THE EFFECT OF AGE ON THE PRESENTATION OF PATIENTS WITH TUBERCULOSIS

Setting: A regional hospital in Hong Kong. Objective: To study the differences in presentation of young and elderly patients with tuberculosis (TB). Design: Between January 1991 and December 1992 all patients with TB diagnosed at the Department of Medicine, Prince of Wales Hospital, were recruited into the study. The following data were collected: body weight, coexisting medical problems, presenting symptoms, radiographic appearance, sputum results for acid-fast bacilli and peripheral blood biochemistry. The patients were divided into young (< 65 years) and elderly (greater than or equal to 65 years) age groups and differences in presentation of the 2 groups were analysed. Results: There were 78 young and 94 elderly patients with TB. The elderly patients had lower body weight, less haemoptysis but more non-specific complaints (25% vs 1%, P = 0.001). The chest radiographs in the elderly patients were less likely to have upper lobe infiltration (9% vs 37%, P = 0.0002) but more commonly had extensive infiltration of both lungs (17% vs 2%, P = 0.014). The only biochemical abnormality that was more common in the elderly was a low serum albumin level (64% vs 45%, P < 0.05). Conclusion: Elderly patients with TB are more likely to present with non-specific complaints and atypical radiographic appearance. A high index of suspicion and prompt investigations in elderly patients may allow for earlier diagnosis and treatment of TB.