XXXX in the Elderly: More Severe Disease and Suboptimal Outcomes.

@entity1 @entity137 @entity6 @entity1200 @entity7663
BACKGROUND: The clinical presentation of @entity7663 disease and the safety and effectiveness of treatment may differ in elderly compared with younger populations related to relative @entity1200 , co-morbidities and drug interactions. However, elderly populations with @entity7663 disease have not been comprehensively studied. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective analysis was performed on an observational cohort of all confirmed @entity7663 cases managed at Barwon Health from 1/1/1998-31/12/2014. The cohort included 327 @entity1 ; 131(40.0%) >= 65 years and 196(60.0%) <65 years of age. @entity1 >= 65 years had a shorter median duration of symptoms prior to diagnosis (p<0.01), a higher proportion with @entity6 (p<0.001) and immune suppression (p<0.001), and were more likely to have lesions that were multiple (OR 4.67, 95% CI 1.78-12.31, p<0.001) and WHO category 3 (OR 4.59, 95% CI 1.98-10.59, p<0.001). Antibiotic complications occurred in 69(24.3%) treatment episodes at an increased incidence in those aged >= 65 years (OR 5.29, 95% CI 2.81-9.98, p<0.001). There were 4(1.2%) deaths, with significantly more in the age-group >= 65 years (4 compared with 0 deaths, p = 0.01). The overall treatment success rate was 92.2%. For the age-group >= 65 years there was a reduced rate of treatment success overall (OR 0.34, 95% CI 0.14-0.80, p = <0.01) and when surgery was used alone (OR 0.21, 95% CI 0.06-0.76, p<0.01). @entity1 >= 65 years were more likely to have a paradoxical reaction (OR 2.06, 95% CI 1.17-3.62, p = 0.01). CONCLUSIONS/SIGNIFICANCE: Elderly @entity1 comprise a significant proportion of @entity7663 disease @entity1 in Australian populations and present with more severe and advanced disease forms. Currently recommended treatments are associated with increased @entity137 and reduced effectiveness in elderly populations. Increased efforts are required to diagnose @entity7663 earlier in elderly populations, and research is urgently required to develop more effective and less toxic treatments for this age-group.
