Table 2.

Summary of strategic framework of TB control and prevention in the elderly: identified in 19 selected articles

	Strategy	Affecting factors/Strategic concerns	Suggestions/recommendations
Preventing transmission	Infection control measures [6, 13, 19–26]  • Administrative actions  • Engineering and environmental controls  • Personal protective measures Maintaining good ventilation and avoiding overcrowding in public [6, 13, 19, 21, 23–25, 27]	Longer delay in diagnosis and treatment [6, 13, 19, 20, 22, 24, 26–28], Residents and healthcare worker in elderly institution [6, 13, 19–24, 26–28] Immigration from a high-prevalence country [13, 19, 24, 26, 28, 29]	Early diagnosis and containment [13, 19–21, 24] Evaluation of infection control measures for TB suspects and patients [21, 25, 26]  • Stay in infection isolation rooms or single rooms wearing surgical masks  • Transferred to a facility with appropriate isolation capacity
Early detection	Optimizing case-finding along patient-initiated pathway [15, 19, 25, 29–32]  • Increasing patient access to care  • Using new diagnostics  • Streamlining the diagnostic pathway Systematic screening pathway in high risk groups  • Screen of LTBI [6, 13, 15, 19–32]  • Active case-finding of TB patients [15, 20, 21, 27, 29–31, 33]  • Diagnostics and screening algorithms: TST [6, 13, 19–28, 30, 32] or IGRA [6, 26–28, 31]; CXR and bacteriological examination [15, 20, 21, 27, 29–31, 33].	High risk factors [6, 22, 23, 26, 27]  • Ageing itself, male predominance, smoking, malnutrition, and BMI < 18.5 Comorbidities [6, 13, 19, 20, 22–24, 27, 28, 33]  • chronic obstructive pulmonary disease, DM, lung cancer, silicosis, malignancy, liver disease, cardiovascular diseases and gastrectomy Atypical presentation [6, 13, 19, 20, 22–28, 34]  • Atypical symptom: weight loss, weakness, anorexia, cognitive impairment, and dyspnoea  • Atypical CXR presentation: lower lobe infiltrate, pleural effusions and extensive disease Extrapulmonary TB [6, 13, 19, 22–26, 28] and NTM [13, 19, 27, 28, 34] Economic and impact evaluation [15, 29–33] Limitation of diagnostic tools for LTBI [6, 13, 19–28, 30, 31]	A high index of suspicion and close contacts [6, 13, 19, 21–24, 26–28] Systematic screening is recommended in  • Residents and healthcare workers in elderly institutions on admission and periodically [6, 13, 19–21, 24–26, 28]  • Regions with high prevalence of infection [6, 13, 19, 22, 23, 27, 28] and TB disease [13, 19–21, 25, 26]  • Targeted approach on high-risk groups of recent infection or reactivation [6, 13, 19, 28]  • Integrating health examination [33] More aggressive diagnostic tools [6, 13, 19, 22, 23, 25, 26] Rapid diagnostic tools [22, 23, 25, 26, 28]
Appropriate treatment	Preventive treatment of LTBI  • Isoniazid preventive therapy [6, 13, 15, 19–28, 30, 31]  • Rifampicin preventive therapy and other alternatives [6, 13, 19, 26, 28] Treatment of TB  • The therapy for elderly is not necessarily different [6, 13, 19, 24, 28], but can be compromised [13, 19, 28] or prolonged [26]  • Empirical initiation of treatment for presumptive TB [13, 19, 26–28]  • Adequate follow-up treatment[13, 19, 21–23, 26–28]	Hepatotoxicity for preventive therapy [6, 13, 19, 22–28, 30] Comorbidities [6, 13, 19, 20, 22–24, 27, 28, 33] Drug interaction and adverse effect [6, 13, 19, 22–24, 26, 27, 34] Poor drug tolerance [6, 26, 27] Poor treatment adherence [13, 19, 26, 27] Unfavourable treatment outcome [6, 13, 19, 27, 28]	No age limit and used less reluctantly for LTBI preventive treatment in elderly [13, 19, 26, 27, 28] Short, less toxic preventive therapy regimens [6, 15, 30] Careful pre-treatment assessment and close clinical monitoring for IPT [6, 13, 19–26, 28] Baseline and periodic laboratory testing for liver function [6, 13, 19, 22, 23, 25, 26, 28] Closer monitoring and evaluation during follow-up treatment [13, 19–21, 24, 26–28]  • Evaluation of therapy compliance  • Investigation of sputum conversion  • Screening for adverse effects and toxicity Education [6, 20, 28]
Programmatic management	Responsibility [20, 21, 24, 25, 27]  • Department of health  • Primary healthcare provider Surveillance [21, 25, 27, 29] Education [19–21, 24, 25] Assessment [21, 25]	Increasing source of TB reactivation [6, 13, 15, 19, 20, 22–28] Socioeconomic determinants [6, 19, 24, 27]  • Poverty, inadequate healthcare, stigma and misconception, malnutrition, unhealthy lifestyle	Awareness of changing epidemic and impact of the elderly towards End TB targets [6, 13, 15, 19, 26, 27, 29] Interventions aimed at reducing TB reactivation [6, 15, 30] Maintaining high-quality programme [30] Actions for improving socioeconomic status [6, 19, 24, 27]