Caring for Elderly Patients with Tuberculosis: Best Practices and Considerations

Q: Caring for Elderly Patients with Tuberculosis: Best Practices and Considerations

Hello： 1. <br>The condition of sputum produced varies with each set, and the bacterial load may differ. <br>2. <br>Aside from cases with infectious potential, caregivers should have protective measures and pay special attention to possible side effects of medications; otherwise,

How to care for patients with pulmonary tuberculosis?

1.
My father-in-law, who is 88 years old, was diagnosed with open pulmonary tuberculosis in mid-April.
He was hospitalized at Taipei Veterans General Hospital for two weeks, during which three sets of sputum tests were conducted: one was negative, and two were positive.
Is this a high risk for transmission? Why are some tests negative while others are positive?
2.
After being hospitalized, my father-in-law had a nasogastric tube inserted (the doctor recommended it to maintain his nutritional balance and to prevent choking).
He was previously able to take care of himself, but after the tube was inserted, he was often restrained to prevent him from pulling it out.
After two weeks, he became unable to manage his bowel and bladder functions.
To feed him, we initially tried giving him water or milk, but he refused to drink.
Recently, we noticed that he has become reluctant to speak when he sees us.
The hospital has informed us that he can be discharged for self-isolation at home, but considering that he currently has a nasogastric tube and cannot care for himself, and there is no one at home to assist him, it has been suggested that he be transferred to the Veterans General Hospital's Wanli branch, which has special beds for tuberculosis treatment.
However, we are concerned that this might further lower his spirits.
What are some better methods for caring for a patient with tuberculosis?

anny, 40~49 year old female. Ask Date: 2016/05/08

Dr. Zhou Ziguang reply Pulmonology

Hello: 1.
The condition of sputum produced varies with each set, and the bacterial load may differ.
2.
Aside from cases with infectious potential, caregivers should have protective measures and pay special attention to possible side effects of medications; otherwise, general care is not significantly different from that of other pulmonary disease patients.
The best care approach should be assessed by healthcare professionals, and it may not be possible to provide a remote response.

Reply Date: 2016/05/08

More Info

Caring for elderly patients with tuberculosis (TB) presents unique challenges, particularly when considering their physical, emotional, and social needs. In the case of your 88-year-old father-in-law diagnosed with open tuberculosis, there are several important factors to consider regarding his care and treatment.

Understanding Infectiousness and Diagnostic Variability
1. Infectiousness: The fact that your father-in-law has had two positive sputum tests and one negative test indicates that he is likely still infectious, especially if the positive tests were obtained during the active phase of the disease. Tuberculosis is primarily spread through airborne droplets when an infected person coughs or sneezes. The variability in test results can occur due to several reasons:
- Sample Quality: The quality of the sputum sample can affect the results. If the sample was not collected properly or if the patient did not produce enough sputum, it may lead to a false negative.

- Bacterial Load: The amount of bacteria present in the sputum can fluctuate. It is possible for a patient to have a high bacterial load at one time and a lower load at another, leading to different test results.

- Stage of Disease: The stage of the disease can also impact test results. If the patient is responding to treatment, the bacterial load may decrease, resulting in a negative test.

Nutritional Support and Emotional Well-being
2. Nutritional Support: The insertion of a nasogastric (NG) tube is often necessary for patients who cannot maintain adequate nutrition orally, especially in cases where there is a risk of aspiration. However, it is crucial to monitor the patient’s comfort and dignity. The use of restraints to prevent the removal of the NG tube can lead to increased agitation and a decline in mental health. Here are some strategies to consider:
- Frequent Reassurance: Regularly reassure your father-in-law that he is safe and cared for. This can help reduce anxiety and agitation.

- Engagement: Encourage family members to engage with him verbally and emotionally. Even if he is not responding verbally, your presence and interaction can provide comfort.

- Alternative Feeding Methods: If possible, explore the option of using a different feeding method that may be less distressing for him, such as a percutaneous endoscopic gastrostomy (PEG) tube, which is more comfortable for long-term feeding.

Transitioning Care and Emotional Considerations
3. Transitioning to Home Care or Specialized Facilities: Given your father-in-law’s current condition and the need for ongoing care, transitioning him to a facility that specializes in TB treatment may be beneficial. However, it is essential to consider his emotional state:
- Familiar Environment: If he is more comfortable at home, consider arranging for home health care services that can provide the necessary medical support while allowing him to remain in a familiar environment.

- Mental Health Support: Consult with a mental health professional who specializes in geriatric care. They can provide strategies to help manage his emotional distress and improve his overall well-being.

Best Practices for Caring for Elderly TB Patients
- Regular Monitoring: Ensure that he is regularly monitored for signs of improvement or deterioration. This includes checking his nutritional intake, respiratory status, and emotional well-being.

- Medication Management: Adherence to the TB treatment regimen is crucial. Work closely with healthcare providers to ensure that he is receiving the appropriate medications and that any side effects are managed effectively.

- Education and Support: Educate family members about TB, its transmission, and the importance of completing the treatment course. This knowledge can help alleviate fears and stigma associated with the disease.

In conclusion, caring for an elderly patient with tuberculosis requires a multifaceted approach that addresses both medical and emotional needs. By ensuring proper nutritional support, considering the patient’s emotional well-being, and facilitating a supportive environment, you can help improve your father-in-law’s quality of life during this challenging time. Always consult with healthcare professionals for personalized advice and treatment plans tailored to his specific needs.

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