Transcript UCLA School of Nursing Public Health Training Workshop Disasters

Travel health for special groups:
Older travelers
Peter A. Leggat, MD, PhD, DrPH, FAFPHM, FACTM, FFTM
Associate Professor
School of Public Health and Tropical Medicine
James Cook University
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.
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
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)
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.
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
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
Some common problems
• Motion sickness
• Jet lag
• Heatstroke and
• Malaria
• Vaccine
•
•
•
•
hypothermia
Thromboembolic
disease
Injuries and
accidents
Travelers’ diarrhea
preventable
disease
Issues associated
with disability,
including exercise
tolerance, visual or
hearing
impairment
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
Motion sickness
• Nonpharmacological
– e.g. distant horizon, close eyes
• Pharmacological
– e.g. diphenydramine, hyoscine (c.i.
glaucoma and prostatic hypertrophy)
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
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
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
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
Travelers’ diarrhea
• Traveler’s 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.
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
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
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
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
Want more information?
• Older travellers
– McIntosh IB. Health
hazards and the elderly
traveler. J Travel Med
1998; 5: 27-29
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)
Specific WWW sites
Internet Guide to Travel Health by Connor,
2004 (Harworth Press)
• Older travelers
– Elderly travelers
(http://www.fitfortravel.scot.nhs.uk/gener
al/elderly.html)
– FirstGov for seniors-travel and leisure
(http://www.firstgov.gov/topics/seniors.s
html)
– Infirm travelers (http://www.faa.gov/acr)
(Karl Newman)
General WWW resources
• www.who.int/ith
• www.cdc.gov/travel
• www.istm.org
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), autoimmune 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.