Common respiratory problems in elderly

Prepared by :
Group A5

Supervised by :
Dr. Martha Melek Labieb
Dr. Heba Mohamed Ibrahim
• Outlines:

• Introduction
• Age related changes and effect on respiratory system
• Most common respiratory disease among elderly
o Lung cancer
o Pneumonia
o Asthma
o Chronic Obstructive Pulmonary Disease.
▪ _Chronic bronchitis
▪ _emphysema
o EG.5 ( COVID-19)
• Reference
 Introduction
The effects of aging in the respiratory system are similar
to those in other organs: maximum function gradually
declines.
Older people are at greater risk of developing pneumonia
after bacterial or viral infections. Thus, vaccines for
respiratory infections, such as influenza and
pneumococcal pneumonia, are especially important for
older people.

These age-related changes rarely cause symptoms in

healthy people.
However, these changes contribute to some extent to the
decreased ability of older people to engage in vigorous
exercise, especially intense exercise, such as running,
cycling, and mountain climbing.
 Age related changes and effect on respiratory system

The respiratory system undergoes several age-related

changes that can affect its function. Here are some
common effects of aging on the respiratory system:
1. Reduced lung capacity
2. Decreased muscle strength
3. Altered gas exchange
4. Decreased cough reflex
5. Increased risk of respiratory diseases

It’s important to note that the effects of aging on the

respiratory system can vary among individuals, and
maintaining a healthy lifestyle, such as not smoking,
 exercising regularly, and avoiding environmental
pollutants, can help mitigate some of these changes and
promote better respiratory health.

Most common respiratory disease among elderly

(1) lung cancer

Introduction:
Lung cancer is a disease of the older adult. More than 50% of
patients with lung cancer are diagnosed after the age of 65, and
30% are older than age 70.
1 _ In addition, lung cancer is responsible for more deaths than
colon, breast, and prostate cancer combined
2 _ Over the next several decades, the aging demographic,
particularly octogenarians, will increase exponentially.higher
prevalence of geriatric syndromes as compared with older
adults without cancer.
Incidence and prevalence in lung cancer in aging

Lung cancer incidence and mortality increased with age, peaking in the 70–79 age
group (375.0/100,000 person-years) among males, while at 60–69 age group for
females
(148.1/100,000 person-years). The male-to-female incidence rate ratio reached
2.46–3.01
(p < 0.0001) among the 70–79 age group. We found 2–11% decrease in male
incidence rate at most age groups .
 Definition:

1_ Non-Small Cell Lung Cancer (NSCLC):

The most common type of lung cancer is NSCLC, which usually
grows slowly and often has no symptoms, making it difficult to
diagnose in the early stages.

2_ Small Cell Lung Cancer (SCLC):

SCLC is less common but grows rapidly and can easily

metastasize to other organs in the body.

Causes:
• Environmental Factors
• Genetic Factors
• Lifestyle Factors

Signs and Symptoms:

1. Early Stages
The early stages of lung cancer in elderly often have no symptoms or only mild
symptoms such as a persistent cough, shortness of breath, and fatigue.

2. Moderate Stages
As lung cancer in elderly progresses, symptoms such as chest pain, weight loss,
hoarseness, and difficulty swallowing may occur.
3. Advanced Stages
In the advanced stages of lung cancer in elderly, symptoms can be severe and
include coughing up blood, severe chest pain, and difficulty breathing.Sharp or
dull pain in the chest region, often worsened by deep breathing or coughing.

Complication:

1. Metastasis
2. Pneumonia
3. Respiratory Distress

Management

1 _ Surgery

Lung cancer in elderly can be treated with surgical resection, though this option is
generally reserved for patients in the early stages of the disease.

2 _ Chemotherapy

Chemotherapy is a common treatment option for lung cancer in elderly, and can
help to slow the progression of the disease in later stages.

3 _ Radiation Therapy

Radiation therapy is often used in combination with chemotherapy to treat lung

cancer in elderly patients with advanced disease.

• Nursing Care Plan:

Nursing Assessment
1. Assess for the following subjective and objective data
2. Unexplained weight loss
3. Fatigue and weakness
4. Persistent pain
5. Changes in the skin, such as yellowing or darkening
6. Changes in bowel or bladder habits
7. Difficulty swallowing or persistent indigestion
8. Changes in a mole or wart
9. Persistent cough or hoarseness
10.Unexplained bleeding or bruising
Nursing Goals
Goals and expected outcomes may include
1. The patient will identify and express feelings appropriately.
2. The patient will continue normal life activities, looking toward/planning for the
future, one day at a time.
3. The patient will verbalize understanding of body changes and acceptance of
self in the situation.
4. The patient will begin to develop coping mechanisms to deal effectively with
problems.
5. The patient will demonstrate adaptation to changes/events that have occurred as
evidenced by the setting of realistic goals and active participation in
work/play/personal relationships as appropriate.
6. The patient will report maximal pain relief/control with minimal interference
with ADLs.
7. The patient will demonstrate the use of relaxation skills and diversional activities
as indicated for the individual situation.
8. The patient will demonstrate stable weight/progressive weight gain toward the
goal with normalization of laboratory values and be free of signs of malnutrition.
 Nursing Interventions and Actions
1. Providing Emotional Support and Assisting in Grieving
2. Assess the patient and significant other (SO) for the stage of grief currently
being experienced. Explain the process as appropriate
3. Review past life experiences, role changes, and coping skills. Talk about things
that interest the patient.
Health Education:

1. Smoking Cessation
2. Avoiding Air Pollution
3. Lifestyle Changes
 (2) Pneumonia :

Introduction :

Elderly adults with pneumonia may have a low-grade fever or even a normal
temperature. They may also be less alert, show signs of confusion, or experience
changes in mental awareness. If you suspect your aging loved one has pneumonia,
see a doctor promptly.

Definition:
Pneumonia is a respiratory infection that causes inflammation in the air sacs in the
lungs, called alveoli.

Incidence:
 Worldwide incidence of community-acquired pneumonia varies between 1.5 to 14
cases per

1000 person-years, and this is affected by geography, season, and population

characteristics.
Diagnosis:
In order to make a diagnosis, your doctor may also order the following:

1-Blood test

2-imaging

3-culture

4-pulse oximetry
Causes :_
1. Bacteria. Bacteria are a common cause of pneumonia in adults. such as
Streptococcus pneumoniae (also called pneumococcus bacteria)

2. Viruses. Viruses that infect your lungs and airways can cause pneumonia. The
flu (influenza virus) and the common cold (rhinovirus)

3. Fungi. Fungi such as Pneumocystis jirovecii may cause pneumonia,

especially for people who have weakened immune systems.

Symptoms of pneumonia in older adults

The symptoms of pneumonia in older individuals can differ from those in other
age groups.

Older adults with pneumonia may be more likely to:

• Feel weak or unsteady, which can increase the risk of falling
• Be without a fever or have a body temperature that’s lower than normal
• Experience confusion or delirium
• Have changes in functional status, which is the ability to perform daily
activities
 • Experience urinary incontinence
• Lack an appetite

The classic symptoms of pneumonia

Cough that can bring up phlegm

Fever and chills
Chest pain that worsens when you breathe in deeply or cough
Fatigue
Shortness of breath

Risk factor:_
The known independent risk factors for pneumonia include:_

1. Alcoholism
2. Asthma
3. Immunosuppression
4. heart disease
5. institutionalization
6. age greater than 70
Complications :_
• Respiratory failure
• Fluid accumulation in and around the lungs
• Sepsis
• Lung abscess
• Death

Treatment for Pneumonia :_

1. Antibiotics for bacterial pneumonia
2. Antiviral medication for viral pneumonia
 3. Antifungal medication for fungal pneumonia
4. Over-the-counter options to reduce your fever or to ease breathing

If your pneumonia is advanced enough to go to the hospital, the

effective forms of treatment they might give you are:
• Antibiotics
• An IV with fluids
• Oxygen ttherapy
• Ventilator
In serious cases, you might need to get surgery or have a procedure done to
remove severely damaged parts of your lungs.

Pneumonia Nursing Care Plans:_

Assessment :
- Changes in rate, depth of respirations

- Abnormal breath sounds (rhonchi, bronchial lung sounds, egophony)

- Use of accessory muscles

- Dyspnea, tachypnea

Diagnosis :
- Ineffective air way clearance related to secretion in bronchi evidenced by
shortness of breath

- Impaired gas exchange related to inflamation evidenced by dyspnea

- Risk for infection related to Inadequate primary defenses: decreased ciliary

action, respiratory secretions
Goals :
1. Patient will demonstrate improved ventilation and oxygenation of tissues by
ABGs within the patient’s acceptable range and absence of symptoms of
respiratory distress.

2. Patient will maintain optimal gas exchange.

3. Patient will participate in actions to maximize oxygenation.

Intervention :
- Assess the rate, rhythm, and depth of respiration, chest movement, and use of
accessory muscles.

- Observe the color of skin, mucous membranes, and nail beds, noting the
presence of peripheral cyanosis (nail beds) or central cyanosis (circumoral).

- Change position frequently and provide good pulmonary hygiene.

Health education :_

1. Washing your hands regularly.

2. Practicing good hand hygiene
3. Avoiding smoking.
4. Making healthy lifestyle choices.

Vaccine :_
Getting the pneumococcal vaccine.
Getting the influenza vaccine each year.

(3)ASTHMA:

Introduction :

Asthma in the elderly differs from other ages in that it is non-allergic in most
cases, meaning that it is not caused by allergies, the most important of which are
the psychological state, anxiety, and medications that cause asthma, such as
aspirin, painkillers, and beta-blockers used in asthma. High blood pressure and
glaucoma in the eye

Definition of Asthma :
Is a chronic respiratory condition that causes inflammation and
narrowing of the airway, If left untreated, there’s a greater risk for long-
term effects and severe complications

Incidance :

Globally, asthma is ranked 16th among the leading causes of years lived
withdisability and
28th among the leading causes of burden of disease, as measured by
disabilityadjusted life
years. Around 300 million people have asthma worldwide, and it is likely that by
2025 a
further 100 million may be affected

The signs and symptoms of Asthma in older adults :-

• Shortness of breath
• Cough

• Chest tightness or pain

• Wheeze (a whistling sound when you breathe)

How to diagnose asthma in older adults :-

1.activity intolerance related to Airway constriction , Imbalance between oxygen

supply and demand evidenced by Poor sleep due to dyspnea or coughing
2.Ineffective Breathing Pattern related to Inflammation and swelling to the lungs
evidenced by Coughing
Cyanosis
3.ask about medical history and family history, try to do a physical exam, and do
lung function tests, if possible

The risk factors of asthma in older adults:-

• Are female (due to hormonal changes or estrogen treatments) • Have allergies

• Work in an environment with a lot of allergens, irritating chemicals and
particles in the air (occupational asthma)
• Smoke
• Overweight
• Have gastroesophageal reflux disease (GERD

Treatment of asthma in elderly :

1_ Inhaled corticosteroids which is the most effective long term medication for
asthma as it reduces the inflammation of the airway.
2_ Short acting beta agonists which is quick relief and used to relief symptoms
during the asthma attack.
3_ Leukotrien modifiers :these medication block the action of Leukotrienes
which are chemicals
That cause inflammation to the.

Nursing care plan for asthma in elderly :

Assessment :
- Changes in respiratory rate and rhythm
- Changes in vital signs
 - Chest tightness
- Confusion
- Cough
- Cyanosis
- Dyspnea (including orthopnea)
Diagnosis :
1. Activity intolerance related to airway constriction evidence by dyspnea
2. Ineffective breathing pattern airway spasming and increase secretion evidenced
by cyanosis and nasal flaring
3. Readiness for Enhanced Therapeutic Regimen Management to be developed
evidenced by Expressed desire to learn about asthma
Goals :
- The client will maintain an optimal breathing pattern, as evidenced by relaxed
breathing
- The client will be free of cyanosis and other signs and symptoms of hypoxia.
- The client will verbalize understanding of the cause and therapeutic management
regimen.

Intervention :
- Assess signs of dyspnea ( flaring nostrils,use of accessory muscles )
- Assess for color changes in the buccal mucosa, lips, and nail beds.
- Assess the effectiveness of cough.
- Assess the amount, color, odor, and viscosity of the secretions.

*- Medical Administration and Pharmacologic Support*

 1. Short-acting beta-2 adrenergic agonist agents ( albuterol )
2. Oral corticosteroids
3. Leukotriene receptor antagonists

(4) Chronic Obstructive Pulmonary Disease (COPD)

• Introduction
COPD in seniors is pretty common, especially if your parent is a smoker or
former smoker. Medical researchers estimate that between 11% and 18% of adults
aged 65 years or older are living with COPD. About 20% of all hospital
admissions in the US for adults over age 65 are for COPD.
Definition :
Is a chronic inflammatory lung disease that causes obstructed airflow from the
lungs.It’s typically caused by long-term exposure to irritating gases or particulate
matter, most often from cigarette smoke.
Causes of COPD
• Tobacco exposure from active smoking or passive exposure to second-hand
smoke;

• Occupational exposure to dusts, fumes or chemicals;

•Indoor air pollution:

• People with a chronic asthma

• Genetics
* Signs and symptoms
* Shortness of Breath (Dyspnea )

* Chronic Cough:

* Wheezing
*. Chest Tightness:

* Fatigue:

*Recurrent Respiratory Infections:

* Diagnosing COPD
1. Chest X-ray
2. Lung function tests
3. Treadmill tests and pulse oximetry

* Risk Factor
• A history of respiratory infections
• Smoke exposure from coal or wood burning stove
• Exposure to secondhand smoke
 • People with a history of asthma
• People who have underdeveloped lungs
• Those who are age 40 and older as lung function declines as you age
Genetics

* Complications
1. Respiratory infections
2. Heart problems
3. Lung cancer
4. High blood pressure in lung arteries
5. Depression

* COPD Treatment
There is no cure for COPD, but most mild forms of COPD require little in terms
of treatment apart from quitting smoking.

1. Inhalers
2. Oral Medications (phosphodiesterase-4 inhibitors)
3. Surgery

* Nursing Care Plans & Management

The following are the nursing priorities for patients with COPD:

• Maintain airway patency.

• Assist with measures to facilitate gas exchange.

• Enhance nutritional intake.
• Prevent complications, slow progression of condition.
• Provide information about disease process/prognosis and treatment regimen.
• Quitting smoking — The first and most important part of any treatment plan for COPD is
to stop smoking .

• Learning proper inhaler technique .

Nursing care plan :
Assessment :

- Difficulty breathing
- Changes in depth/rate of respirations, use of accessory muscles
- Abnormal breath sounds, e.g., wheezes, rhonchi, crackles
- Persistent cough, with/without sputum production
- Confusion, restlessness
- Bronchospasm
- Increased production of secretions; retained secretions; thick, viscous secretions

Diagnosis :

- Ineffective airway clearance related to retained secretion evidenced by dyspnea

- Impaired gas exchange related to airway narrowing evidenced by cyanosis
- Ineffective breathing pattern related to related to secretions evidenced by
accessory muscles use

Goals :

- The client will maintain clear and patent airways, demonstrating effective breath
sounds and the ability to effectively cough and clear secretions.
- The client will achieve improved ventilation and optimal tissue oxygenation, as
evidenced by ABG values within the normal range and the absence of respiratory
distress symptoms.
- The client will demonstrate improved breathing patterns, maintaining a normal
respiratory rate, and be free from cyanosis and other signs of hypoxia.

Intervention :
- Assess and monitor respirations and breath sounds, noting rate and sounds
(tachypnea, stridor, crackles, wheezes). Note the inspiratory and expiratory ratio.
- Assist the client to assume a position of comfort (elevate the head of the bed,
have the client lean on an overbed table, or sit on edge of the bed)
- Assess and routinely monitor skin and mucous membrane color.
- Monitor changes in the level of consciousness and mental status.
- Auscultate breath sounds as indicated.
* Health education

Health education plays a vital role in empowering individuals with COPD to

actively manage their condition, reduce exacerbations, and improve their overall
well-being.

1. Understanding COPD
2. Symptoms and Diagnosis
3. Treatment Options
4. Breathing Techniques
5. Lifestyle Modifications
6. Self-Management
7. Regular Follow-up

1. (Chronic bronchitis)

• Definition
Defined as lasting for at least three months and returning at least two years in a
row. In chronic bronchitis, breathing can be more difficult because the airway
lining stays inflamed, which leads to swelling and more mucus production.

• Causes
• Cigarette smoking or exposure to secondhand smoke (cigarette smoke from
someone else)
• Older age
• Exposure to fumes or certain kinds of dust
• A family history of COPD
• A history of respiratory diseases such as asthma, cystic fibrosis, or
bronchiecstasis.
 • _ Signs and symptoms

1. Cough with mucus

2. Chest pain
3. Tiredness
4. Low fever of below 100.4 degrees Fahrenheit
5. Shortness of breath
6. Wheezing

• _ Nursing care plan of bronchitis

• Chronic bronchitis/COPD treatment focuses on managing

symptoms.
• Depending on how severe the symptoms are, your provider
might suggest many types of therapy,Including : Smoking
cessation , Bronchodilators.
• Steroids , The doctor might prescribe corticosteroids — in an
inhaler or as a pill — to reduce inflammation.
• Pulmonary rehabilitation teaches you exercises and other
strategies to help you breathe
better and improve your quality of life , Oxygen therapy ,
Antibiotics and Vaccination.
1. Monitor for adverse effects of bronchodilators-tremulousness,
tachycardia, cardiac
arrhythmias, central nervous system stimulation, hypertension.
2. Monitor oxygen saturation at rest and with activity.
3. Eliminate all pulmonary irritants, particularly cigarette smoke.
Smoking cessation usually
reduces pulmonary irritation, sputum production, and cough.
Keep the patient’s room as
dust-free as possible.
4. Use postural drainage positions to help clear secretions
responsible for airway obstruction.
5. Teach controlled coughing.
6. Encourage high level of fluid intake (8 to 10 glasses; 2 to 2.5 L
daily) within level of cardiac reserve.
7. Give inhalations of nebulized saline to humidify bronchial tree
and liquefy sputum.
8. Avoid dairy products if these increase sputum production.
9. Encourage the patient to assume comfortable position to
decrease dyspnea.
10. Use pursed lip breathing at intervals and during periods of
dyspnea to control rate and depth of respiration and improve
respiratory muscle coordination.
11. Discuss and demonstrates relaxation exercises to reduce
stress, tension, and anxiety.
12. Encourage frequent small meals if the patient is dyspneic; en
a small increase in abdominal contents may press on diaphragm
and impede breathing.
13. Offer liquid nutritional supplements to improve caloric intake
and counteract weight loss.
14. Avoid foods producing abdominal discomfort.
15. Encourage use of portable oxygen system for ambulation for
patients with hypoxemia and marked disability.
 2. (Emphysema)

• Definition
Is a chronic and progressive lung disease that primarily affects the air sacs
(alveoli) in the lungs. It belongs to a group of lung diseases known as Chronic
Obstructive Pulmonary Disease (COPD).

• Cause of emphysema
1. Smoking:

2. Environmental factors:dust

3. Occupational exposure:

4. Genetic factors: In rare cases, emphysema can be caused by a genetic condition

called alpha-1 antitrypsin deficiency.
• Signs and symptoms:
1. Shortness of breath (dyspnea):

2. Chronic cough:

3. Wheezing

4. Chest tightness:

Treatment
1. Smoking cessation:
2. Medications:

- Bronchodilators: These medications help relax the muscles around the airways,
making breathing easier.

- Inhaled corticosteroids: These medications help reduce airway inflammation

and may be prescribed for individuals with frequent exacerbations or significant
inflammation.
- Mucolytics: These medications help thin and loosen mucus, making it easier to
cough up and clear from the airways.
3.Pulmonary rehabilitation:
4.Oxygen therapy:
5. Surgery

Nursing care plan:

Assessment:
- Monitor respiratory status, including respiratory rate, depth, and effort.
- Assess oxygen saturation levels.
- Evaluate the patient’s cough and sputum production.

- Assess the patient’s level of dyspnea and activity tolerance.

- Evaluate nutritional status and weight changes.

- Assess the patient’s knowledge and understanding of the disease and treatment
plan.
Nursing Diagnosis:
- Ineffective Airway Clearance Related to: Damaged alveoli , Excess sputum
production
- Smoking , Inflammations
- As evidenced by Dyspnea , Wheezing, crackles , Excessive secretions
- Usage of accessory muscles , Coughing
Expected outcomes:
- 1. Patient will maintain clear breath sounds and unlabored respirations
- 2. Patient will demonstrate effective expectoration of excess sputum.
- 3. Patient will develop techniques for maintaining an effective airway.
- 4. Patient will maintain an oxygen saturation over 92%.
Interventions:

- 1. Encourage expectoration of secretions. Suction if necessary

- 2. Provide supplemental oxygen as prescribed.
- 3. Assist the patient in assuming a semi-Fowler’s position.
- 4. Instruct on breathing techniques.
- Pursed-lip breathing slows the pace of breathing, allows trapped air to be
released, and keeps
- the airways open longer to decrease the work of breathing.
- 5. Prepare for surgery.
- Lung volume reduction surgery removes damaged lung tissue so the remaining
lung tissue
- can expand and work efficiently. Severe cases may require a lung
transplant.
 (5) EG.5 ( COVID-19 ) INTRODUCTION:

COVID also known as the coronavirus, continues to be a significant global health

concern, especially for older adults. Older adults, generally defined as individuals
aged 65 years and older, have been identified as a high-risk group for developing
severe illness from COVID
*Incidence and prevelance
The World Health Organization (WHO) provides a dashboard that presents
official daily counts of COVID-19 cases and deaths worldwide, along with
vaccination rates and other vaccination data. As of 27 September 2023, there have
been 770,875,433 confirmed cases of COVID-19, including 6,959,316 deaths
reported to WHO. As of 19 September 2023, a total of 13,505,262,477 vaccine
doses have been administered globally 1

Definition:
Coronavirus disease is an infectious disease caused by the SARS-CoV-2 virus.
Eris(E.5) and BA.2.86 is the newly designated variants of SARS-CoV-2 that has a
number of additional mutations compared with previously detected Omicron
variants.

Factors ( causes)
• age-related changes in the immune system
• chronic medical conditions (such as heart disease, diabetes, or lung
disease)
• a higher prevalence of immunocompromised stdiseas
• Additionally, congregate living situations
Signs & Symptoms:
• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body ache
• Headache
• New loss of taste or smell • Sore throat
• Congestion or runny nose
• Diarrhea
• Nausea or vomiting

Complications:

1. Pneumonia:

2. Acute Respiratory Distress Syndrome (ARDS)

3. Organ failure:

4. Blood clots and stroke

•. Management

1. Vaccination:

2. Follow preventive measures

 3. Health monitoring

4. Regular testing
Nursing care plan
1. diagnosis
- Infection related to failure to avoid pathogen secondary to exposure to COVID-19.
- Deficient knowledge related to unfamiliarity with disease transmission information.

- Hyperthermia related to increase in metabolic rate.

- Impaired breathing pattern related to shortness of breath.

- Anxiety related to unknown etiology of the disease.

2. intervention
_ Monitor vital signs.
_ Monitor the patient’s temperature _ Monitor
O2 saturation.
_ Monitor the patient’s O2 saturation because respiratory compromise results in
hypoxia.
_ Educate the patient and folks.
_ Provide information on disease transmission, diagnostic testing, disease process,
complications, and protection from the virus.

3 . goals
_ Prevent the spread of infection.
_ Learn more about the disease and its management.
_ Improve body temperature levels.
_ Restore breathing pattern back to normal.
_ Reduce anxiety.
Vaccination
The development of effective vaccines has been essential in our collective fight
against COVID-19. These vaccines play a key role in reducing the severity of
illness, hospitalizations, and deaths, especially among people age 65 and older.
“We have more tools than ever to prevent the worst outcomes from COVID-19,”
said CDC Director Mandy Cohen, MD, MPH.

Evaluation

1- Patient was able to stop the spread of infection

2- Patient was able to learn more about the disease and how to manage as well
3- Patient was able to improve fever
4- Patient was able to restore breathing back to normal

Health education and guidance for carers of older people at home:

1. General protective measures against EG5

2. Regularly wash your hands with soap and water before and after:
3. Eat or use toilet.
4. Providing any physical care, having any physical contact with person or animals
.
5. Supporting older people with dementia and other cognitive impairments*
6. Protecting against COVID-19.
7. Looking after older people's broader health & wellbeing
8. It's important that you take care of the general health.
9. Continuous taking any medication recommend by doctor.
Reference:

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Asthma Data.
https://www.cdc.gov/asthma/most_recent_national_asthma_data.ht m
2. https://www.mayoclinic.org/asthmatreatment
https://www.healthline.com/asthma-complication
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Retrieved from https://www.who.int/tb/areas-
ofwork/populationgroups/older-people/en/
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(TB). Retrieved from
5. https://www.cdc.gov/tb/topic/basics/default.htm
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https://www.lung.org/lung-health-diseases/lungdiseaselookup/tuberculosis
7. Smith, J. et al. (2020). Epidemiology of Lung Infections in Geriatric
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8. Johnson, R., & Brown, K. (2019). Management Strategies for Common
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