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Travelling comes of age: advice for the older voyager

Old is increasingly becoming younger. It is a known fact that the older population is healthier than ever before and that 55 has become the new middle age.(1) With many older people travelling well into their 90s, holistic travel advice is essential if we are to meet the growing needs of the more mature traveller

Liz Rosies
RGN MSc(Travel Health) PGCE
Travel Health Adviser
Lecturer
Author of www.travelhealth.co.uk

For some time now, economists have been predicting a new travel market for the "older traveller". However, it is difficult to define what we mean as "older" today. In the UK the average age for a pension is 65, and many pensioners remain in good health for several years into their retirement. Free from family and financial commitments, they continue to travel well into their 80s and beyond. This increased leisure time combined with cheaper travel is allowing more older travellers the opportunity to scale the globe and make the most of their freedom, travelling to places they once only dreamt of.(2) When we read of 74-year-olds bungee jumping and an increase in sexually transmitted diseases among the over-60s, it is time to sit up and think how we can best serve this age group within the travel clinic.(3)
The physiological changes that occur in the body as we age make the older traveller more vulnerable to travel health concerns. From the age of 60 there is a noticeable slowing down of major organ systems.(4) These changes put the older traveller at an increased risk. Furthermore, an increasing number of older people are travelling with preexisting medical conditions and numerous medications. 
Because some older patients potentially have a more complicated medical history and medication list, it is essential to allow adequate time for a risk assessment. While age is not a contraindication for travel, the effects that aging can have on the body must be recognised. In a travel consultation this might require some "precautionary counselling" in order to ensure they remain in good health while travelling.(5)

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Medication
For many older patients with preexisting conditions, medication is a major part of their lives. It is important to understand what medications they are already taking and how these might affect their travel plans. It is worth advising that they carry in their hand luggage adequate supplies of their medication for the flight, as well as a list of their medication and the doses, and any preexisting medical conditions. Advice might also be required on timings of medications across time zones, as well as a gentle reminder to take their medication on the day of travel.
With an increase in the number of patients with diabetes over the age of 65, advice must be adapted for the elderly. It is especially important for travellers with diabetes to be able to adjust their medication to different time zones and to their altered lifestyle and diet. Reminding travellers with diabetes of potential delays at airports, unfamiliar food and potential stress will enable them to consider how they will deal with difficult situations prior to them happening.(6)
Considering their current health status and medication will also affect decisions regarding malaria prophylaxis. Mefloquine, for example, can exacerbate already existing cardiac problems.(7)
Preventing mosquito bites is essential, both to avoid disease and skin infections. Over the age of 65 the skin can take up to 50% longer to heal than in a young person.(8) It is also good to carry a small first-aid kit to deal with minor injuries and to ensure good sun protection in order to prevent burning. Heat in itself also puts the older traveller at a higher risk of stroke, heart attacks and thrombosis. It is a well recorded fact that during heat waves there is a dramatic increase in death from such conditions.(9)
As a person ages, the kidneys gradually decrease in size and output, resulting in lower creatinine clearance and reduced renal function.(10) This decrease in function can also lead to increased sweating and a higher risk of dehydration in hot climates. Those travellers on diuretics should ensure an adequate fluid intake as dehydration can cause electrolyte imbalances in the heat. Many older people refrain from drinking in a new location due to worries about finding toilets. Understanding local symbols for toilets and learning phrases to enable them to ask for directions prior to travel can alleviate some of these concerns. 
Older people are at no greater risk of traveller's diarrhoea than younger people; however, diarrhoea-related complications such as dehydration and increased fluid loss do make them more vulnerable and advice must be given regarding prompt treatment.(11) Dehydration can cause an increased risk of cardiac problems such as angina. In a study of how travellers die overseas it was found that of the 28% over the age of 60, 82% of deaths were related to cardiovascular causes.(12) The inevitable stress that goes with travel can potentially complicate existing health problems, especially in the older traveller. Booking seats on a plane before the day of travel, requesting any special meals or equipment in advance, and ensuring they arrive at an airport in good time, if not the night before, can all help alleviate some of the initial stress. Each airport will be able to provide information to help those requiring assistance. Any special assistance required should be booked well in advance of travel.(13)
Travellers should also be advised to pace themselves, to ensure that they have rest times as well as periods of activity to avoid unnecessary accidents. Research has shown that most accidents occur early on during the time overseas, when the surroundings are still unfamiliar.(14) Travellers should also be reminded not to engage in exertion above and beyond their normal lifestyle.
Travel insurance is an essential requirement for the elderly but one that is increasingly expensive or difficult to purchase, especially for those with preexisting medical conditions. Companies such as Saga and Help the Aged are able to offer unbiased advice, as well as offer their own policies. It is also essential that all preexisting medical conditions are declared on purchase.(15) (See Resources.)

Cruises
Over recent years there has been an increase in the older population opting to take a cruise, which is often heralded as the perfect way to see the world. The average age of cruise passengers being 53 is an indication of the popularity of cruising among older people.(16)
However, when considering a cruise there are many potential risks that should be considered. Cruise ships often have an abundance of food, available day and night, and the inevitable weight gain can see many people returning with elevated cholesterol levels and extra pounds around their waist.
While the brochures show calm waters and sunny skies, they often fail to realise that the sea can be rough. For the frail and unsteady traveller this can, along with steep staircases and narrow hallways, cause potential injury. Added to this is the risk of sunburn, often not recognised because of the cool breezes coming from the sea.
Risk of infection is also high on cruise ships - seven cruise ships reported outbreaks of gastroenteritis between April and June of 2006 alone. Travellers should be reminded to adhere to good hygiene and consider taking hand wipes and hand sanitiser as well as drinking bottled water while on board.(17)
For the more exotic cruise traveller, vaccinations and malaria prophylaxis need careful consideration with so many short stops in a variety of locations. While malaria is not usually a problem for most travellers back on board their ship during the evening, those on excursions or cruises along rivers in risk areas, such as the Amazon, will need consideration.(7)

Conclusion
Keeping all of this in mind, it must also be remembered that increased age does not necessarily mean a less experienced older traveller. A large number of older travellers are in good health and have taken time to carefully plan and consider their travel. Many in their 80s and 90s are products of early retirement and have become seasoned travellers, who just need to ensure that their vaccines are up-to-date, or maybe have a chat and tell you about their latest adventure.

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References

  1. European Travel Commission. Tourism trends of Europe. 2006. Available from: http://www.etc-corporate.org/resources/uploads/ETC_Tourism_Trends_for_Eu...
  2. Over 55 and up for it. The Guardian March 6 2004.
  3. Ward B, Plourde P. Travel and sexually transmitted infections. J Travel Med 2006;13:300-17.
  4. Abrass IB. The biology and physiology of aging. West J Med 1990;153:434-40.
  5. McIntosh I. Elderly travellers in travellers health - how to stay healthy abroad. Oxford: Oxford University Press; 2002.
  6. Chandran M, Edelman S. Have insulin, will fly: diabetes management during air travel and time zone adjustment strategies. Clinical Diabetes 2003;21:82-5.
  7. Chiodini P, Hill D, Lalloo D, et al. Guidelines for malaria prevention in travellers from the United Kingdom. London: Health Protection Agency; 2007.
  8. McIntosh I. Health hazards in the elderly. Int J Travel Med 1998;5:27-9.
  9. Department of Health. Heatwave plan for England. London: DH; 2008. Available from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
  10. Lockie C, Walker E, Calvert E, et al. Travel medicine and migrant health. London: Churchill Livingstone; 2000.
  11. National Travel Health Network and Centre. Travellers' diarrhoea. Available from: http://www.nathnac.org/travel/misc/travellers_dir.htm
  12. Paixao ML, Dewar RD, Cossar JH, et al. What do Scots die of when abroad? Scot Med J 1991;36:114-6.
  13. British Airways. Special assistance. Available from:http://www.britishairways.com/travel/special/public/en_gb
  14. Kniestedt R, Steffen R. Travel health insurance - indicators of serious travel health risks. J Travel Med 2003;10:185-7.
  15. Fit For Travel. Elderly travellers. Available from: http://www.fitfortravel.scot.nhs.uk/advice/travellers/elderly.htm
  16. Skidmore J. Cruise holidays' popularity continues to grow. Telegraph Online. 6 June 2008. Available from: http://www.telegraph.co.uk/travel/cruises/2074470/Cruise-holidays%27-pop...
  17. Takkinen J. Recent norovirus outbreaks on river and seagoing cruise ships in Europe. Eurosurveillance 2006. Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2973