understanding the relationship between holiday taking and self-assessed health: an exploratory study...

Understanding the relationship between holiday taking andself-assessed health: an exploratory study of senior tourismPhilippa Hunter-Jones and Adele Blackburn

University of Liverpool Management School, Liverpool, UK

Keywords

Senior tourism, health, carers, qualitativeresearch.

Correspondence

Philippa Hunter-Jones, University of LiverpoolManagement School, Chatham Street,Liverpool L69 7ZH, UK.E-mail: [email protected]

doi: 10.1111/j.1470-6431.2007.00607.x

AbstractThe senior market is particularly attractive to the tourism industry. Alongside evidence ofa growing propensity to travel and spend, consumption is often deliberately linked to lowseasons, balancing out the peaks and valleys for tourism suppliers. Health is one variablewhich is particularly significant to this consumer. Personal health influences all patterns ofconsumer behaviour regardless of age, although the full extent to which this models seniortourism activity is unclear. An exploratory qualitative study was undertaken in the springof 2005, with 22 senior consumers (aged 55 years plus) interviewed. Utilizing the earlierwork by Zimmer et al. into self-assessed health as a framework, travel propensity, theperceived effects of travel and factors inhibiting full participation were questioned. Con-clusions drawn outline both a senior tourism typology and areas for future research.Notably the relationship between caregiving and tourism consumption is singled out forfurther investigation.

IntroductionAccording to Huang and Tsai (2003, p. 561), ‘seniors will soon beone of the largest prospective market segments for the hospitalityand travel industries’, industries contributing significantly to theleisure sector. Leisure is a growth sector of many modern devel-oped societies. In the UK alone, it now accounts for a greaterproportion of household spending than housing and food (Roberts,2004), makes an important social, cultural and psychological con-tribution to individuals’ lives, and provides a means of identity inan increasingly services-dominated environment. For the seniormarket in particular, it has long been recognized (see for instanceearlier accounts by Long and Wimbush, 1985 and Tokarski, 1991)that leisure consumption offers the basis for a fulfilling old ageand, significantly, has the potential to be more stable than in anyother age group. When focusing specifically upon the tourismindustry, the senior market takes on a further significance. Along-side evidence of a growing propensity to travel and spend (Huangand Tsai, 2003; Reece, 2004), consumption is often deliberatelylinked to low seasons, filling the peaks and valleys for tourismsuppliers (Capella and Greco, 1986).

Consciously or subconsciously, health and well-being influ-ences all patterns of consumer behaviour, albeit to varyingdegrees. It is likely to be most obvious within the senior marketgiven that generally as people age, they naturally experience anincrease in health-related problems, be it impaired vision andhearing, digestive problems, knee or hip problems for instance.Indeed, according to Age Concern (2004), in 2002, 63% of peopleaged 65–74 years, and 72% of people aged 75 years and over,

reported a long-standing illness. Yet, as this report shows, beyonda statistical analysis of how conditions differ by age, little is reallyunderstood about how individuals may perceive their own healthand, indeed, how this perception may model patterns of consump-tion. The existing academic tourism literature provides a goodexample of this shortfall. Here there is a tendency to explore healthmatters only within the context of the travel-related illnessesresulting from holidays, malaria, sexually transmitted infections,accidents and injuries for instance. Travel with pre-existing con-ditions is seldom considered. The main exception to this, theliterature embracing tourism consumption of the disabled commu-nity, strongly supports the case for investigating such. Yet, whilethe psychological and ethical reasons for enabling consumptionare considered, it is really the economic benefits of attracting thismarket which traditionally have generated most interest. Such afocus has inevitably neglected the main beneficiary of the activity,the consumer, and also, as a consequence, has failed to take fullaccount of the relationship between perceived health and tourismparticipation.

The senior market‘New senior citizens’, ‘young sengies’ (young senior generation),‘whoopies’ (well-off older people), ‘retiring baby boomers’, ‘gen-eration between’ and the ‘grey market’ (Lohmann and Danielsson,2001) are all terms used to describe what is collectively known asthe ‘senior market’. Within most developed countries, the seniormarket is growing at an increasing rate (Shoemaker, 1989; Smithand Jenner, 1997; Lohmann and Danielsson, 2001; Age Concern,

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2004). In the UK, in 2002 there were 19.8 million people aged50 years and over (National Statistics, 2004), representing a 24%increase over four decades from 16.0 million in 1961. This figureis set for a further 37% increase by 2031, when there will beapproximately 27 million people in this category (National Statis-tics, 2004). Yet, it is not merely volume which makes this marketsignificant, but rather as Huang and Tsai (2003) argue, it is thefundamental shift in buyer behaviour patterns which makes this aparticularly attractive and lucrative consumer segment. Challeng-ing the stereotypical image of seniors as elderly, weak, poor,isolated and lacking inspiration, these authors make the case thatthis population, more so than its predecessors, is increasinglylikely to have, and be prepared to spend, incomes and investmentsupon leisure consumption, rather than saving such for siblings.This shift in mindset is seen by others (e.g. Smith and Jenner,1997) to have facilitated the emergence of an increasingly discern-ing and sophisticated consumer more prepared to accumulatetravel experiences than ever before.

Health and holiday takingLiterature documenting the relationship between health andholiday taking in general is fragmented. Drawing together earlierpapers, Hunter-Jones (2003) highlights the bias towards detailingthe health consequences of travel, such as travel-related illnesses,accidents and injuries for instance. In contrast, people travellingwith pre-existing conditions are seldom covered. The frequentlyquoted World Health Organization (WHO, 1948) definition ofhealth as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (p. 100)reminds us of the diversity of conditions, both physical andmental, which can challenge health status. Chronic illnesses, ofwhich Kabak (2004) classifies 80 disorders, for example arthritis,diabetes and heart disease, present a particular problem to thesenior market. While most learn to cope with conditions on aday-to-day basis, studies indicate that ‘older people are also morelikely than younger adults to experience chronic ill health and(. . .) a change in environment might pose a threat to well-established coping mechanisms’ (Schofield, 2000, p. 50).Although this may be true, the WHO (2003) standpoint is thatadvanced age is not necessarily a contraindication for travel if thegeneral health status is good. Indeed, from a consumer perspec-tive, holidays can provide many benefits to somebody with ill-health. Examining the perceived effects of holiday taking uponpatients treated for cancer, for instance, Hunter-Jones (2003)identified four areas of contribution: personal health (psychologi-cal and physical), social effectiveness, personal identity andregaining independence, areas likely also to be a feature of seniortourism.

Yet tourism activity, as with any consumer group, is not acces-sible to all. Barriers to participation have been a feature of manystudies. Smith’s (1987) review of the leisure of disabled tourists,and Gladwell and Bedini’s (2004) study of the leisure patterns ofinformal caregivers, provide two examples of general inhibitors,while Fleischer and Pizam’s (2002) study of the travel constraintsof the Israeli senior market provides an age-linked perspective. Inthis latter study, citing the work of McGuire et al. (1988), fivetravel inhibitors are identified, which include: external resources,time factors, approval, social and physical well-being. While these

constraints may be subject to budget and time pressures, as ageincreases, they will be conditioned in part by the tourist’s indi-vidual health: ‘in each case as health status deteriorates, eitherobjectively, as measured by chronic conditions and mobility prob-lems, or subjectively, as measured by self-assessed health, thetendency to travel decreases’ (Zimmer et al., 1995, p. 6). Morecontentious though, and challenging much of the accepted think-ing, these authors also found that seniors reported a relatively highlevel of self-assessed health status despite experiencing a numberof chronic conditions and mobility restrictions. This is corrobo-rated by a more recent study (Mintel 2000) which concluded thatwhile some third-age travellers (aged 45–64 years) consider theirhealth before travelling, many have a ‘live for today’ attitudewhereby regardless of health problems, they generally feel welland good about themselves, an optimism both the consumer andindustry could do more to capitalize upon.

Research methodologyFocusing specifically upon the role that self-assessed health playswithin senior tourism consumption, face-to-face, semi-structuredinterviews were conducted over a 3-month period during thespring of 2005. Three research parameters were established. First,the sample population was to consist of those aged 55 years andover, an age range targeted in related research which was instru-mental in the development of the interview schedule (e.g. Zimmeret al., 1995; Fleischer and Pizam, 2002; Huang and Tsai, 2003).Second, the travel was to be specifically leisure travel. Third, thewindow of reflection was to be the main holiday taking activityundertaken within the 2 years prior to the interview. Snowballsampling techniques were applied and 22 informants accessed. Noclaims are made that this provides representative data, but ratherthat a number of commonalities are highlighted, which themselvesprovide a platform for further research.

The interview schedule included informant profiling by age,gender, health and employment status, travel propensity andpatterns of holiday taking, including motivations, choice andinhibitors. Zimmer et al. (1995) used three variables to identifyself-assessed health status: (1) the number of chronic health con-ditions experienced (heart trouble, stroke, diabetes, etc.); (2) thenumber of mobility restrictions experienced (six daily activitiesare listed); and (3) a subjective assessment of health (based on howhealthy individuals perceive themselves to be). Such an approachwas applied within this study (see Table 2). Once piloted and thequestion wording altered accordingly, the interviews were con-ducted in a location convenient to the informant (usually home),tape-recorded (with permission) and analysed manually (for flex-ibility and additional insight) using template analysis (Saunders,Lewis and Thornhill, 2003).

Results and discussion

Profile of respondents

Table 1 profiles each respondent by age, gender, occupation andmain holiday preference. The sample included 10 male and 12female people; the majority retired, with ages ranging from 57to 81 years. With the exception of only four people, leisure travelwas at least an annual activity for the majority of respondents.

Holidays and health P. Hunter-Jones and A. Blackburn

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Consistent with general patterns of holiday taking, the most popularforms included organized travel to European destinations, long-haul travel, and visiting friends and relatives. A preference forlonger holidays (10 nights or more) was expressed, the commonreasons summarized by Paul: ‘short breaks are too exhausting.Youarrive, unpack and then it’s time to go home. I’d much rather pacethings these days and make the most of visiting new places’.

Table 2 details the results of the health self-assessment. While acrude indicator of health status, this approach provides a usefulindicator of respondents’ self-perceptions. With the exception oftwo respondents, the remainder perceived their own health to bebetween excellent and fair, and only three reported mobilityrestrictions, while the majority identified with only one illness,high blood pressure and arthritis being the most commonly noted.These findings endorse the earlier claims by Zimmer et al. (1995)of a health optimism among the senior market. However, as theinterviews progressed, a flaw in the self-assessment processbecame clear. Such a process fails to recognize the extent to whichthe health of others, family member or friend for instance, mayimpact upon individual consumer behaviour. For Terence and Dot,informal caring responsibilities were cited as the primary obstacleto tourism participation. For Paul, Ian and Sylvia, participationwas still possible but compromised through similar circumstances.Consequently, the following discussion reflects the viewpoint ofthose able to travel alongside those compromised through caringresponsibilities. While the nature of holidays taken varied, the rolethat health plays within modelling patterns of participation wasreflected through a range of discussion topics: perceived health(benefits and costs); transportation; accommodation; ancillary ser-vices – insurance; and the caring role.

Perceived health

Health benefits

Holiday taking is frequently associated with health benefits. Mostoften it is the psychological benefits of the activity which gainmost attention, as reflected through the work of authors such as theEnglish Tourism Council (2002) and Horner and Swarbrooke(1998), both of whom argue that the simple act of changing envi-ronments can make one feel better and lift the spirits in a widersense. When questioned about the primary reasons for holidaytaking, travelling to warm and sunny places was a significantfactor identified by the majority of the respondents: ‘. . . well it’sgood for you isn’t it to go away in the sunshine and get away fromit all’ (Keith) and ‘. . . you get depressed with the weather roundhere, grey skies, that you look forward to a bit of sunshine’ (John).Such comments support the claims by Age Concern (2004, p. 52)that the warm weather ‘. . . causes the release of stimulating andeuphoric brain chemicals, which makes people feel happier and, inturn, healthier’.

Although weather was a significant factor, consistent with Min-tel’s (2000) study of third-age travellers, respondents preferred acomfortably warm, pleasant heat while, on holiday, ‘. . . we feel illif it’s too hot, it’s too much for us now’ (Margaret). A commonpattern of holiday taking which emerged was to take holidays outof peak season so as to avoid extremely hot conditions: ‘. . . if yougo abroad it’s too hot for us so we prefer to go say March to Mayand then perhaps October’ (Margaret). Such corroborates Capellaand Greco’s (1986) claim that senior tourists are a critical marketfor the tourism industry filling the peaks and valleys for airlines

Table 1 Profile of respondentsNamea Age Gender Occupation Holiday preferences

Keith 57 M Factory worker European package holidaysElizabeth 64 F Retired Australia VFR, European package holidaysJack 65 M Retired Australia VFR, European package holidaysFrank 66 M Retired Cruising, Spain, UKBetty 68 F House wife Cruising, Spain, UKSheila 68 F House wife WorldwideJean 69 F Retired America VFR, European package holidays, UKWilliam 70 M Retired America VFR, European package holidays, UKJohn 71 M Retired European package holidays and the UKMary 72 F Retired Canada VFR, cruising, UKJames 72 M Retired Mainly Europe and some long-haul destinationsMargaret 75 F Retired European package holidays and the UKIrene 81 F Retired Cruising, coach holidays in the UKMark 58 M Taxi driver European package holidaysPaul 64 M Retired Coach holidays in the UKKerry 59 F Teacher WorldwidePaula 61 F Retired Walking holidays, UK and abroadIan 57 M Office worker European package holidaysTerence 62 M Retired Non-traveller (informal carer)Sylvia 60 F Receptionist Non-traveller (poor health)Irene 58 F Dinner lady Non-traveller (poor health)Dot 65 F Retired Non-traveller (informal carer)

Source: Primary data.aNames have been changed to respect confidentiality.F, female; M, male; VFR, visiting friends and relatives.

P. Hunter-Jones and A. Blackburn Holidays and health


and hotels. Additionally, most respondents commonly travelled to‘. . . relax, walk, have a swim’ (Frank) and rejuvenate, motivationswhich have long been recognized. Anderson and Langmeyer(1982, p. 24) believe ‘. . . over 50 travelers preferred non-hectic,pre-planned pleasure trips for rest and relaxation and for visitingrelatives’. Likewise, Romsa and Blenman’s (1989) study ofseniors placed a high priority on health alongside wanting to relaxwith friends and family.

Consistent with Hunter-Jones’s (2003) claim that a psychologi-cal benefit of travel relates to social effectiveness, respondentshighlighted the feelings of inclusion travel generated: ‘. . . you’vegot something to talk about as well, when you come back fromholiday if you never went away and other people are talking abouttheir holidays and where they’ve been you’ve nothing really todiscuss have you’ (Jean). To Mary, it was the opportunity tointeract with others that represented the greatest benefit to travel.Commenting upon the circumstances of a neighbour, she

remarked ‘. . . I feel sure it would do him the power of good ifhe only went and had a break and got him some company. I thinkyou should do it whilst you can’ (Mary).

Even those experiencing health complications believed stronglythat holidays benefited their health. Irene and Jean, for instance,both singled out physical health improvements ‘. . . when I’mcruising I have arthritis and I have chronic bronchitis and asthmaand I have stones in my kidneys and it does me a power of good onthe water, I never cough I’m great’ (Irene), and ‘. . . as far as likeyour arthritis goes, see you go and after a week in the sun you feelbrilliant because it’s good for your bones isn’t it and things likethat’ (Jean). These comments endorse the earlier ETC (2002)study, which claimed that 16% of adults recognize that holidayscan improve asthma or allergies. To Paula and Mark, travel pro-vided an excuse and opportunity to retain physical mobility. Bothengaged in active forms of leisure. Paula singled out walkingholidays as a particular favourite, while Mark commented uponthe various sports pursuits (e.g. hill walking, abseiling) pursued aspart of a package holiday. ‘Holidays provide you with the time tokeep fit, but I don’t mean fit in a diet sort of way, no that’s toointense. They give you a chance to have some fun but to keep thelimbs moving and not packing up’ (Paula), and ‘we love includingsome physical challenge in our holiday. Even as we get on a bit it’sstill really good to know your body can keep up with physicalpursuits (. . .) we use the holiday as a goal (. . .) we train, I don’tmean seriously but you know a bit of exercise here and there,before we go and then really make the most of the time away to bea bit active’ (Mark).

Perceived health problems

Travel was not without health complications, however. Somerespondents voiced anxieties about visiting a long-haul or lessdeveloped destination, with injections, flight durations, humidityand risk each cited as contributory concerns. Comments made byJohn summarize the key issues ‘. . . well I wouldn’t relish going toplaces like these African countries where you’ve to have thesevarious injections you know (. . .) I wouldn’t like to risk going toplaces like that where you can pick up these things’. Of the fiverespondents who had undertaken long-haul travel, each case wasto visit relatives, and each confirmed this to be the only reason fortravelling there. This is significant as it highlights the importanceof visiting family wherever they live and however challenging it isto get there. Jean, while terrified of flying, visited her grandson inAmerica. Having survived the experience, she was quick to pointout ‘. . . the only time I’ll ever do it again is if he gets married youknow if anything important happens’. That said, not all respon-dents shared travel anxieties. James perceived the preparatoryneeds of travel to be an integral part of the experience: ‘If you’regoing to Egypt or any of them places you’ve got to have theinoculations, but yeah we just go and get them’ (James).

Often health complications voiced really related to perceptionsof risk rather than actual experiences of such. Wilks (2003) placesrisks at destinations usually at the bottom of the list of real threatsto tourists. While this may well be true, this study found perceivedrisks to figure highly within respondents’ travel planning: ‘Iwouldn’t go to Africa or a place like that, I mean you wantsomewhere it is more modernised and less outback type of thingmore so now when we are getting older’ (William). ‘I don’t think

Table 2 Self-reported health status

Namea

Self-assessedhealth

Number of mobilityrestrictions

Number ofillnesses Total

Keith 1 0 1 2Elizabeth 1 0 1 2Jack 2 0 1 3Frank 2 0 1 3Betty 2 0 1 3Sheila 2 0 1 3Jean 2 0 4 6William 2 0 1 3John 2 0 1 3Mary 2 0 2 4James 2 0 3 5Margaret 2 0 1 3Irene 3 3 4 10Mark 1 0 1 2Paul 2 0 1 3Kerry 2 0 2 4Paula 1 0 1 2Ian 2 0 1 3Terence 2 0 1 3Sylvia 4 3 4 11Irene 4 2 3 9Dot 2 0 1 3

Source: Primary data.aNames have been changed to respect confidentiality.Self-assessed health: 1 = Excellent; 2 = Good; 3 = Fair; 4 = Poor;5 = Very poor. Source: Zimmer et al. (1995).Number of mobility restrictions: (1) walking round the block – yes/no; (2)getting in and out of the car – yes/no; (3) getting in and out of the bathtub – yes/no; (4) getting in and out of bed – yes/no; (5) going up anddown a flight of stairs – yes/no; (6) getting in and out of the chair –yes/no. Source: Zimmer et al. (1995).Number of Illnesses: heart trouble, stroke, high blood pressure, othercirculation problems, kidney trouble, cancer, diabetes, breathing prob-lems, palsy, thyroid trouble, stomach trouble, dental problems, emo-tional problems, foot or limb problems, skin trouble, arthritis, eyetrouble, ear trouble, incontinence and other bladder problems. Source:Zimmer et al. (1995).



we would go to these outback countries . . . and I think with all thisterrorism really’ (Jean). ‘I wouldn’t go back to Jamaica it was verythird world, very primitive I just didn’t feel safe’ (Shelia). Themajority of the destinations visited were mostly westernizedresorts, with a comment made by William summarizing the keyrationale: ‘we’ve always gone to countries where we’ve thoughtthat it would have appropriate health facilities’.

Actual health problems

According to Mansfield (1992), previous experience is a criticalfactor in travel choice. Conflicting health experiences emerged inconversation. Three respondents sustained injuries abroad andused the healthcare facilities to receive medical treatment, mainlyfor slips and falls. In each case, the exceptional service theyreceived left them with little fear of future travel: ‘facilities wereexcellent, top class’ (Frank), ‘they were absolutely wonderful (. . .)no comparison to here’ (Mary), and ‘. . . I was a bit frightened,well not frightened no I would say worried about this time as I’vegone diabetic, so you see that was another thing that bothered me.You’ve got to be, well not careful but you don’t want to be anuisance to anybody, you want to make sure that you’re ok’ (Jean).In contrast, Irene was hospitalized in Benidorm when she con-tracted pneumonia: ‘I went to Benidorm yes and I went for eightweeks on my own . . . and five weeks out of the eight I was withpneumonia’. When asked whether she would take another holidaylike this, she replied: ‘Can’t, the doctor won’t let me and my eldestson he’d soon be on the phone to him’. This case proved to be theexception rather than the rule. According to Zimmer et al. (1995),as health status deteriorates, the tendency to travel decreases. Yet,within this study the contrary was found. Of those who voicedapprehensions about health and holiday taking, many had madeslight alterations to future travel patterns, with only Irene ceasingto travel at all.

Transportation

Corroborating the work of McGuire et al. (1988), certain modes oftransportation presented obstacles to participation. Three femalerespondents, all aged 69 years and over, voiced anxieties specifi-cally about the impact of air transport upon health. ‘When I fly itdoesn’t do for me. Well I think it’s the atmosphere when you getup there it bothers my chest (. . .) I’m a little bit frightened to tellyou the truth’ (Irene). Likewise, Mary stated ‘. . . I can’t do withthis changing [changing flights], not now it didn’t used to botherme when I was younger but it does now’, while Jean expressed herfear of boarding the plane: ‘I didn’t want to get on it, I said I justdon’t want to get on I was nearly in tears’. Deep vein thrombosiswas a concern for some respondents, although not sufficientlyworrying to stop any of them from flying: ‘I thought dear, you hearso much about thrombosis and various things and that did botherme but apart from that no it’s never put me off, but I’m not a happyperson when I’m flying’ (Mary). Jet lag was a further issue raised,‘the long flights, what are they seventeen hours depending whereyou go, and then it takes you like about two days to get over it’(John).

Beyond the psychological concerns voiced, two respondentsidentified tangible aspects of air travel, specifically airport termi-nals as stressful environments, the comment made by John sum-

marizing the key issues ‘. . . flying itself doesn’t bother me butwhat gets me worked up and is a lot of stress to me is going to theairport. I’m alright going but once I get in the airport and see thecrowds and your checking this in and checking that in you know itgets me all stressed out’. This corroborates the earlier claim byCox et al. (1999), who suggest pre-flight anxiety, walking longdistances within the terminal and carrying luggage to representair-terminal stress. To an extent, this issue was age linked. Theyounger respondents, mainly aged 68 years or younger, were veryblasé about such matters, being generally more open to long-haultravel and the consequential demands.

Accommodation

With the exception of only one respondent, all acknowledgedfinding appropriate accommodation deals to be an area of potentialstress. Mary, a widower, expressed anger at having to pay a single-room supplement, a common complaint among this age categoryaccording to Butler (2004). While for Irene, Sylvia and Eileen,respondents with the highest number of mobility restrictions,finding accessible accommodation was the issue. Each turned tomainstream tour operators when making travel plans. None wereable to name any specialist organizations offering support in thisarea, Holiday Care Service or RADAR (Royal Association forDisability and Rehabilitation) for instance, findings not uniqueto this study. Hunter-Jones (2004) uncovered similar problemsrelated to the availability of tourism information for peopledealing with cancer. However, further probing revealed otherreasons for this pattern. With the exception of only James, allrespondents acknowledged SAGA holidays to be a particularlysignificant holiday provider to the senior market, although nonehad used the company, often for the reason voiced by Margaret‘they are supposed to be good but one of the dearest’. As only fourrespondents had actually received brochure information detailingcostings, such a comment was primarily perception based.

Ancillary services: insurance

Travel insurance, particularly that linked to individual health,proved a controversial issue with mixed responses voiced. Ninerespondents spoke of their experiences of paying inflated age-based insurance premiums: ‘buying insurance can be a hassle(. . .) they have these magic barriers at 65 again at 70 then at 80then suddenly you cross that line you become higher risk’ (Frank),and ‘. . . as you turn 80 it’s nearly the price of another airfarethat’s the trouble’ (Mary). Comments voiced by one of the eldestrespondents with poorer health highlighted the difficulties expe-rienced in taking out any insurance at all: ‘with me being over 80you see they wanted 200 pounds for insurance I said oh goodgracious I’m not paying that (. . .) I said right I will take mybusiness elsewhere (. . .) anyhow I got it for 34 pounds’ (Irene).These comments are consistent with research by Butler (2001)and Schofield (2000), which indicates that insurance companiesnormally charge more for older travellers because they representa higher risk on holiday especially for medical claims. While thismay be true, and indeed was acknowledged by some respondents,blanket coverage of an age group may be misleading. Two respon-dents (Terence and Dot), both compromised by caring responsi-bilities, suggested the need for insurance assessments to be



individually assessed against a predetermined health question-naire to avoid unnecessary penalties.

In contrast, four respondents did not find insurance an issue,they claimed, because they took out annual insurance policies. Afurther two respondents believed their health to be so importantthat paying extra was a necessary situation: ‘you’ve got to paymore but what’s more important that’s how I look at it, I mean itis a barrier if you’ve got a small budget to think about but youknow it’s important’ (Sheila). This indicates that some people arewilling to pay more for their insurance because they believe thiswill protect their health while on holiday. Not all are in a positionto though. Furthermore, paying for more expensive policies doesnot automatically mean that all circumstances will be covered, asthe experience of Paula demonstrates: ‘we had a bit of a shock acouple of years back (. . .) my husband is a diabetic but not badly,I mean it doesn’t affect him normally at home (. . .) we were inSpain walking, the Picos area, and he tripped and needed somehospital treatment (. . .) we always took out fully comprehensiveinsurance cover what with the type of holidays we take [walking/activity]. Anyway when it came to claiming back some medicalexpenses we were told the policy was void because we hadn’tdeclared the diabetes (. . .) it was a real shock, I mean it [diabetes]had never been an issue so it just didn’t cross our minds’. Withsuch a health insurance lottery in place, it is hardly surprising thatgrowing numbers of travellers are failing to take out any policiesat all, an action which directly contradicts the advice of organiza-tions including the British Travel Health Association (seeMcIntosh, 2005).

The caring role

Six respondents identified caring responsibilities as impactingupon patterns of tourism consumption. In two instances, Terenceand Dot, travel had ceased altogether. This pattern is consistentwith the findings of Gladwell and Bedini (2004), who, investigat-ing the leisure patterns of caregivers, noted that 30% of familycaregivers abandoned holidays altogether as a consequence ofthese responsibilities. For the remaining four respondents, Mark,Paul, Paula and Ian, participation continued but required‘. . . meticulous planning if it [the holiday] is going to stand anychance of working out’ (Ian). Consistent with the general caringtrends in the UK [nine out of 10 carers care for relatives (DoH,1999)], all six respondents cared for family members, partnerswith compromised health status. Conditions prompting such aneed included physical disabilities (Terence, Mark and Ian), mul-tiple sclerosis (Paul) and heart-related conditions (Dot and Paula).All identified themselves as informal carers, informal meaningthat they cared for less than 35 hours a week and were unpaid. USestimates place 54 million people as informal carers (NationalFamily Caregivers Association, 2000), and UK estimates placesome 6 million people, or one-tenth of the UK population, in thiscategory (DoH, 1999).

Impediments to travel, found to be hierarchical, included physi-cal, social and emotional obstacles. Paul spoke of the physicalbarriers to international travel, in particular he faced when tryingto accommodate the needs of a wife with multiple sclerosis‘. . . even travelling what I would consider locally, you knowFrance or Spain, you need to do lots of work to find out if airportscan cope with wheelchairs and even which airlines will carry

disabled people. You presume everyone does, but believe me theydon’t’. Comments voiced by Terence typify the social and emo-tional obstacles carers face: ‘. . . even if I can get someone to lookafter Betty [wife] for a week I would end up paying all sorts ofadd-ons to travel on my own (. . .) it’s not much fun either youhaven’t got anyone to share the break with or talk to about itafterwards so why bother with all the hassle at all?’ Significantly,even where the physical and social support was in place, theemotional baggage attached to taking a break all too often pre-vented carers from capitalizing upon opportunities. Such isentirely consistent with the findings of both Gladwell and Bedini(2004, p. 692), ‘even if the caregiver actually travelled without thecare-recipient, the emotional worry and concern for consequencesupon return from their trip clearly negated the “leisure” in leisuretravel’, and Weightman (1999, p. 11), ‘even the prospect of a shortbreak can be a cause for anxiety’. Additionally, one furtherobstacle, mentioned on three occasions (Dot, Paul and Ian), wasthe simple lack of time to take holidays, as each respondent hadbeen forced to utilize holiday entitlements within their caringcapacity. Given that Gladwell and Bedini (2004) also mentionedthis as a barrier, claiming that 77% of their sample fell into thiscategory, this matter may well be more widespread than hasperhaps been appreciated to date.

ConclusionsThis exploratory study has reviewed patterns of senior tourismconsumption specifically from a self-assessed health perspective.It has intentionally neglected many equally significant factorswhich might influence patterns of consumption, income, workpatterns, dependents and pension entitlements for instance. It hasalso focused upon holiday taking and specifically neglected thewider leisure picture. Assessment of the findings must be consid-ered within this context.

Similar to earlier related research, the findings suggest thatholiday taking offered significant benefits to respondents in termsof personal health (psychological and physical) and social effec-tiveness. Perceived and actual health benefits, identified on anumber of occasions, ranged from subjective feelings of relaxationand well-being to more quantifiable improvements noticed inchronic conditions, asthma and arthritis for instance. Contribu-tions to social effectiveness were noted through the interactionexperienced with others both within the holiday environment, andoutside reminiscing over the previous tourism experience. Giventhis contribution, overcoming the barriers to participation identi-fied takes on a greater significance.

Barriers identified included concerns about injections, humid-ity, airport stress, jet lag, deep vein thrombosis, being subjected toan insurance lottery, alongside risks different types of destinationpose, less developed countries of particular concern. The identifi-cation of these obstacles presents the tourism industry with aclearer agenda for change. The key to encouraging participationlies in communicating with would-be consumers over the extentthat such perceived issues may pose an actual problem, alongsidealerting them to the range of information sources which mayempower them to overcome lotteries such as healthcare insurance.The challenge for the industry is to find avenues of communica-tion, and for the consumer, to enter into an extended dialogue.Collaborating further with the wider senior support network, the



medical community, practice nurses or travel clinics for instance,may provide one avenue which to date has been under-utilized.

In concert with earlier research, this study also reaffirms thatsenior tourists are anything but a homogenous consumer group.Instead, at least three broad types of senior traveller from a healthperspective alone have been uncovered, with further subsegmentsidentifiable even within these broad types.• The health optimist: those in actual good health and those whoconsidered themselves healthy. Characterized by an energy andenthusiasm to pursue travel careers, including both domestic andinternational travel.• The travel recipient: those with pre-existing health complica-tions and those who considered themselves to be in poor health.Reticent to make travel plans with the decision-making processdirectly influenced by health status.• The carer: those with compromised patterns of consumption,compromised through a need to care, usually informally, for others(family members and friends). Likely to take fewer holidays, oftenwithin domestic environments as a result of circumstances ratherthan through choice.Of the three types, it is the carer who raises the most questions.This study has tended to treat informal carers as a homogenousgroup, all caring for family members with health-related condi-tions. Yet various approaches to categorizing carers exist whichcan provide for a greater insight into the needs of different groups.Aberg et al. (2004), for instance, categorize the different carergroups by carer task performed, be it socio-emotional caregiving(e.g. maintaining contact, face to face or by telephone); proxycaregiving (e.g. arranging medical check-ups on behalf of therecipient); or instrumental caregiving (e.g. assistance with house-hold tasks, including washing, shopping). Bowers (1987) catego-rizes by the lesser understood area of meaning. A more commonapproach is to group by the different types of care offered: short-term, long-term and transitional care.

Today, modelled by demographic, economic and social trends,the nature of caregiving is changing. Significantly the shift frominstitutionalized care delivered in formal spaces, for example hos-pitals and nursing homes, towards care provided in informal set-tings, such as the home, has expanded the population of carers,often through choice although sometimes through force, to rela-tives and friends. Research exploring the implications of this hasnot been comprehensive. Furthermore, the caring dimension isfrequently neglected within senior consumer behaviour research.Consequently, investigating issues such as the meaning and impli-cations of forced family caregiving, the rising incidence and impli-cations of chronic health conditions, and the relationship betweeninformal care and work may ultimately help provide a greaterinsight into patterns of senior tourism consumption than studies todate have been able to achieve.

ReferencesAberg, A.C., Sidenvall, B., Hepworth, M., O’Reilly, K. & Lithell, H.

(2004) Continuity of the self in later life: perceptions of informalcaregivers. Qualitative Health Research, 14, 792–815.

Age Concern (2004) Older People in the United Kingdom, Some BasicFacts. [WWW document]. URL http://www.ageconcern.org.uk/AgeConcern/media/factcard2004.pdf (accessed on February 5, 2005).

Anderson, B. & Langmeyer, L. (1982) The under 50 and over 50 travel-lers: a profile of similarities and differences. Journal of TravelResearch, 20, 20–24.

Bowers, B. (1987) Intergenerational caregiving: adult caregivers andtheir aging parents. Advances in Nursing Science, 9, 20–31.

Butler, S. (2001) Before you go. Sunday Telegraph, February 11th:Travel 12.

Butler, S. (2004) Glad to be grey. Sunday Telegraph, October 24:Travel.

Capella, L.M. & Greco, A.J. (1986) Information sources of elderly forvacation decisions. Annals of Tourism Research, 14, 148–151.

Cox, I.D., Blight, A. & Lyons, J.P. (1999) Air-terminal stress and theolder traveller. Age and Ageing, 28, 236–237.

Department of Health (1999) Caring about Carers. A National Strategyfor Carers. DoH, London.

English Tourism Council (2002) Health Benefits Fact File. ETC,London.

Fleischer, A. & Pizam, A. (2002) Tourism constraints among Israeliseniors. Annals of Tourism Research, 29, 106–123.

Gladwell, N.J. & Bedini, L.A. (2004) In search of lost leisure: theimpact of caregiving on leisure travel. Tourism Management, 25, 685–693.

Horner, S. & Swarbrooke, J. (1998) The Health Tourism Market,Insights, The Tourism Marketing Intelligence Services 1997/98. ETB/BTA, London.

Huang, L. & Tsai, H.T. (2003) The study of senior traveller behaviour inTaiwan. Tourism Management, 24, 561–574.

Hunter-Jones, P. (2003) The perceived effects of holiday-taking uponthe health and wellbeing of patients treated for cancer. InternationalJournal of Tourism Research, 5, 183–196.

Hunter-Jones, P. (2004) Young people, holiday-taking and cancer – anexploratory analysis. Tourism Management, 25, 249–258.

Kabak, J. (2004) Holiday Cheer Is a Challenge for the ChronicallyIll: Tips for Coping. [WWW document]. URL http://www.immunesupport.com (accessed on February 5, 2005).

Lohmann, M. & Danielsson, J. (2001) Predicting travel patterns ofsenior citizens. How the past may hold the key to the future. Journalof Vacation Marketing, 7, 357–366.

Long, J. & Wimbush, E. (1985) Continuity and Change: Leisure AroundRetirement. Economic and Social Research Council/Sports Council,London.

McGuire, F.A. Uysal, M. & McDonald, C. (1988) Attracting the oldertraveller. Tourism Management, 9, 161–164.

McIntosh, I. (2005) Ensure travellers insure for emergency health care.Travel Wise. The Newsletter of the British Travel Health Association,Spring, 6.

Mansfield, Y. (1992) From motivation to actual travel. Annals ofTourism Research, 19, 399–419.

Mintel (2000) Third Age: A Time to Travel – June 2000, [WWW docu-ment]. URL http://reports.mintel.com/ (accessed on February 5, 2005).

National Family Caregivers Association (2000) Caregiver Survey 2000.National Family Caregivers Association, Kensington, MD.

National Statistics (2004) Focus on: Older People. [WWW document].URL http://www.statistics.gov.uk (accessed on February 5, 2005).

Reece, W. (2004) Are senior travellers different? Journal of TravelResearch, 43, 11–19.

Roberts, K. (2004) The Leisure Industries. Palgrave Macmillan,Basingtoke.

Romsa, G. & Blenman. M. (1989) Visitor patterns of elderly Germans.Annals of Tourism Research, 16, 178–188.

Saunders, M., Lewis, P. & Thornhill, A. (2003) Research Methods forBusiness Students. Pearson Education Limited, Harlow.

Schofield, I. (2000) Promoting travel health for older people. NursingStandard, 14, 50–55.



http://www.ageconcern.org.uk

http://www

http://reports.mintel.com

http://www.statistics.gov.uk

Shoemaker, S. (1989) Segmentation of the senior pleasure travel market.Journal of Travel Research, 27, 14–21.

Smith, C. & Jenner, P. (1997) The seniors’ travel market. Travel andTourism Analyst, 5, 43–62.

Smith, R. (1987) Leisure of disabled tourists: barriers to participation.Annals of Tourism Research, 14, 376–389.

Tokarski, W. (1991) Research note: leisure lifestyle careers in old age.Leisure Studies, 10, 79–81.

Weightman, G. (1999) A Real Break. A Guidebook for Good Practice inthe Provision of Short-Term Breaks as a Support for Care in the Com-munity. HMSO, London.

Wilks, J. (2003) Safety and security for destinations: WTO case studies.In Managing Tourist Health and Safety in the New Millennium (ed. byJ. Wilks & S.J. Page), pp. 127–139. Elseveir, Oxford.

World Health Organization (1948) Constitution. WHO, Geneva.World Health Organization (2003) International Travel and Health.

WHO, Geneva.Zimmer, Z., Brayley, R.E. & Searle, M.S. (1995) Whether to go and

where to go: identification of important influences on senior’s deci-sion to travel. Journal of Travel Research, 33, 3–10.



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