Tuberculosis in the Elderly: Everything You Need to Know

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What is Tuberculosis?

The NHS states, “TB is a potentially serious condition, but it can be cured if treated with the right antibiotics.” It’s a bacterial infection that impacts the lungs; anyone can get TB. However, it is prevalent among the elderly as their immune system tends to be weaker than other healthier adults. So, it is essential to take preventative measures where possible to help decrease the condition’s impact on your or your loved one’s body.

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Tuberculosis Potential Causes

As we age, we become more susceptible to infections due to different reasons, including a weakened immune system. TB only spreads after prolonged exposure to someone with the condition. However, the immune system is the body’s natural defence against infections. A weakened immune system doesn’t allow us to fight effectively against health conditions, making it one of the leading potential causes of TB.

Also, exposure to bacteria can potentially cause infections, including TB. Exposure to bacteria can be common in places such as care homes and hospitals. Plus, bad hygiene practices can increase exposure to bacteria. With this in mind, many older individuals with weakened immune systems won’t be able to fight against bacterial infections, or it may take longer to recover. So, ensuring good hygiene is necessary to prevent infections from spreading.

Furthermore, comorbidities are known to be a potential cause of TB. The World Health Organization states, “it is important to identify these co-morbidities in people diagnosed with TB to ensure early diagnosis and improve co-management.” These comorbidities are medical conditions like diabetes, malnutrition, tobacco smoking, and alcohol, which are all risk factors that can cause TB.

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Symptoms of Tuberculosis

According to the NHS, TB symptoms can vary depending on what part of the body is affected. However, most TB infections affect the lungs. It tends to develop slowly and in some cases, symptoms may not appear straight after the initial infection; it can take months or even years.

It is important to note that there are two types of TB – latent TB and active TB. Individuals with latent TB won’t show any symptoms and aren’t infectious. However, the bacteria will remain in your body, and it can develop into active TB at a later stage, especially if you have a weak immune system.

Active TB occurs when the infection spreads within the lungs or to other parts of the body and symptoms are more prominent.

Here are symptoms to look out for:

• A persistent cough that lasts for three weeks or more
• Coughing up phlegm or blood
• Breathlessness
• Weight loss
• Night sweats
• Fatigue
• High temperature
• Chest pain or pain while breathing

Some of these symptoms can be underlying problems of other conditions. However, it is always best to seek advice from the GP if you are concerned.

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Diagnosis

If you or your loved one shows any symptoms of tuberculosis, there are several ways in which your GP can diagnose the condition. Your GP may also refer you to a TB specialist.

Diagnosis can include a chest X-ray to see the impact TB may have on your lungs. Samples of your phlegm may be taken to diagnose the condition, also known as a sputum test.

A blood test is one of the main ways of diagnosing TB. This will help detect an infection by looking at the immune system cells in the blood. This is especially effective if you don’t show any symptoms. A blood test can be given to those who have had close contact with someone with active TB or travelled to a country where TB is prevalent. Individuals who work in a healthcare setting such as a hospital or nursing home can also have a blood test to diagnose the infection.

A skin test may also be conducted, which “involves injecting a small amount of a substance called PPD tuberculin into the skin of your forearm” (NHS). If you have TB, a hard red lump will appear after 48 to 72 hours of having the skin test.

 

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Treatment

Treatment is integral for individuals with TB, and it can be fatal if left untreated. Most people are treated via a course of antibiotics which lasts for at least six months. Most individuals feel better after two weeks of antibiotics, but it is essential to complete the course to treat the infection.

TB outside the lungs, otherwise known as extrapulmonary TB, can be treated with a combination of steroids and antibiotics to help reduce swelling in affected areas.

It is essential to be aware of the side effects of taking antibiotics. According to the NHS, side effects can include being sick, jaundice which is yellowing of the skin, high temperature, tingling and numbness in your hands or feet, a rash, itchy skin and changes in your sight, such as blurred vision. If you experience any of these side effects, contact your GP immediately.

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Prevention

With all health conditions, prevention is always the best strategy. Although there is no definite way to prevent TB, there are certain things you can do to avoid the spread.

BCG vaccination

The NHS states the vaccination is “given on the NHS only when a child or adult is thought to have an increased risk of coming into contact with TB”. Those eligible may have had close contact with someone with TB or been born in part of the UK with a high TB rate. If they have a parent or grandparent born in a country with increased rates of TB, they will also be able to have the vaccination.

Good hygiene practice

TB spreads through the air and when someone coughs or sneezes. So it is essential to take hygienic measures to prevent this, such as covering your mouth when you sneeze or cough. Or cough into the fold of your elbow and make sure you throw away used tissues.

Avoid close contact

Avoiding close contact with anyone with TB is best. If you live with a loved one with TB, it is advised to wear a face mask. Ensure rooms are well-ventilated as TB bacteria can remain in the air for hours, so keeping windows open can help. Plus, plenty of natural UV light can kill germs.

Healthy immune system

Having a strong immune system can help fight viruses and bacteria. TB alert states, “60% of adults with a healthy immune system can completely kill TB bacteria.” There are many ways to maintain a healthy immune system. These include:

• A healthy diet including fresh vegetables and fruit
• Ensure you are getting enough sleep
• Keep active – a walk around the block or park will do
• Keep hydrated
• Reduce alcohol

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Special considerations

It can be a challenge to treat and prevent tuberculosis in older adults. They are more at risk, which can be due to compromised immune systems, medication reactions, potential drug resistance and underlying conditions. These conditions can include diabetes which “triples the risk for active tuberculosis.” (Science Direct)

Furthermore, arthritis and cancer treatments can increase the risk of TB. Pathways Health states, “rheumatoid arthritis, treated with drugs that suppress the immune system, can be a breeding ground for a future infection.” They further argue that cancer treatments like chemotherapy can impact the immune system “whereby the body can’t produce enough white blood cells to defend itself.” Therefore, making individuals more vulnerable to infections like TB.

It is important to note that with treatment, there is the potential of drug resistance, where your body doesn’t respond effectively to antibiotics and fails to kill the bacteria. If this is the case, healthcare professionals will look at other options.    

In a nutshell, early diagnosis and treatment is the most effective way of preventing the spread of TB, especially among seniors. Without knowing, you may be spreading the infection. But in most cases, once treatment has started, individuals are no longer infectious after two weeks. Ultimately, treating the infection early will reduce the spread of TB.