Travel in Advanced Age Vers1
-
Upload
prof-hakan-yaman -
Category
Documents
-
view
221 -
download
0
Transcript of Travel in Advanced Age Vers1
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 1/20
STILL A BARRIER?STILL A BARRIER?
Hakan YAMAN, MD, MS Assoc.Prof. of Family Medicine
Akdeniz University, Faculty of Medicine,Department of Family Medicine,
Antalya, Turkey
TRAVELLING IN ADVANCED AGESTRAVELLING IN ADVANCED AGES
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 2/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
2
Monthly incidence rates of health problemsMonthly incidence rates of health problems
during stays in developing countriesduring stays in developing countries
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 3/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
3
Causes of death
Southern Europe, Florida and Caribbean elevatedmortality rates due to a variety of natural causes
Developing destinations risk of fatal accidents ishigher
Assaults or terrorism are infrequent causes of death at present New illness, or complications of a pre-existing
illness. (cardiovascular conditions) Evidence: Pulmonary embolism in long distance
air travel (five per million travelers)
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 4/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
4
STILL A BARRIER?STILL A BARRIER?
The elderly- 500 million travelers
Age alone is not a contraindication
Increased risk of illness, injury, or death (even w/o pre-existingmedical problems)
Difficulty in acclimatizing Longer to adjust to extremes
(temperature or humidity or altitude)
More prone to jet lag, insomnia,and constipation.
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 5/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
5
pre-travel assessments
Focus: prevention of travel-related infections(1±3% of deaths)
Majority: Cardiovascular disease or trauma
Evaluation of an individual¶soverall fitness for travel shouldbe performed by the
individual¶s own physician prior to travel.
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 6/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
6
GENERAL ADVICE
Choosing a trip
Fitness to travel Making travel arrangements
Health insurance
Medications and medicalsupplies
Medical services abroad
Travel safety Vaccine Preventable Infections
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 7/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
7
Fitness to travel
General check-up Specific travel advice Enough in advance to allow for investigation
and treatment of any undiagnosed
conditions Absolute contraindications to air travel:- pneumothorax or pneumomediastinum;- acute coronary syndromes, congestive heart
failure, or significant dysrhythmias within 4
weeks of travel;- thoracic, cardiac, abdominal, or middle-ear
surgery within 3 weeks;- cerebrovascular accidents within 2 weeks;
and
- some infectious diseases during the periodof communicability (e.g., chicken pox,measles, SARS, tuberculosis).
Relative contraindications to air travel:- Respiratory tract infections and other
pulmonary disorders,- Anemia
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 8/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
8
Absolute contraindicationsto air travel
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 9/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
9
Increase in Activity
Fitness or conditioningprogram
(1 or 2 months before) Exercise stress testing is
not routinely recommended Particularly men > 40 y.,women > 50 y., History of
coronary artery disease(>= 2 risk factors)
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 10/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
10
Making travel arrangements
Specific needs of individualtravelers should be discussed withthe travel agent
Aisle or bulkhead seats (increasedlegroom)
Seating in the non-smokingsection
Special diets
Other special needs: the need for a wheelchair or motorizedtransportation
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 11/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
11
Medications and medical supplies
Medications and medical supplies
Denture wearers: Denture adhesive
First aid medications: well tolerated
Renew prescriptions: run out or expire
during the trip Minimize the chance of loss or theft (Plusan extra several days)
Duplicate medications and a prescriptionfor each, should carried
Medications: original bottles Opiate analgesics, narcotics, and needlesand syringes ± may pose problems for importation across borders
Travelers should contact the embassy or consulate of each country they intend tovisit to find out if there are any restrictionsin bringing medications into or out of thecountry.
Travelers: name and phone number of their physician and personal contacts in the
event of an emergency (summary of medical record, complete list of currentmedications, and most recentelectrocardio ram
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 12/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
12
Tips during air travel
Comfort and safety should beoptimized
Comfortable clothing Intestinal gas expands with
altitude and can cause
abdominal discomfort Alcohol and caffeinated
beverages (Dehydration!)
Regular contraction of legmuscles while seated, andshort walks may reduce the
risk of thrombosis.
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 13/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
13
MEDICAL CONDITIONS ARISING DURING TRAVEL
Motion sickness
(C/I anticholinergic agent) In-flight emergencies
(10 000 air travelers; 21 - 90 death per year)
Thromboembolic disease Jet lag
Hyperthermia and hypothermia
(diuretics, coffee and alcohol)
Altitude sickness
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 14/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
14
Thromboembolic disease
3-year study: 104 deaths in long-distance travelersarriving at Heathrow Airport, 12% of all deaths and18% of those occurring in-flight were attributed topulmonary embolism
Travelers have a four-fold increased risk of idiopathic VTED;
VTED risk factors:- low risk: < 75; women taking oral
contraceptive pills (OCPs); pregnantwomen; and < 45 genetic traits for hypercoagulability.
Exercise and hydration- Moderate risk: >75; women > 45 who take
estrogen; and traits for hypercoagulability+ OCPs.
Below knee graduated compression stockings or ASA.
- High-risk: History VTED; activemalignancy; gross obesity; markedrestriction in mobility due to muscular or cardiovascular disease; large varicoseveins; and > 75 with cardiac andpulmonary disease.
Use of graduated compression stockings, ASA, or, if stockings are not used, low molecular weightheparin.
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 15/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
15
Altitude sickness
Acute mountain sickness (AMS)
5-day acclimatization period (tolerate
altitudes of 2
500 m well) Hypoxemia, sympathetic activation,pulmonary hypertension, andreduced plasma volume do
contribute to reduced exercisecapacity (cardiopulmonary disease or anemia)
Beta-blockers (compensatorytachycardia/dyspnea)
Level of fitness and adequateacclimatization will minimize the risk
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 16/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
16
Accidents and injury
Trauma-related deaths intravelers are more common inmales, and in the young andelderly
The elderly may be at higher
risk:- slowed reaction times
- auditory and visual impairment
- medication side effects
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 17/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
17
Further Information
International Association for Medical Assistance toTravelers (IAMAT)(www.iamat.org).
WorldMed.MD/Executive
Physicians Worldwide,(www.executive-physicians.net)
International SOS
(www.internationalsos.com)
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 18/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
18
CONCLUSION
Older travelers will continue toincrease in the future
Some limitations andrestrictions to travel may benecessary
Little reason restrict elderlycannot travelling
Adequate preparation and
appropriate advice, the elderlytraveler can enjoy good healthduring travel.
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 19/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
19
THANK YOU
8/9/2019 Travel in Advanced Age Vers1
http://slidepdf.com/reader/full/travel-in-advanced-age-vers1 20/20
23.06.2010 Dr. Hakan Yaman,WONCA Singapore 2007
20
Wonca 2008 stanbul
You are invited to«