PRACTICE RECOMMENDATIONS
• Advise older adults to prepare a health travel kit containing all their medications and medical supplies, a list of chronic conditions, and emergency contact information, and to pack it in their carry-on luggage. C
• Instruct patients who will be airborne for ≥4 hours to stay hydrated, avoid alcohol and sedating drugs, and either do seated calf exercises or get up and move about the cabin periodically. B
• Remind patients who will spend time in developing countries to drink only bottled beverages, eat only hot food and fruit that can be peeled, and avoid ice cubes and food from street vendors. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
CASE Larry R, a 77-year-old retired college professor, comes in for a checkup because he is planning a trip to Kenya—on a safari he describes excitedly as “the trip of a lifetime.” He’ll be going with a group, but before he signs on he wants to be sure you think he can manage the tour’s “moderate pace.” He also thinks that he’ll “need to get some shots.”
The patient is overweight (BMI 29) and smokes a pipe daily. He has a history of hypertension, hyperlipidemia, and mild osteoarthritis in both knees and hips, all of which are well controlled.
What would you advise Professor R about the health care preparations needed for his big trip?
Chances are you have patients like Professor R—retired and relatively healthy, and endowed with a sense of adventure and the financial resources that make it possible to visit distant lands. With the nation’s 78 million baby boomers starting to reach retirement age—the oldest cohort turned 65 in 2011—you’re likely to see increasing numbers of older patients with plans for international travel in the years ahead.1
Like their younger counterparts, older people travel for a variety of reasons: Some have planned for decades to take the “trip of a lifetime” when they retire. Others plan longer excursions, sometimes referred to as an adult “gap year,” to relive a long-ago experience, volunteer in an underdeveloped country, or hike and bird watch in a rainforest. Many more are immigrants who travel to visit relatives or friends in their country of origin, usually a lower-income, environmentally depressed locale with a higher incidence of infectious diseases like malaria, typhoid, and hepatitis A. 2
And while the older traveler will have to take many of the same steps to stay healthy as his or her younger counterpart, it is the older traveler who is more likely to have chronic conditions and special needs that require additional preparation. With careful planning, however, even those with decreased faculties, ranging from impaired vision or hearing to mild cognitive impairment, can safely travel abroad.3
A pretravel visit is your opportunity to assess the patient’s fitness to make the trip being planned, ensure optimal management of chronic conditions while traveling, and identify (and recommend steps to mitigate) travel-related risks.
Morbidity and mortality abroad: A review of the risks
Although much pretravel advice centers on the prevention of tropical infectious diseases, such infections account for a very small percentage of deaths of Americans outside of the United States.1 In fact, the major health risks facing older adults traveling abroad are similar to those they face at home: Cardiovascular events are responsible for the preponderance of deaths and for half of all travel-related illnesses.1
International travel can be physically demanding for older individuals and injuries are common, accounting for a large proportion of deaths of Americans overseas4 and an estimated 25% to 38% of travel-related incidents.1,5 A third of injury-related deaths of US citizens traveling abroad involve traffic accidents, followed by homicide (17% of cases) and drowning (13%).1,5 Thus, injury prevention and management of chronic conditions are key issues to address in a pretravel consult.
Even small steps help safeguard older travelers
Older patients planning to travel abroad should schedule an appointment at least 4 to 6 weeks before their departure.2 Ask about the locale, political and environmental climate, length of stay, location and type of accommodations, accessibility to health care, and activities planned,6 which will enable you to offer both general and destination-specific health and safety tips. When advising older adults with complex comorbidities and/or particularly high-risk itineraries, referral to a travel medicine specialist should be strongly considered.
Exercise. Encourage older patients to initiate a graduated exercise program, starting several months before the trip.3 Even a modest improvement in endurance, strength, and flexibility can reduce the likelihood of injury.