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. 2023 Feb 21;23(1):370.
doi: 10.1186/s12889-023-15197-7.

Tuberculosis in older adults: case studies from four countries with rapidly ageing populations in the western pacific region

Alvin Kuo Jing Teo  1   2   3 , Kalpeshsinh Rahevar  4 , Fukushi Morishita  5 , Alicia Ang  6 , Takashi Yoshiyama  7 , Akihiro Ohkado  7 , Lisa Kawatsu  7 , Norio Yamada  7 , Kazuhiro Uchimura  7 , Youngeun Choi  8 , Zi Chen  9 , Siyan Yi  1   10   11 , Manami Yanagawa  5 , Kyung Hyun Oh  5 , Kerri Viney #  12 , Ben Marais #  2   3 , Heejin Kim #  8 , Seiya Kato #  7 , Yuhong Liu #  13 , Catherine W M Ong #  14   15   16 , Tauhid Islam #  5
Affiliations

Tuberculosis in older adults: case studies from four countries with rapidly ageing populations in the western pacific region

Alvin Kuo Jing Teo et al. BMC Public Health. .

Erratum in

Abstract

Background: The Western Pacific Region has one of the fastest-growing populations of older adults (≥ 65 years) globally, among whom tuberculosis (TB) poses a particular concern. This study reports country case studies from China, Japan, the Republic of Korea, and Singapore reflecting on their experiences in managing TB among older adults.

Findings: Across all four countries, TB case notification and incidence rates were highest among older adults, but clinical and public health guidance focused on this population was limited. Individual country reports illustrated a range of practices and challenges. Passive case finding remains the norm, with limited active case finding (ACF) programs implemented in China, Japan, and the Republic of Korea. Different approaches have been trialled to assist older adults in securing an early diagnosis, as well as adhering to their TB treatment. All countries emphasised the need for person-centred approaches that include the creative application of new technology and tailored incentive programs, as well as reconceptualisation of how we provide treatment support. The use of traditional medicines was found to be culturally entrenched among older adults, with a need for careful consideration of their complementary use. TB infection testing and the provision of TB preventive treatment (TPT) were underutilised with highly variable practice.

Conclusion: Older adults require specific consideration in TB response policies, given the burgeoning aging population and their high TB risk. Policymakers, TB programs and funders must invest in and develop locally contextualised practice guidelines to inform evidence-based TB prevention and care practices for older adults.

Keywords: Aging; Best practices; Challenges; China; Japan; Policy; Republic of Korea; Singapore.

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Conflict of interest statement

The authors declare that they have no competing interests. The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Figures

Fig. 1
Fig. 1
The proportion of notified TB cases aged ≥ 65 in Japan, the Republic of Korea, Singapore, China, the Western Pacific region, and globally 2013−2020 Data source: World Health Organization Global TB Programme 2021
Fig. 2
Fig. 2
TB management among older adults in China, Japan, the Republic of Korea, and Singapore TB management experiences were mapped based on three main domains: case finding and detection, treatment, and prevention. The relevant policies and interventions are tagged to the respective implementing countries. Areas shaded in grey represent cross-cutting interventions that extend beyond the older adult population. Treatment support was historically known as directly observed treatment (DOT) Abbreviations: TB; tuberculosis, TPT; TB preventive treatment, CN; China, JP; Japan, KR; Republic of Korea, SG; Singapore
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