Luggage. The right luggage can benefit your patients. Recommend that older patients purchase lightweight suitcases with wheels, which are easier to maneuver in and out of airports6 and less likely to cause muscle strain or musculoskeletal injury.
Insurance. If an individual becomes ill or sustains an injury overseas, the right insurance can be crucial. Advise older adults to review their health insurance policy to see whether it provides overseas coverage. If not, suggest they consider a short-term supplemental policy to cover medical care and evacuation, if needed. Recommend trip cancellation insurance, as well.
Patients should pack pills, medical supplies in a carry-on kit
Encourage all older travelers to compile a personalized travel health kit equipped with common over-the-counter (OTC) medications, prescription drugs, and any personal medical supplies they’ll need, such as a continuous positive airway pressure (CPAP) machine.1,3 Remind patients to take an ample supply of both prescription and OTC drugs, each in its original labeled container.3,6 Buying medications outside the United States is not advisable, given the variation in international regulatory standards. Stress the importance of keeping the kit in a carry-on bag.
The health kit should also include descriptions of the patient’s preexisting medical conditions, which you or a nurse or medical assistant in the practice can help to prepare; a list of prescription drugs he or she takes (using both the generic and brand names); and a copy of a recent electrocardiogram, if available, along with contact information in case of an emergency.1,3,6 A patient who uses injectable medication, such as insulin, should obtain a letter (on the practice’s letterhead) from the prescribing physician and be prepared to show the letter to airport security personnel.3,6
Staying safe in the air
The lower barometric and oxygen partial pressures found in aircraft cabins, which are pressurized at 5000 to 8000 feet, can affect both the respiratory and cardiovascular systems of older adults—particularly those with pulmonary or cardiac disorders.6,7 Individuals who do not routinely require oxygen and are able to walk the equivalent of one city block or climb one flight of stairs without shortness of breath should have little trouble compensating for the reduced oxygen in the cabin.3 Patients with stable heart failure, including New York Heart Association grades III and IV, can tolerate flights of up to one hour without additional oxygen.7
Advise older adults who will require oxygen that they are not permitted to bring their own oxygen canisters onboard an airplane.1 In-flight oxygen needs to be ordered at least 7 days before departure, and there may be a charge.7 Most airlines have medical consultants available to help patients who will need oxygen or other medical provisions.7 In addition, tour companies or travel consultants can help older patients with special needs ensure that they have access to oxygen or other medical supplies at their destination.
Thrombosis—the other in-flight risk
Sometimes referred to as “economy class syndrome” or “traveler’s thrombosis,” the venous stasis of air travel is responsible for a 3-fold increase in the risk of venous thromboembolism (VTE).8 While fatal pulmonary embolism is rare, duration of travel and risk of VTE follow a dose-response relationship, with each 2-hour increase in flight time conferring an additional 18% risk.8 Other risk factors for VTE include varicose veins, metastatic cancer, major surgery within the past 2 weeks, prior VTE, and BMI >40. Advanced age increases travelers’ risk of VTE, as well.7,8 The absolute risk, however, is low.
Among travelers older than 50 years, symptomatic VTE occurs at an estimated rate of one in 600 for flights >4 hours and one in 500 for flights >12 hours.9,10 While there is no evidence that first-class seating lowers the risk, there are preventive measures that patients can take.11
Tell patients to stay hydrated, drinking plenty of fluids but avoiding alcohol during flights of ≥4 hours’ duration. Sedating drugs should be avoided, as well. Advise anyone planning a long flight to either do seated exercises (intermittent calf contractions) or to periodically get up and walk about the cabin.9 You may also want to recommend that patients purchase below-the-knee elastic compression stockings to help decrease venous stasis.12