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Travellers with pre-existing medical conditions and special needs http://whqlibdoc.who.int/publications/2005/9241580364_chap1.pdf
OVER 65
& CHRONIC ILLNESS
Advancing age is not a contraindication to travel. However
you should take the following precautions.
General
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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.)
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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)
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Travellers with a chronic Illness should obtain information
on the medical facilities available in the country to be visited.
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Check whether your travel insurance covers evacuation.
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Having a "will" filled out can save your next of
kin a lot of problems with the public trustee.
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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)
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Hot climates can exacerbate diseases of the cardiovascular
system and digestive systems.
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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.
-
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 serious consequences from infections with older
travellers & those with Chronic illness, Flu
and Pneumococcal vaccination and/or antibiotics should be considered particularly in
people 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
Diabetes & travel fact sheet - http://www.acrn.com.au/factsheets/Travel.pdf
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People who have had a Gastrectomy are more at
risk to even a moderate illness such as gastro-enteritis or a febrile respiratory illness.
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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 treatment 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
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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.
Source: WHO - http://whqlibdoc.who.int/publications/2005/9241580364_chap1.pdf (page
8)
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