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General Principles in Older Adults

  1. Older adults, because of their diminished physiologic reserve, are more vulnerable to most of the hazards facing any traveler.

  2. Because exacerbation of chronic illness is a major risk for any traveler, focusing on “disease management and education” in advance of travel is particularly important for older travelers.

  3. Any form of travel increases the risk of venous thromboembolism, which can be more serious in older adults.

  4. A prior knowledge of resources available to health professionals called to help in a medical emergency during air travel may be lifesaving.

Overview of Travel Problems

“Wandering reestablishes the original harmony which once existed between man and the universe.”

Anatole France

Travel is enjoyed by many and tolerated by some, but is simply a part of modern life. Everyone who travels, however, is subject to certain “risks” inherent in travel. Among them are exposures to unfamiliar climates, foods, illnesses, language and customs, hazards caused by “relaxed” public safety standards, lack of handicap access, crime in unfamiliar settings and risks specific to a particular mode of travel. Problems for elders also increase when stressed by dehydration, temperature extremes, acute illness or exacerbation of chronic illnesses and increased falls risk as a result of such factors as lack of handrails, uneven surfaces or even an unfamiliar hotel room in the middle of the night. Older adults are also affected more by jet lag and this condition, when coupled with confusion in a person with even mild cognitive impairment in an unfamiliar setting can be a formula for adverse events. Anyone who has ever been confused in a busy airport while worrying about how to get to the correct airport gate in time for their flight will realize that any underlying confusion will likely make travel even more stressful. Thus, almost all of the factors that contribute to travel risk are amplified in elder travelers.

Robust data about the demographics of the medical problems of travel are lacking. There are some surveillance systems in place, such as the GeoSentinal Surveillance Network, which aggregates data about infectious diseases worldwide from a network of travel and tropical-medicine clinics on 6 continents. This network may be useful in assessing the likely causes of febrile illness in a returning traveler or understanding infectious disease travel risks based on the location of travel. There are, however, really no comparable entities collecting data about other problems related to travel. Nations usually do not keep information about victims of crime or accidents in formats that allow aggregation of those data and there are many problems assembling international statistics. Many travel-related health problems are never reported and institutions such as hotels and airlines are not in the business of collecting this kind of information. What data we do have indicate that common infections (upper respiratory infections and gastroenteritis) are common and motor vehicle accidents are the most likely traumatic event followed ...

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