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Over 65 - 2 page pdf

see also Travellers with pre-existing medical conditions and special needs  http://whqlibdoc.who.int/publications/2005/9241580364_chap1.pdf

Information mostly taken from: "International Travel and Health" (WHO year book)
Australian Immunisation Handbook, 9th Edition - 4/2008 - Part 2 & Part 3 (large pdf files)
Centre for Disease Control, USA -  www.cdc.gov/travel Travel Health Seminar Oct 96, June 97,Feb 98, March 99, May 2000, August 2002 & March 2005 - Victorian Medical Postgraduate Foundation.
Manual of Travel Medicine, Melbourne, 3rd edition 2011.  Additional references & disclaimer.

OVER  65 & or CHRONIC ILLNESS 

Advancing age is not a contraindication to travel. However you should take the following precautions.

General

  • Carry a letter from your doctor (or write your own) to summarise past illnesses, current medications and allergies. (copy of a recent cardiograph should also be carried by persons with heart problems.)
  • Contra indications to air travel include cardiac failure, recent heart attack or stroke, angina (chest pain) at rest, certain heart rhythm disorders (paroxysmal tachycardia, left ventricular heart block, atrial fibrillation), uncontrolled systolic hypertension of more than 200mm Hg, severe anaemia, sickle cell anaemia, acute mental disorder, decompression sickness, recent surgery where trapped air or gas may be present, severe chronic respiratory disease and any serious and acute contagious disease. (W.H.O. year book 2002 page22)

  • Travellers with a chronic Illness should obtain information on the medical facilities available in the country to be visited.

  • Check whether your travel insurance covers evacuation.

  • Having a "will" filled out can save your next of kin a lot of problems with the public trustee.

  • Be aware that long air travel hauls predisposes to swollen legs and deep vein thrombosis (exercise legs during flight + aspirin -- self administered heparin injections if previous DVT)

  • Hot climates can exacerbate diseases of the cardiovascular system and digestive systems.

  • Respiratory infections are among the commonest infections acquired by travellers. Prevalence of different respiratory infections varies in different places. The influenza season in the tropics is all year round. Diarrhoel infections are more common in the elderley and or those on ulcer/hearburn medication
  • Legionella infection is well known in Spain and the Mediterranean. Although primarily a respiratory infection it may present as a bout of diarrhoea with fever. Shower heads and airconditioners have been incriminated as the source of outbreaks. Running the shower for a few minutes to flush out the stagnant water in the shower head before entering the shower has been recommended by some authorities. (ventilate area & wait in another room.)

Altitude
Travelling and staying at high altitudes may initially give rise to insomnia and may be distressing and even dangerous for people with cardiac or pulmonary conditions. In these situations sleeping tablets should be avoided as they depress respiration and aggravate hypoxia (low oxygen in bloodstream)

Antibiotics & Vaccinations.
As there is an increased risk of life threatening consequences from tropical infections (especially Hepatitis A, typhoid, yellow fever and malaria) with older travellers & those with Chronic illness, adequate vaccination is mandatory. Flu and Pneumococcal vaccination should also be routinely given and/or antibiotics prevention should be considered. The use of oral cholera vaccine (Dukoral) can reduce the incidence of common travellers diarrhoea and should be considered. High risk people include those with:

  • impaired immune system (eg. leukaemia, lymphoma, AIDS, on chemotherapy or cortisone), a chronic debilitating illness such as Crohns disease, Ulcerative colitis, insulin dependant diabetes, chronic kidney disease or heart disease
    see also Diabetes & travel information
  • People who have had a Gastrectomy are more at risk to even a moderate illness such as gastro-enteritis or a febrile respiratory illness
  • Splenectomised travellers should consider vaccination with Fluvax, Pneumovax,  MMR, Mencervax and even Hib. Two new vaccines available soon in Australia, Chicken Pox and Cholera (WC/rBS) vaccines should also be considered. A "Standby" antibiotic such as 3Gms of Amoxycillin for an acute febrile illness is advised given the high risk of rapid overwhelming bacterial infection. Malaria is particularly dangerous in persons without a functioning spleen and the rapid diagnostic kit for falciparum malaria and appropriate stanby treatment (eg malarone) is advised if at risk.
    see also:

  • Certain ulcer healing drugs such as ranitidine, pepcidine, tagamet or losec increase your risk of contracting gastro-enteritis because they reduce the protective acid in the stomach. Consider typhoid & cholera vaccination
  • Preventative Antibiotics can be taken to prevent illness in certain circumstances particularly if vaccinations such as the live oral typhoid vaccine is contraindicated.
  • Hepatitis A is a common and particularly dangerous illness in the over 65 age group traveller with a death rate of approx 20%. An effective vaccine is available.
  • Yellow Fever vaccination: Serious but rare reactions to this vaccine occur and are more common after age of sixty. Vaccination should be restricted to those truly at risk. www.cdc.gov/travel/diseases/yellowfever.htm

  • Boostrix: vaccination against diphtheria, tetanus and pertussis.

Air Travel
Most commercial jetliners are pressurised to about 1600 to 2300 m. Above 1600 m there is a risk of hypoxia (low oxygen), especially if the traveller is anaemic. Carbonated drinks are best avoided as they may cause gaseous distension which can be uncomfortable.

A particular problem of long haul air travel is deep vein thrombosis (blood clot in the legs). Sitting in a cramped position for a long period favours the development of thrombosis. Take an aisle seat and stand up and walk about the cabin regularly. Tense up your legs and wriggle your toes from time to time. 

Dehydration also predisposes to thrombosis, and the low humidity in aircraft aggravates dehydration. DRINK plenty of fluid not containing alcohol (or caffeine). Taking half an aspirin daily (provided their is no contra-indication) will help to reduce the risk of thrombosis (blood clot) occurring in the legs. Those who have a past history of deep vein thrombosis should use injectable low molecular heparin.
(also Air travel and Cruise ships - www.cdc.gov/travel/cruiships.htm )

Medical examination after travel
A medical examination is unnecessary after a short trip with no problems, or if you have only suffered a trivial ailment (traveller's diarrhoea, cold).
People with chronic diseases should nevertheless consult their doctor for a check-up.
Some diseases do not develop immediately but may appear some time later. The commonest of these are malaria, amoebic dysentery, viral hepatitis, typhoid and paratyphoid fevers, sexually transmitted diseases, intestinal parasitoses (e.g., giardiasis), schistosomiasis (bilharziasis), filariasis, leishmaniasis, trachoma, trypanosomiasis, and typhus.
You probably have not heard of some of these diseases but they can have serious consequences. Tuberculosis should be considered if you have a persisting respiratory illness after a course of antibiotics. ( www.cdc.gov/travel/diseases.htm#TB )

It is advisable (if not essential) to visit your local doctor promptly if you:

  • suffer from a chronic disease, such as cardiovascular disease, diabetes mellitus, chronic respiratory disease;
  • experience illness in the weeks following their return home, particularly if fever, persistent diarrhoea, vomiting, jaundice, urinary disorders, skin disease or genital infection occurs;
  • consider that you may have been exposed to a serious infectious disease while travelling;
  • have spent more than 3 months in a developing country.

Last edit: 1-aug-12

 

 

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