All travellers abroad, especially the elderly, should prepare to manage any health problems- should they arise - alone. Aged travellers must assume an inability to communicate with their own doctor, an inability of the attending doctor to speak English or, even with the best intention, achieve familiarity with the medical history or of the medications carried by the traveller. Sometimes, there is no doctor at all.
Unfortunately, in some cases, there is no travelling companion familiar with the health of our aged traveller.
With these thoughts in mind, the following are suggestions for a safe and healthy trip.
1. ROUTINE MEASURES a. Pre-trip physical conditioning:
Most travellers will exert themselves more than usual on their holiday. They should therefore, 3-4 weeks prior to departure, embark on a routine of walking, with some strengthening and flexibility exercises in preparation for their trip. b. Pre-trip medical exam / documents:
All aged travellers, especially those over 75 and those taking medications, should arrange a full health assessment by their own GP. (This takes time and the traveller should arrange for a prolonged consultation.)
Always collect, and carry with you, a copy of your past medical history and current treatment from your doctor. This, together with other relevant history such as allergies to medications - should be taken with you on your trip. c. Medical attention in a foreign land
Aged travellers may need to consult a doctor or visit a hospital in a foreign land. Hospitals in many countries are listed at Hospitals Worldwide. Lists of recommended hospitals are obtainable through the web site of the International Society of Travel Medicine.
Always take enough medicines to cover the duration of your trip. Leave medications in original packaging. Do not carry loose tablets. Your list of medications should include the generic names of medications, as brand names differ from country to country.
If you need to take restricted drugs and syringes, a certifying letter from your doctor is essential.
Before leaving home, you should check that your medications are legal in the country you are visiting. You can do this by contacting the embassy or high commission of the country you are visiting.
Remember the first rule of travel: if you can't afford travel insurance, you can 't afford to travel.
Australia has health care agreements with other countries including Finland, Italy, Ireland, Malta, the Netherlands, New Zealand, Norway, Sweden and the United Kingdom. Australians can be provided with urgent or emergency medical treatment in these countries. To receive medical services under the agreements, you need to advise local medical staff you wish to be treated under the Reciprocal Health Care Agreement with Australia.
Medicare does not cover the cost of health care incurred while in transit to or from these countries. Nor does it cover cancellation of trip, loss or theft of items or the cost of medical evacuation or repatriation of a body.
In these cases, and for all costs related to health care in other countries, it is essential to purchase travel insurance from a reputable insurer.
Additionally, ready access to cash or credit is essential to facilitate emergency services.
4. MEDICAL TRAVEL KITS
Since heart attack and stroke pose the greatest risk to travelling elders, aspirin should be used and carried. Medications directed at gastrointestinal illness, mild to moderate pain, motion sickness, fever, infection, and skin problems are best included. Diarrhoea should be dealt with aggressively since elderly individuals are often on vital medications, which must be effectively absorbed from the bowel.
Medications, such as scopolamine, may be prescribed or bought over the counter for the management of motion sickness but should be used with care in the elderly, as they may cause severe constipation, urinary retention, and/or mental confusion.
Finally, anti-malarial preventive and treatment medications are indicated for certain destinations.
Vaccine recommendations for those over 65 years are the same as those for younger travellers, except that influenza and pneumococcal pneumonia vaccines are recommended to all older Australians, travelling or not.
Older people may have let their routine vaccinations, such as diphtheria and tetanus, fall away. The pre-travel check should include a reappraisal of these vaccines, as well as those indicated for the trip.
6. SPECIAL CONSIDERATIONS a. Vision
Falls must be avoided at all costs and an eye examination before leaving is worthwhile. Consider taking spare glasses with you, preferably not bifocal if you will be walking a lot. A copy of your prescription should be carried. Do not clean glasses in water treated with iodine.
Travellers with low vision and needing a guide dog must make special arrangements with the airline and agencies in the country of destination. b. Hearing
Hearing is essential in unfamiliar environments, especially in noisy cities or airport transit areas. Existing deafness may be exacerbated by barotrauma, by the changes in pressure experienced while flying, by concurrent ear infections or allergies.
People with middle ear infections or eustachian tube malfunction are advised to defer travel until fully recovered. Check with your GP if this may be a problem.
Earplanes are available and help with pressure changes. Dont forget to take extra batteries for your hearing aides. c. Eating and diets
Dentures sometimes cause difficulties in foreign countries. Make sure they are well fitted and not newly acquired on the day of departure. Always carry extra denture adhesive, if this is used.
Special diets are often essential for travellers. For instance, diabetics, sufferers from food allergy, vegetarians or those with religious objections to certain foods should notify airlines 12 days before departure. Others with heart disease, high blood pressure, kidney disease, etc. may also require special diets. d. Foot care
The feet of the aged traveller may be affected by chronic illness such as diabetes, poor circulation, peripheral neuritis or conditions affecting the feet. Minor lacerations or injuries will become a serious problem in the aged traveller.
Never walk in the open in bare feet. Elderly travellers are advised to wear comfortable shoes, not a new untried pair, while travelling. Excessive walking may produce blisters, strains or stress fractures. Moderation is in order.
Excessive sweating may lead to fungal infections and anti-fungal powders may be useful. Diabetics should inspect their feet every day. e. Deep vein thrombosis
Calf exercise and frequent walking about the cabin of the aircraft helps reduce the risk of deep vein thrombosis (DVT). Drugs such as diuretics, alcohol and caffeine are best avoided while flying. If you have an increased risk of thrombosis, supportive stockings (eg JetSox) and anti-clotting agents should be considered and discussed with your doctor.
The ability to adapt to heat and cold is diminished with ageing. The presence of disease such as diabetes, heart failure or obesity, exacerbates this problem. A number of medications, such as beta-blockers, calcium-channel blockers, antidepressants, antihistamines, and anti-Parkinsonian drugs, interfere with body temperature responses.
In a hot climate, the traveller is advised to take frequent rests, drink more non-alcoholic fluids, wear loose clothing, access air-conditioned rooms and take cool baths / showers.
Adaptation to altitudes above 3000 metres is often a problem for the intrepid traveller and the elderly are more at risk. Health problems, such as anaemia, heart disease and lung disease, may cause serious problems at high altitudes. Certain drugs, such as betablockers, may slow the adaptation of heart rate to the lower oxygen levels and result in severe incapacity. Elderly people contemplating trekking in Nepal or Peru should seek appropriate assessment. The key to avoiding symptoms is gradual and slow ascent to allow the body time to acclimatise.
8. AIRLINE and CRUISE SHIP TRAVEL
Portable Oxygen -- Airlines may or may not accommodate a medical condition requiring supplemental oxygen in transit. Implementing this is laborious, often taking 3-4 weeks to arrange.
The airline will probably require independently arranged oxygen in place up to the time of boarding and at the disembarkation point.
9. POST-TRAVEL EXAMINATION
If an elderly person has been overseas for over 3 months, it is prudent to consider a brief check-up with their personal physician upon return home.
If there had been fever, diarrhoea, or other unexplained persistent or protracted medical problems associated with traveling, medical evaluation is advisable.