Protecting Vulnerable Groups: Early Detection and Treatment of Tuberculosis in the Elderly

MALARIA PERDHAKI-JAKARTA. Indonesia continues to face a high burden of tuberculosis (TB). Global Tuberculosis Report 2025 reported around 1.1 million TB cases in Indonesia, resulting in 118,000 deaths in 2024.

One of the biggest challenges in TB elimination is the large number of undetected cases. If left untreated, people with TB can transmit the disease to those close to them. Older adults are among the groups at higher risk due to declining immunity.

The burden of TB among older adults continues to rise, said Mr. Imran Pambudi, Director of Health Services for Vulnerable Groups at the Ministry of Health of the Republic of Indonesia, as quoted by AFU.ID. Global data from 2023 showed that people aged 65 and over accounted for 21% of all TB cases and 23% of total deaths from the disease. This trend has continued to rise since 2000, even as overall TB incidence has declined in various regions.

TB symptoms in the elderly often resemble signs of aging or other chronic illnesses. A persistent cough, weight loss, or fatigue is often considered a normal part of aging. As a result, many cases are detected late, increasing the risk of transmission. Breaking the chain of transmission is also difficult because many older adults live in multigenerational households, putting children in the same household at risk of infection.

Late diagnosis can be fatal because TB in older adults tends to be more severe and carries a higher risk of death.

Treatment is also challenging because many older adults have comorbidities, meaning two or more diseases occurring at the same time, requiring them to take multiple medications. Side effects of TB drugs, such as liver problems, are also more common among older adults. Therefore, intensive support from families and health cadres is essential to ensure treatment is completed.

“These vulnerable groups face structural barriers, stigma, and even violence that make access to health services difficult or dangerous,” Mr. Imran added.

The Ministry of Health is working to strengthen and expand active case-finding strategies at service points closest to older adults, namely elderly health posts, nursing homes, and primary healthcare services.

Specialized training is also needed for health workers so they can recognize signs of TB in older adults while safely managing polypharmacy—the use of more than five medications at the same time.

Community-based approaches have proven effective in building patient trust, detecting new cases, and supporting treatment adherence. The role of communities needs to be strengthened through sustainable funding and by ensuring the stability of supply chains and data, Mr. Imran said.

Older adults can recover from TB and live healthy lives in their later years. Together, let us eliminate TB through early detection, regular treatment, and family support.

Photo by Saulo Meza on Unsplash