Liam Butler interviews Dr Marc Shaw Worldwise Travellers Health
How can older people stay healthy whilst traveling?
Dr Marc Shaw DrPH, FRNZCGP Medical Director WORLDWISE Travellers Health Centres NZ:Â Older individuals represent a substantial proportion of international travellers. An estimated 15â€“30% of travellers being aged 60 years or older and this population is increasing. This â€˜seniorsâ€™ group has greater difficulty in acclimatizing during travel, adjusting to extreme climatic conditions (temperature, humidity, and altitude), waning immunity from vaccines previously received, and reduced responses to vaccines provided at a pre-travel consultation.
Before any travel overseas, elderly patients should seek a medical assessment with a review of their current therapies, and an appraisal of their travel itinerary. Immunisation is still the most efficient strategy to prevent infectious disease and the increased vulnerability to infection of the elderly makes them a particularly important target population for immunisation programmes. Nevertheless, most vaccines are less immunogenic and efficient in the elderly because of age-related changes in the immune system. With increasing â€˜safeâ€™ travel opportunities in old age the importance of travel vaccines for persons over the age of 60 is growing.
In general there are three risk groups of elderly travellers:
1)Â Â Â Â Â Â Â Â Â Â Â the young elderly who travel to low risk destinations on short-haul journeys and are Â Â Â Â free from any existing illness
2)Â Â Â Â Â Â Â Â Â Â Â those with pre-existing medical conditions. This group may involve travel to climatic extremes, and may challenge the frail elderly
3)Â Â Â Â Â Â Â Â Â Â Â A high risk group including physically unfit, terminally ill and those with pre-existing illness to high health risk destinations with pre-existing illness, environmental extremes and to tropics.
Illnesses which may be aggravated by air-travel
About 5-10% of airline passengers, many elderly, suffer from chronic illness. Senior travellers are more likely to get the following: Chest and stomach infections, urinary tract infections, strokes and heart attacks, and deep vein thrombosis. Interestingly they were less likely to get: sudden diarrhoea, upper airway infections, flu and flu-like illness, genital infections (no surprise this!) and mossie infections like malaria and dengue fever.
So, what then is an appropriate Top-Tip Checklist for the senior traveller to discuss at a pre-travel consultation?
1.Â Â Â Â Â Â Documentation. Get their documents about their health issues in an up-to-date medical letter. This should note any health dis-ease, any medications and details on family contacts and health insurance.
2.Â Â Â Â Â Â Arrange a medical check-up before departure
3.Â Â Â Â Â Â Anticipate potential medical problems. Analyse any pre-travel itinerary with a view to pre-travel circumstances: including transport embarkation, intra-travel comfort and post-travel unwellness
4.Â Â Â Â Â Â Managing Medications: appropriate advice needs to be sought on a projected itinerary and time zone-travel, with respect to ongoing medications and those related to preventative travel health. Advice on the carriage of medications is imperative, particularly if carrying medicine may be impacted by temperature, like insulin. Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
5.Â Â Â Â Â Â Diabetics will require advice on adjustment of food intake and insulin dosage
6.Â Â Â Â Â Â Warn airlines of special medical, dietary, mobility, requirements
7.Â Â Â Â Â Â Extra attention for those with chronic health dis-ease. The higher likelihood of travel-associated UTI, gastritis, peptic ulcer, and GERD suggests that these diseases should also be considered in older travellers receiving pre-travel advice. Antibiotics for the presumptive treatment of respiratory and UTIs may be considered, as well as antacid medications although the latter may possibly increase the risk of travellerâ€™s diarrhoea.
Senior travellers presume that they will be fit to travel but they also like to know it and have evidence of it too! With good pre-travel organisation from travel health professionals, the â€˜seniors groupâ€™ will be able to travel with safety knowing that any medical conditions that they have are minimalised.