic aspects of elderly patients is recognising frailty to prevent loss of independence. Challenges facing with elderly TB are difficult to reach out to hospital because of poor health seeking behaviour especially elderly female either due to ignorance or neglected by the family members, atypical presentation mimicking other disorders leading to diagnostic delay, if at all diagnosed impoverished tolerance and adherence to treatment due to various factors like associated comorbidities leading to pill load, impaired renal and hepatic functions with aging and stigma. Emerging resistance with usage of non-standard treatment regimens lead to unpropitious outcomes and increases mortality. The mortality rate is six times higher in elderly compared to younger individuals. Hence elderly people need tertiary level health care facilities for enhancing the diagnosis and appropriate management of tuberculosis and its complications. New set of guidelines to be made for elderly to increase adherence and tolerance thereby decreasing drug interactions and adverse drug reactions. With the increased prevalence of TB in the elderly, it is the need of the hour for India, to focus on this vulnerable population as they are a potential source of infection in the community. Awareness to be created among the elderly community regarding this deadly disease and its outcomes to increase their health consciousness and medical attention. Priming the special focus on females coterie as they are the most neglected population in our society.

Comparison of profile and treatment outcomes between elderly and non-elderly tuberculosis patients in Puducherry and Tamil Nadu, South India

The rising geriatric population and the increased susceptibility of this age group to tuberculosis (TB), the deadliest single infectious agent, is bothersome for India. This study tried to explore the demographic and treatment outcome differences between the elderly (aged 60 years and above) and non-elderly TB (<60 years) patients from South India. This study was part of a large ongoing cohort study under the RePORT India consortium. Newly diagnosed TB patients recruited into the cohort between 2014 and 2018 were included in this study. Pretested and standardized questionnaire and tools were used to collect data and were stored securely for the entire cohort. Required demographic, anthropometric and treatment related variables were extracted from this database and analyzed using Stata version 14.0. Prevalence of elderly TB was summarized as percentage with 95% confidence interval (CI). Generalized linear modelling was attempted to find the factors associated with elderly TB. A total of 1,259 eligible TB patients were included into this present study. Mean (SD) of the participants in the elderly and non-elderly group was 65.8 (6.2) and 40.2 (12.0) respectively. Prevalence of elderly TB was 15.6% (95%CI: 13.6%-17.6%) with nearly 71% belonging to 60–69 age category. Male sex, OBC caste, poor education, unemployment, marriage, alcohol consumption and unable to work as per Karnofsky score were found to be significantly associated with an increased prevalence of elderly TB. Unfavorable outcomes (12% vs 6.5%, p value: 0.018), including death (9.3% vs 3.4%, p value: 0.001) were significantly higher among the elderly group when compared to their non-elderly counterparts. The current TB programme should have strategies to maintain follow up with due attention to adverse effects, social support and outcomes. Additional research should focus on predictors for unfavorable outcomes among the elderly TB group and explore ways to handle the same. Rendering adequate social support from the health system side and family side would be a good start.

Community-Acquired Pneumonia in the Asia-Pacific Region

Community-acquired pneumonia (CAP) is an important cause of mortality and morbidity worldwide. Aging population, dense urbanization, and poor access to health care make the Asia-Pacific region vulnerable to CAP. The high incidence of CAP poses a significant health and economic burden in this region. Common etiologic agents in other global regions including Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Chlamydophila pneumoniae, Staphylococcus aureus, and respiratory viruses are also the most prevalent pathogens in the Asia-Pacific region. But the higher incidence of Klebsiella pneumoniae and the presence of Burkholderia pseudomallei are unique to the region. The high prevalence of antimicrobial resistance in S. pneumoniae and M. pneumoniae has been raising the need for more prudent use of antibiotics. Emergence and spread of community-acquired methicillin-resistant S. aureus deserve attention, while the risk has not reached significant level yet in cases of CAP. Given a clinical and socioeconomic importance of CAP, further effort to better understand the epidemiology and impact of CAP is warranted in the Asia-Pacific region.

Profile and treatment outcomes of tuberculosis in the elderly in southeastern Nigeria, 2011-2012

Background

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.

Methods

Retrospective 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.

Results

Elderly (≥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).

Conclusions

Treatment 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.

Epidemiology and disease burden of ischemic stroke in Taiwan

BACKGROUND

The incidence and prevalence of ischemic stroke (IS) are increasing in Asian countries. We conducted this retrospective database research to investigate epidemiology and disease burden of IS in Taiwan.

METHODS

We identified cases from the National Health Insurance Research Database during period from 2000 to 2005 to calculate prevalence and mortality. We analyzed the relationship between disease burden and gender in Taiwan during the period from 2000 to 2005 using Dismod II.

RESULTS

From study period, stroke mortality increased from 50 to 2300 per 100 000 among individuals aged 50-90 years, with a higher prevalence among females than males. The highest prevalence was observed among men aged 80-84 years, but prevalence among women was highest in patients aged >85 years. The burden of stroke during the period per 1000 population was estimated as follows: the sum of the years of life lost as a result of premature mortality of 55-80 years, years lost as a result of disability of 11-19 years, and disability-adjusted life years (DALYs) of 70-80 years. Most of the DALYs of stroke occurred among those aged 65-69 years. The DALY value was higher among women than among men before 2005; there was no clear trend in 2005.

CONCLUSIONS

Stroke is a significant health concern in Taiwan. The associated disease burden was found to increase each year, especially among individuals aged 65-69 years. Overall, the DALY value increased from 2000 to 2005, which suggests that the associated disease burden will continue to increase over time.

Tuberculosis in ageing: high rates, complex diagnosis and poor clinical outcomes

BACKGROUND

worldwide, the frequency of tuberculosis among older people almost triples that observed among young adults.

OBJECTIVE

to describe clinical and epidemiological consequences of pulmonary tuberculosis among older people.

METHODS

we screened persons with a cough lasting more than 2 weeks in Southern Mexico from March 1995 to February 2007. We collected clinical and mycobacteriological information (isolation, identification, drug-susceptibility testing and IS6110-based genotyping and spoligotyping) from individuals with bacteriologically confirmed pulmonary tuberculosis. Patients were treated in accordance with official norms and followed to ascertain treatment outcomes, retreatment, and vital status.

RESULTS

eight hundred ninety-three tuberculosis patients were older than 15 years of age; of these, 147 (16.5%) were 65 years of age or older. Individuals ≥ 65 years had significantly higher rates of recently transmitted and reactivated tuberculosis. Older age was associated with treatment failure (OR=5.37; 95% CI: 1.06-27.23; P=0.042), and death due to tuberculosis (HR=3.52; 95% CI: 1.78-6.96; P<0.001) adjusting for sociodemographic and clinical variables.

CONCLUSIONS

community-dwelling older individuals participate in chains of transmission indicating that tuberculosis is not solely due to the reactivation of latent disease. Untimely and difficult diagnosis and a higher risk of poor outcomes even after treatment completion emphasise the need for specific strategies for this vulnerable group.

Prevalence of type 2 diabetes mellitus in Taiwan: ethnic variation and risk factors

The purpose of this study was to compare the prevalence of diabetes and risk factors for the disease in three ethnic groups in Taiwan; the Hakaas, Fukienese, and aborigines. A cross-sectional study of men and women aged 50-79 years were invited to attend a standardized interview and physical examination. Diabetes mellitus was defined as a fasting plasma glucose (concentration of greater than or = 126) or a previous diagnosis of diabetes. Demographic, socioeconomic, and risk factor data were obtained. A total of 1293 persons (468 Hakaas, 440 Fukienese, and 385 aborigines) completed the examination. Hakaas had the highest age-adjusted prevalence of diabetes, 17.9% in men and 15.5% in women, followed by Fukienese, 14.5% in men and 12.8% in women. Aborigines had a prevalence of 10.0% in men and 13.3% in women. Diabetes prevalence was positively associated with family history of diabetes, obesity, hypertension, and hypertriglyceridemia. The ethnic variation in diabetes prevalence was reduced after adjustment for age, sex and significant factors. The multivariate-adjusted odds ratios (95% confidence interval) were 1.27 (0.76-2.12) for Fukienese and 1.44 (0.89-2.33) for Hakaas compared with aborigines. Diabetes mellitus is a major public health problem in Taiwan and warrants prevention efforts tailored to the country's different ethnic groups.