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A clinical and social investigation of tuberculous persons aged 60 and over in widely spread areas of England, Scotland and Wales in 1959 and 1960 has been carried out retrospectively.
2,307 patients of both sexes were studied. Notification and death rates of the country as a whole were considered in relation to these age groups. A number of factors were investigated which included hospital or clinic of origin, sex, age and marital condition, racial origin, occupational group, duration of hospital treatment, duration of symptoms, Ministry of Health classification; sputum and infectivity; drug sensitivity; contact history; the patients' co-operation; income and living conditions and their fitness for work.
The main facts which emerge are the following:
- 1.There is a great preponderance of elderly tuberculous males over females (4 to 1). The males have more serious disease and an earlier death. The continuous ageing of the population now occurring is liable to aggravate this problem.
- 2.Great difficulty is experienced in persuading elderly people to attend for chest examination, but compulsion is not practicable. Full use should be made of the existing legislation and the co-operation of those dealing with old people, particularly the general practitioner, should be enlisted. Males of low social status with a cough or sputum form the essential target. Mass sputum examination may be of special value. If these elderly people with tuberculosis remain undiagnosed, they form a dangerous reservoir of infection and a menace to younger age groups.
- 3.A moderate percentage of infectious patients known to the chest clinics harbour bacilli resistant to the standard drugs. They constitute a special danger, but one which is to some extent self-limiting, and futher it is to be hoped that with chemotherapy this problem will diminish.
- 4.These patients are amenable to treatment by chemotherapy and it is felt that a sputum conversion rate approaching 100 per cent.should be achieved. This is to considerable extent dependent on early diagnosis and on patients taking their drugs conscientiously when at home.
- 5.Many of these cases, perhaps surprisingly, show a fairly acute onset of their disease. A clear ches X-ray, therefore, is no contra-indication to further X-rays.
- 6.Once diagnosed, the great majority co-operate well with treatment and supervision, but there is a small hard core of antagonistic patients who cause disproportionate trouble and risk of infection to others.
- 7.At least 20 per cent.of these people, predominantly the under-65s, can be made fit for full-time employment.
- 8.A certain number of these patients either live alone or become homeless during hospital treatment and need some form of institutional care. If their disease has been successfully treated they should be dealt with through the existing services, but remaining under clinic supervision, although it is appreciated that these services are now overloading in most areas. Patients remaining infectious should, if possible, be retained in hospital until the sputum is negative.
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Received: January 30, 1961
© 1962 Published by Elsevier Inc.