travel in advanced age vers1

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STILL A BARRIER?STILL A BARRIER?

Hakan YAMAN, MD, MS Assoc.Prof. of Family Medicine

Akdeniz University, Faculty of Medicine,Department of Family Medicine,

Antalya, Turkey

TRAVELLING IN ADVANCED AGESTRAVELLING IN ADVANCED AGES



23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007

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Monthly incidence rates of health problemsMonthly incidence rates of health problems

during stays in developing countriesduring stays in developing countries




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Causes of death

Southern Europe, Florida and Caribbean elevatedmortality rates due to a variety of natural causes

Developing destinations risk of fatal accidents ishigher

Assaults or terrorism are infrequent causes of death at present New illness, or complications of a pre-existing

illness. (cardiovascular conditions) Evidence: Pulmonary embolism in long distance

air travel (five per million travelers)




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STILL A BARRIER?STILL A BARRIER?

The elderly- 500 million travelers

Age alone is not a contraindication

Increased risk of illness, injury, or death (even w/o pre-existingmedical problems)

Difficulty in acclimatizing Longer to adjust to extremes

(temperature or humidity or altitude)

More prone to jet lag, insomnia,and constipation.




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pre-travel assessments

Focus: prevention of travel-related infections(1±3% of deaths)

Majority: Cardiovascular disease or trauma

Evaluation of an individual¶soverall fitness for travel shouldbe performed by the

individual¶s own physician prior to travel.




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GENERAL ADVICE

Choosing a trip

Fitness to travel Making travel arrangements

Health insurance

Medications and medicalsupplies

Medical services abroad

Travel safety Vaccine Preventable Infections




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Fitness to travel

General check-up Specific travel advice Enough in advance to allow for investigation

and treatment of any undiagnosed

conditions Absolute contraindications to air travel:- pneumothorax or pneumomediastinum;- acute coronary syndromes, congestive heart

failure, or significant dysrhythmias within 4

weeks of travel;- thoracic, cardiac, abdominal, or middle-ear

surgery within 3 weeks;- cerebrovascular accidents within 2 weeks;

and

- some infectious diseases during the periodof communicability (e.g., chicken pox,measles, SARS, tuberculosis).

Relative contraindications to air travel:- Respiratory tract infections and other

pulmonary disorders,- Anemia




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Absolute contraindicationsto air travel




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Increase in Activity

Fitness or conditioningprogram

(1 or 2 months before) Exercise stress testing is

not routinely recommended Particularly men > 40 y.,women > 50 y., History of

coronary artery disease(>= 2 risk factors)




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Making travel arrangements

Specific needs of individualtravelers should be discussed withthe travel agent

Aisle or bulkhead seats (increasedlegroom)

Seating in the non-smokingsection

Special diets

Other special needs: the need for a wheelchair or motorizedtransportation




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Medications and medical supplies

Medications and medical supplies

Denture wearers: Denture adhesive

First aid medications: well tolerated

Renew prescriptions: run out or expire

during the trip Minimize the chance of loss or theft (Plusan extra several days)

Duplicate medications and a prescriptionfor each, should carried

Medications: original bottles Opiate analgesics, narcotics, and needlesand syringes ± may pose problems for importation across borders

Travelers should contact the embassy or consulate of each country they intend tovisit to find out if there are any restrictionsin bringing medications into or out of thecountry.

Travelers: name and phone number of their physician and personal contacts in the

event of an emergency (summary of medical record, complete list of currentmedications, and most recentelectrocardio ram




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Tips during air travel

Comfort and safety should beoptimized

Comfortable clothing Intestinal gas expands with

altitude and can cause

abdominal discomfort Alcohol and caffeinated

beverages (Dehydration!)

Regular contraction of legmuscles while seated, andshort walks may reduce the

risk of thrombosis.




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MEDICAL CONDITIONS ARISING DURING TRAVEL

Motion sickness

(C/I anticholinergic agent) In-flight emergencies

(10 000 air travelers; 21 - 90 death per year)

Thromboembolic disease Jet lag

Hyperthermia and hypothermia

(diuretics, coffee and alcohol)

Altitude sickness




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Thromboembolic disease

3-year study: 104 deaths in long-distance travelersarriving at Heathrow Airport, 12% of all deaths and18% of those occurring in-flight were attributed topulmonary embolism

Travelers have a four-fold increased risk of idiopathic VTED;

VTED risk factors:- low risk: < 75; women taking oral

contraceptive pills (OCPs); pregnantwomen; and < 45 genetic traits for hypercoagulability.

Exercise and hydration- Moderate risk: >75; women > 45 who take

estrogen; and traits for hypercoagulability+ OCPs.

Below knee graduated compression stockings or ASA.

- High-risk: History VTED; activemalignancy; gross obesity; markedrestriction in mobility due to muscular or cardiovascular disease; large varicoseveins; and > 75 with cardiac andpulmonary disease.

Use of graduated compression stockings, ASA, or, if stockings are not used, low molecular weightheparin.




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Altitude sickness

Acute mountain sickness (AMS)

5-day acclimatization period (tolerate

altitudes of 2

500 m well) Hypoxemia, sympathetic activation,pulmonary hypertension, andreduced plasma volume do

contribute to reduced exercisecapacity (cardiopulmonary disease or anemia)

Beta-blockers (compensatorytachycardia/dyspnea)

Level of fitness and adequateacclimatization will minimize the risk




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Accidents and injury

Trauma-related deaths intravelers are more common inmales, and in the young andelderly

The elderly may be at higher

risk:- slowed reaction times

- auditory and visual impairment

- medication side effects




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Further Information

International Association for Medical Assistance toTravelers (IAMAT)(www.iamat.org).

WorldMed.MD/Executive

Physicians Worldwide,(www.executive-physicians.net)

International SOS

(www.internationalsos.com)




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CONCLUSION

Older travelers will continue toincrease in the future

Some limitations andrestrictions to travel may benecessary

Little reason restrict elderlycannot travelling

Adequate preparation and

appropriate advice, the elderlytraveler can enjoy good healthduring travel.




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THANK YOU




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