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Vol 69, No 4 (2018)
Review article
Published online: 2018-12-20

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The older traveller

Marcin Woś1, Krzysztof Korzeniewski2
Pubmed: 30589069
IMH 2018;69(4):285-296.


All over the world there has been a sudden increase in the number of international travels, mostly for
touristic purposes. According to the World Tourism Organisation, the number of international journeys
exceeded 1.323 billion in 2017 and it continues to grow. Of the growing number of travellers more and
more are the elderly (> 65 years), this fact can be attributed to longer life expectancy and a better quality of
life, especially in the developed countries. The article lists the main destinations chosen by senior tourists
and their reasons for travel, it also discusses physiological changes in organs and systems affecting the
elderly, which are the result of travelling across time zones and to areas with different environment. The
article looks at various groups of patients affected by chronic diseases and examines health-related consequences
of travel, including the most common complications. The general health prevention measures,
with emphasis on vaccinations and antimalarial chemoprophylaxis, have also been discussed.

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  1. World Tourism Organization. UNWTO Tourism Highlights: 2018 Edition. https://www.e-unwto.org/doi/pdf/10.18111/9789284419876 (Accessed: 30 Oct 2018).
  2. The World Bank. Population ages 65 and above (% of total). https://data. worldbank.org/indicator/SP.POP.65UP.TO.ZS (Accessed: 28 Oct 2018).
  3. Kontis V, Bennett JE, Mathers CD, et al. Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble. Lancet. 2017; 389(10076): 1323–1335.
  4. Eurostat. Mortality and life expectancy statistics. https://ec.europa.eu/ eurostat/statistics/explained/index.php/Mortality_and_life_expectancy_statistics#Life_expectancy_at_birth_increased_in_2016 (Accessed: 30 Oct 2018).
  5. Jaeger VK, Tschudi N, Rüegg R, et al. The elderly, the young and the pregnant traveler: A retrospective data analysis from a large Swiss Travel Center with a special focus on malaria prophylaxis and yellow fever vaccination. Travel Med Infect Dis. 2015; 13(6): 475–484.
  6. Utama R, Bagus P. Motivation and Satisfaction of Senior Tourists for Traveling Overseas. 13th International Conference on Academy and Business, Bali, Indonesia. 2012; September.
  7. Nimrod G. Retirement and tourism Themes in retirees’ narratives. Ann Tourism Res. 2008; 35(4): 859–878.
  8. Boss GR, Seegmiller JE. Age-related physiological changes and their clinical significance. West J Med. 1981; 135(6): 434–440.
  9. King M, Lipsky MS. Clinical implications of aging. Dis Mon. 2015; 61(11): 467–474.
  10. Lee TK, Hutter JN, Masel J, et al. Guidelines for the prevention of travel-associated illness in older adults. Trop Dis Travel Med Vaccines. 2017; 3: 10.
  11. Gautret P, Gaudart J, Leder K, et al. GeoSentinel Surveillance Network. Travel-associated illness in older adults (>60 y). J Travel Med. 2012; 19(3): 169–177.
  12. Eurostat. People in the EU – statistics on an ageing society. https://ec. europa.eu/eurostat/statistics-explained/index.php/People_in_the_EU_-_statistics_on_ an_ageing_society (Accessed: 10 Nov 2018).
  13. Alon D, Shitrit P, Chowers M. Risk behaviors and spectrum of diseases among elderly travelers: a comparison of younger and older adults. J Travel Med. 2010; 17(4): 250–255.
  14. Eurostat. Tourism trends and ageing. https://ec.europa.eu/eurostat/ statistics-explained/index.php/Tourism_trends_and_ageing (Accessed: 31 Oct 2018).
  15. Sundling C, Berglund B, Nilsson ME, et al. Overall accessibility to traveling by rail for the elderly with and without functional limitations: the whole-trip perspective. Int J Environ Res Public Health. 2014; 11(12): 12938–12968.
  16. Paneni F, Diaz Cañestro C, Libby P, et al. The Aging Cardiovascular System: Understanding It at the Cellular and Clinical Levels. J Am Coll Cardiol. 2017; 69(15): 1952–1967.
  17. Gander J, Sui X, Hazlett LJ, et al. Factors related to coronary heart disease risk among men: validation of the Framingham Risk Score. Prev Chronic Dis. 2014; 11: E140.
  18. Joy M. Cardiovascular disease and airline travel. Heart. 2007; 93(12): 1507–1509.
  19. McIntosh IB. Health hazards and the elderly traveler. J Travel Med. 1998; 5(1): 27–29.
  20. Grassi M, Petraccia L, Mennuni G, et al. Changes, functional disorders, and diseases in the gastrointestinal tract of elderly. Nutr Hosp. 2011; 26(4): 659–668.
  21. Rémond D, Shahar DR, Gille D, et al. Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition. Oncotarget. 2015; 6(16): 13858–13898.
  22. Patterson JE. The pre-travel medical evaluation: the traveler with chronic illness and the geriatric traveler. Yale J Biol Med. 1992; 65(4): 317–327.
  23. Driemeier M, de Oliveira PA, Druzian AF, et al. Late diagnosis: a factor associated with death from visceral leishmaniasis in elderly patients. Pathog Glob Health. 2015; 109(6): 283–289.
  24. Gavazzi G, Krause KH. Ageing and infection. Lancet Infect Dis. 2002; 2(11): 659–666.
  25. Farage MA, Miller KW, Elsner P, et al. Characteristics of the Aging Skin. Adv Wound Care (New Rochelle). 2013; 2(1): 5–10.
  26. McIntosh IB. Health hazards and the elderly traveler. J Travel Med. 1998; 5(1): 27–29.
  27. St-Onge MP, Gallagher D. Body composition changes with aging: the cause or the result of alterations in metabolic rate and macronutrient oxidation? Nutrition. 2010; 26(2): 152–155.
  28. Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017; 17(1): 230.
  29. Kim HA, Shin JY, Kim MH, et al. Prevalence and predictors of polypharmacy among Korean elderly. PLoS One. 2014; 9(6): e98043.
  30. Jyrkkä J, Enlund H, Korhonen MJ, et al. Polypharmacy status as an indicator of mortality in an elderly population. Drugs Aging. 2009; 26(12): 1039–1048.
  31. Sabzwari SR, Qidwai W, Bhanji S. Polypharmacy in elderly: a cautious trail to tread. J Pak Med Assoc. 2013; 63(5): 624–627.
  32. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014; 13(1): 57–65.
  33. Doan J, Zakrzewski-Jakubiak H, Roy J, et al. Prevalence and risk of potential cytochrome P450-mediated drug-drug interactions in older hospitalized patients with polypharmacy. Ann Pharmacother. 2013; 47(3): 324–332.
  34. World Health Organisation. Malaria. https://www.who.int/malaria/en/ (Accessed: 10 Nov 2018).
  35. Rees E, Saavedra-Campos M, Usdin M, et al. Trend analysis of imported malaria in London; observational study 2000 to 2014. Travel Med Infect Dis. 2017; 17: 35–42.
  36. Allen N, Bergin C, Kennelly SP. Malaria in the returning older traveler. Trop Dis Travel Med Vaccines. 2016; 2: 2.
  37. Centers for Disease Control and Prevention. Parasites – Malaria. https://www.cdc.gov/parasites/malaria/index.html (Accessed: 10 Nov 2018).
  38. van Genderen PJJ, van Thiel PP, Mulder PGH, et al. Trends in the knowledge, attitudes and practices of travel risk groups towards prevention of malaria: results from the Dutch Schiphol Airport Survey 2002 to 2009. Malar J. 2012; 11: 179.
  39. Checkley AM, Smith A, Smith V, et al. Risk factors for mortality from imported falciparum malaria in the United Kingdom over 20 years: an observational study. BMJ. 2012; 344: e2116.
  40. World Health Organisation. Dengue control. http://www.who.int/denguecontrol/en/ (Accessed: 6 Nov 2018).
  41. Goto K, Hatakeyama S, Okamoto K, et al. Dengue hemorrhagic fever in an adult traveler returning to Japan. Intern Med. 2012; 51(13): 1779–1782.
  42. Rowe EK, Leo YS, Wong JGX, et al. Challenges in dengue fever in the elderly: atypical presentation and risk of severe dengue and hospital-acquired infection [corrected]. PLoS Negl Trop Dis. 2014; 8(4): e2777.
  43. Stanaway JD, Shepard DS, Undurraga EA, et al. The global burden of dengue: an analysis from the Global Burden of Disease Study 2013. Lancet Infect Dis. 2016; 16(6): 712–723.
  44. Olivero RM, Hamer DH, MacLeod WB, et al. Dengue Virus Seroconversion in Travelers to Dengue-Endemic Areas. Am J Trop Med Hyg. 2016; 95(5): 1130–1136.
  45. Hsieh CC, Cia CT, Lee JC, et al. A Cohort Study of Adult Patients with Severe Dengue in Taiwanese Intensive Care Units: The Elderly and APTT Prolongation Matter for Prognosis. PLoS Negl Trop Dis. 2017; 11(1): e0005270.
  46. Centers for Disease Control and Prevention. Parasites - American Trypanosomiasis (also known as Chagas Disease). https://www.cdc.gov/parasites/chagas/ (Accessed: 18 Nov 2018).
  47. Pereira Ld, Freitas EC, Fidalgo AS, et al. Clinical and epidemiological profile of elderly patients with Chagas disease followed between 2005-2013 by pharmaceutical care service in Ceará State, Northeastern Brazil. Rev Inst Med Trop Sao Paulo. 2015; 57(2): 145–152.
  48. Alves RM, Thomaz RP, Almeida EA, et al. Chagas' disease and ageing: the coexistence of other chronic diseases with Chagas' disease in elderly patients. Rev Soc Bras Med Trop. 2009; 42(6): 622–628.
  49. Pereira MB, Batista AM, Aguiar C, et al. The detection of Trypanosoma cruzi by nested-PCR in elderly patients: relationship to the clinical and epidemiological profile. Pathog Glob Health. 2016; 110(6): 228–232.
  50. Centers for Disease Control and Prevention. Parasites – Leishmaniasis. https://www.cdc.gov/parasites/leishmaniasis/index.html (Accessed: 13 Nov 2018).
  51. Gebremichael Tedla D, Bariagabr FH, Abreha HH. Incidence and Trends of Leishmaniasis and Its Risk Factors in Humera, Western Tigray. J Parasitol Res. 2018; 2018: 8463097.
  52. Montalvo AM, Fraga J, Blanco O, et al. Imported leishmaniasis cases in Cuba (2006-2016): what have we learned. Trop Dis Travel Med Vaccines. 2018; 4: 7.
  53. Leder K. Advising travellers about management of travellers' diarrhoea. Aust Fam Physician. 2015; 44(1-2): 34–37.
  54. Giddings SL, Stevens AM, Leung DT. Traveler's diarrhea. Med Clin North Am. 2016; 100(2): 317–330.
  55. Parise I. Travelling safely to places at high altitude - Understanding and preventing altitude illness. Aust Fam Physician. 2017; 46(6): 380–384.
  56. Hartman-Ksycińska A, Kluz-Zawadzka J, Lewandowski B. High altitude illness. Przegl Epidemiol. 2016; 70(3): 490–499.
  57. Luks AM, Swenson ER, Bärtsch P. Acute high-altitude sickness. Eur Respir Rev. 2017; 26(143): pii: 160096.
  58. Bazemore AW, Huntington M. The pretravel consultation. Am Fam Physician. 2009; 80(6): 583–590.
  59. Hamer DH, MacLeod WB, Chen LH, et al. Pretravel Health Preparation of International Travelers: Results From the Boston Area Travel Medicine Network. Mayo Clin Proc Innov Qual Outcomes. 2017; 1(1): 78–90.
  60. McIntosh IB. The pre-travel health consultation. J Travel Med. 2015; 22(3): 143–144.
  61. Baggett HC, Graham S, Kozarsky PE, et al. Pretravel health preparation among US residents traveling to India to VFRs: importance of ethnicity in defining VFRs. J Travel Med. 2009; 16(2): 112–118.
  62. Weinberger B, Grubeck-Loebenstein B. Vaccines for the elderly. Clin Microbiol Infect. 2012; 18 Suppl 5: 100–108.
  63. Domnich A, Arata L, Amicizia D, et al. Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A systematic review and meta-analysis. Vaccine. 2017; 35(4): 513–520.
  64. Mutsch M, Tavernini M, Marx A, et al. Influenza virus infection in travelers to tropical and subtropical countries. Clin Infect Dis. 2005; 40(9): 1282–1287.
  65. Weinberger B. Vaccines for the elderly: current use and future challenges. Immun Ageing. 2018; 15: 3.
  66. Falkenhorst G, Remschmidt C, Harder T, et al. Effectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine (PPV23) against Pneumococcal Disease in the Elderly: Systematic Review and Meta-Analysis. PLoS One. 2017; 12(1): e0169368.
  67. Lal H, Cunningham AL, Godeaux O, et al. ZOE-50 Study Group. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med. 2015; 372(22): 2087–2096.
  68. Centers for Disease Control and Prevention. Yellow Fever Vaccine. https://www.cdc.gov/yellowfever/vaccine/index.html (Accessed: 23 Nov 2018).
  69. Lawrence GL, Burgess MA, Kass RB. Age-related risk of adverse events following yellow fever vaccination in Australia. Commun Dis Intell Q Rep. 2004; 28(2): 244–248.
  70. Aasheim ET, Seymour M, Balogun K, et al. Acute hepatitis A in an elderly patient after care worker travel to high endemicity country. Hum Vaccin Immunother. 2013; 9(11): 2480–2482.
  71. Mutsch M, Spicher VM, Gut C, et al. Hepatitis A virus infections in travelers, 1988-2004. Clin Infect Dis. 2006; 42(4): 490–497.
  72. Stuurman AL, Marano C, Bunge EM, et al. Impact of universal mass vaccination with monovalent inactivated hepatitis A vaccines - A systematic review. Hum Vaccin Immunother. 2017; 13(3): 724–736.
  73. Poovorawan K, Soonthornworasiri N, Sa-Angchai P, et al. Hepatitis B vaccination for international travelers to Asia. Trop Dis Travel Med Vaccines. 2016; 2: 14.
  74. Wong J, Payne M, Hollenberg S. A double-dose hepatitis B vaccination schedule in travelers presenting for late consultation. J Travel Med. 2014; 21(4): 260–265.
  75. Van Der Meeren O, Crasta P, Cheuvart B, et al. Characterization of an age-response relationship to GSK's recombinant hepatitis B vaccine in healthy adults: An integrated analysis. Hum Vaccin Immunother. 2015; 11(7): 1726–1729.
  76. Connor BA, Jacobs RJ, Meyerhoff AS. Hepatitis B risks and immunization coverage among American travelers. J Travel Med. 2006; 13(5): 273–280.
  77. Mast EE, Weinbaum CM, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep. 2006; 55(RR-16): 1–33; quiz CE1.
  78. Smeti P, Pavli A, Katerelos P, et al. Typhoid vaccination for international travelers from Greece visiting developing countries. J Travel Med. 2014; 21(2): 99–103.
  79. Wagner KS, Freedman JL, Andrews NJ, et al. Effectiveness of the typhoid Vi vaccine in overseas travelers from England. J Travel Med. 2015; 22(2): 87–93.
  80. Mahon BE, Newton AE, Mintz ED. Effectiveness of typhoid vaccination in US travelers. Vaccine. 2014; 32(29): 3577–3579.
  81. Gautret P, Parola P. Rabies vaccination for international travelers. Vaccine. 2012; 30(2): 126–133.
  82. Mills DJ, Lau CL, Fearnley EJ, et al. The immunogenicity of a modified intradermal pre-exposure rabies vaccination schedule--a case series of 420 travelers. J Travel Med. 2011; 18(5): 327–332.
  83. Hahn WO, Pottinger PS. Malaria in the traveler: how to manage before departure and evaluate upon return. Med Clin North Am. 2016; 100(2): 289–302.
  84. McKeage K, Scott L. Atovaquone/proguanil: a review of its use for the prophylaxis of Plasmodium falciparum malaria. Drugs. 2003; 63(6): 597–623.
  85. Warne B, Weld LH, Cramer JP, et al. EuroTravNet Network. Travel-related infection in European travelers, EuroTravNet 2011. J Travel Med. 2014; 21(4): 248–254.
  86. Hill DR. Health problems in a large cohort of Americans traveling to developing countries. J Travel Med. 2000; 7(5): 259–266.
  87. Wingate D, Phillips SF, Lewis SJ, et al. Guidelines for adults on self-medication for the treatment of acute diarrhoea. Aliment Pharmacol Ther. 2001; 15(6): 773–782.
  88. Michal Stevens A, Esposito DH, Stoney RJ, et al. Clostridium difficile infection in returning travellers. J Travel Med. 2017; 24(3).
  89. Luks AM, Swenson ER, Bärtsch P. Acute high-altitude sickness. Eur Respir Rev. 2017; 26(143): pii: 160096.
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