Peter A' Leggat, MD, PhD, DrPH, FAFPHM, FACTM, FFTM

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Travel health for special groupsOlder travelers

• Peter A. Leggat, MD, PhD, DrPH, FAFPHM, FACTM,
  FFTM
• Associate Professor
• School of Public Health and Tropical Medicine
• James Cook University

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About the author

• Dr Peter Leggat has co-ordinated the Australian
  postgraduate course in travel medicine since
  1993. He has also been on the faculty of the
  South African travel medicine course, conducted
  since 2000, and the Worldwise New Zealand Travel
  Health update programs since 1998. Dr Leggat has
  assisted in the development of travel medicine
  programs in several countries and also the
  Certificate of Knowledge examination for the
  International Society of Travel Medicine.

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Objectives of the session

• To review the general approach to travel health
  advice
• To familiarize ourselves with some of the
  potential health concerns relevant to older
  travelers

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• Travel, in the younger sort,
  is a part of education
  in the elder, a part of
  experience
• Francis Bacon 1612

As quoted from The White House, Travel section.
Available at http//www.whitehouse.gov/government
/handbook/travel.html (accessed 19 March 2005)
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Introduction

• Average life expectancy is increasing in most
  developed countries.
• Retired older persons often want to travel.
• Up to 10 of travelers in tropical areas are
  older persons.
• In addition to other organs, the immune system
  function also becomes impaired.

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General Approach (after Ericsson, 2003)

• Risk assessment, determining the risks of the
  destination, mode of travel and the special
  conditions of the traveler
• Vaccinate when possible and indicated
• Provide the traveler with appropriate empirical
  self-treatment
• Consider chemoprophylaxis

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General Approach
(after Ericsson, 2003)

• Consider any concerns regarding underlying
  conditions and possible drug interactions
• Consult experts in travel medicine or specialty
  areas as necessary
• Educate the traveler
• Remind the traveler that these precautions are
  not 100 protective

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Some common problems

• Malaria
• Vaccine preventable disease
• Issues associated with disability, including
  exercise tolerance, visual or hearing impairment

• Motion sickness
• Jet lag
• Heatstroke and hypothermia
• Thromboembolic disease
• Injuries and accidents
• Travelers diarrhea

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Motion sickness

• Common in any traveling group
• Cruise ship travel popular with older travelers
• www.cdc.gov/travel has link to cruise ship
  sanitation inspections

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Motion sickness

• Nonpharmacological
• e.g. distant horizon, close eyes
• Pharmacological
• e.g. diphenydramine, hyoscine (c.i. glaucoma and
  prostatic hypertrophy)

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Jet lag

• Older travelers may be more susceptible
• Nonpharmacological
• well-rested, adaption of activities to
  destination time
• Pharmacological
• e.g. benzodiazepines, melatonin may offer help
  for some travelers

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Heatstroke and hypothermia

• Older travelers may be more susceptible to
  effects of extreme temperatures
• Consider
• Gradual acclimatization
• Adequate hydration
• Appropriate clothing
• Caution with pharmaceutical agents, which may
  impair thermoregulation, e.g. beta blockers,
  antihistamines, diuretics, and anticholinergic
  agents

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Thromboembolic disease

• Increased risk of venous thromboembolism in those
  with known venous disorders and cardiac disease
• Dehydration and prolonged immobility may be
  problematic in these individuals
• Non-pharmaceutical
• e.g. in-flight exercise, compression stockings
• Pharmaceutical for high risk travelers
• e.g. subcutaneous heparin

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Injuries and accidents

• Motor vehicle accidents are a major cause of
  morbidity and mortality in various age group
• Older travelers may be at increased risk due to
  slower reaction times, visual/auditory
  impairments, adverse effects of medications etc

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Travelers diarrhea

• Travelers diarrhea is sometimes more severe with
  older persons, increasing the risk of dehydration
  through loss of fluid and electrolytes.
• Prompt therapy is necessary.
• It is important to consider possible drug
  interactions as older persons often use multiple
  medications for chronic illnesses.

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Malaria

• Incidence of severe illness and death increases
  with age
• Nonpharmaceutical
• e.g. DEET
• Pharmaceutical
• e.g. chemoprophylaxis usually well tolerated
• Caution with some drugs, e.g. mefloquine in
  cardiac and neuropsychiatric conditions

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Vaccine preventable diseases

• Routine immunizations should be checked/boostered
• 65 and over pneumococcal vaccine and annual
  influenza immunization
• Age alone not really contraindication to
  vaccination
• Seroconversion rates may decrease with age

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Vaccine preventable diseases

• Hepatitis A screening may be cost effective in
  older travelers due to higher seropositive rates
• Remember hepatitis A is generally a more severe
  disease in older travelers
• Live vaccines (oral typhoid, oral polio,
  varicella, yellow fever) need to be used with
  caution in immunocompromised travelers

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Illness and Disability

• Increasing incidence of medical problems with age
• Physically demanding trips needs to be balanced
  with exercise tolerance
• Control of pre-existing disease important, as
  important cause of morbidity and mortality abroad
• Travel insurers may require medical risk
  assessment with older travelers and those with
  preexisting disease

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Want more information?

• Older travellers
• McIntosh IB. Health hazards and the elderly
  traveler. J Travel Med 1998 5 27-29

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Textbooks

• Many textbooks have useful chapters dealing with
  issues related to older travelers
• Manual of Travel Medicine and Health (Steffen et
  al., 2003)
• Principles and Practice of Travel Medicine
  (Zuckerman, 2001)
• Primer of Travel Medicine (Leggat et al., 2002)

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Specific WWW sites Internet Guide to
Travel Health by Connor, 2004 (Harworth Press)

• Older travelers
• Elderly travelers (http//www.fitfortravel.scot.nh
  s.uk/general/elderly.html)
• FirstGov for seniors-travel and leisure
  (http//www.firstgov.gov/topics/seniors.shtml)
• Infirm travelers (http//www.faa.gov/acr) (Karl
  Newman)

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General WWW resources

• www.who.int/ith
• www.cdc.gov/travel
• www.istm.org

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Last word

• Fortunately, most older persons that are
  traveling are in good health.
• None-the-less, aging is accompanied by a global
  immune deficit, which increases the incidence of
  cancers (55 of cancers occur after 65 years),
  auto-immune diseases, and infectious morbidity
  and mortality.
• It is important that older travelers must be
  encouraged to present for a pre-travel health
  consultation and obtain appropriate travel
  insurance.