Joan, an 84 year old fit lady, booked a Caribbean cruise and is due to pay for her holiday in 2 weeks. In the last year however, she noticed something amiss with her balance; she feels like she is "walking like a drunk person" at times.
About 3 months ago she fell and broke her big toe on her right foot. She does not want to use a stick as it makes her feel "old". She was feeling fine otherwise and could not understand why she lost her balance. She came to see me for a full assessment and asked whether she should cancel her holiday.
Every older person planning a holiday, especially those with medical problems and taking multiple medicines, should start the preparation by booking an appointment with their GP. This should be done for several reasons:
1. To get a complete list of medical problems and medicines (in case these are needed for any medical emergency during the holiday).
2. Review medicines: some of them might need to be adjusted, for example, water tablets in hot places might cause dehydration.
3. Optimise medical conditions: blood pressure or diabetes might need better control prior to any travel.
4. Some people might need a referral to a specialist for a more comprehensive assessment, like in the case of Joan, who actually needed a brain scan.
Older people are prone to developing clots in the legs, called Deep Venous Thrombosis or DVT. This can be dangerous because clots frequently dislodge from leg veins and may block lung veins. This is why it is important to make frequent stops during the travel, at least every two hours, to stretch the legs and relax a little. Flight stockings, if tolerated, frequent walks and keeping hydrated on the plane will reduce the risk of DVT.
Both constipation and diarrhea are frequent problems during holidays and it is a good idea to have a supply of remedies for both conditions. Simple measures such as packing an extra supply of denture adhesives, and extra sets of batteries for hearing aids, if these are used, will save time and the inconvenience of having to look for a pharmacy in the holiday resort.
Older people have impaired thirst mechanism and are also at risk of dehydration. Having bottles of water in handbags will remind one to drink regularly. Avoiding drinks containing caffeine (drink decaf tea or coffee) will help. People, who are taking water or blood pressure tablets and travelling to hot places, should remember that heat lowers blood pressure too. Feeling too tired and dizzy might be indicative of blood pressure becoming too low. Therefore it is important to review and adjust medicines with the GP prior to travel.
Joan, who has been a life-long smoker since the age of 20, underwent a full comprehensive assessment, part of which was a "Falls and Balance" assessment. Her brain scan showed hardening and furring of blood vessels on the brain and an old stroke on the left side. By the age of 80 most of us will have some furring of our brain blood vessels and most of us will notice some difficulties with balance but in Joan's case, smoking made things worse. I explained to Joan that we can give her medicines to reduce the risk of future strokes but her balance problems are unlikely to get much better. Balance can however be maintained by regular physiotherapy, smoking cessation, blood pressure and cholesterol control.
Joan decided to have some balance training with a physiotherapist before laying down the cash for her cruise. I also optimised her medical treatments. More importantly, she now uses a stick when she is out and feels much safer. She is seeing me again in 3 months for further assessments. I am sure she will enjoy her cruise but later in the year and in much better form.
Geriatric Assessment Service, Hastings. East Sussex : Tel: 07786 545738 : Fax : 01424 758132 : Email: firstname.lastname@example.org
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