Preparedness is Key to Enjoying a Healthy Summer

As the summer months approach, physicians should use every opportunity available to discuss upcoming travel plans with their patients. Regardless of one’s age, the summer months are a time when many individuals seek an escape and time away from their usual routine. Although this special “away” time may provide rejuvenation and relaxation, it can also present certain health risks that may last well beyond the return of frost. Therefore, it is well worth encouraging patients to contemplate their risks before making travel plans and leaving home. Ideally, you will be able to suggest steps they can take to minimize risks, including risks they may not have considered, and help them be prepared in the event something does occur.

In this issue of Clinical Geriatrics^®, Dr. Stefanacci advises physicians to discuss with their older patients the various health risks associated with flying. The article, “Caring for Older Adults at 30,000 Feet”, also discusses how to manage inflight medical emergencies, as many physicians will likely encounter this experience sometime during their career. Flying, however, is not the only risk associated with summer travel. What follows are just a few additional examples of what can and should be thought about and discussed with geriatric patients before their departure.

Heatstroke, also known as hyperthermia, is always a risk when someone is exposed to hot, non–air-conditioned environments. Elderly persons are at particularly high risk of hyperthermia due to the changes in thermoregulation that accompany aging, use of certain medications that may predispose to this problem, and decreased thirst sensation in the setting of higher serum osmolarity. Keeping hydrated is key, especially in dry environments, where loss of body fluids may occur despite minimal perspiration. Patients should also be encouraged to limit physical activities during peak daylight hours.

Sunburn is an ever-present risk that may not only result in significant damage to one’s skin, but also increases one’s risk of developing skin cancers. Using sun-blocking lotions and creams and wearing protective clothing and hats is advised whenever sun exposure is likely. Wearing sandals increases the risk of sunburn to the dorsal portion of the foot and is a frequently forgotten location to apply sun-blocking lotion. Make sure to tell your patients to obtain a sun-blocking lotion with an appropriate SPF (most dermatologists recommend an SPF of 15 to 30) and to apply it before exposure and as directed on the product. Ultraviolet (UV) light not only increases the risk of sunburn and damage to one’s skin, but also has the potential to promote cataracts and even damage the retinas over time. Wearing sunglasses with 100% UV protection against type A and B rays should be advised.

Insect-borne illnesses are also more prevalent during the summer months. Whether it is West Nile Virus, Lyme disease, ehrlichiosis, or some other infectious disease, it is important to know what is present in your surroundings and find ways to avoid contact with insects that may serve as vectors. Mosquitoes are best avoided by not going out from dusk to dawn in infested regions and using mosquito sprays or lotions as needed to help prevent insect bites. Long-sleeve clothing and long pants tucked into socks or boots may help prevent tick bites when walking in infested areas.
If at high risk, daily inspection for ticks ensures these offenders are removed early. Prophylaxis against malaria or other insect-borne illnesses may be necessary when traveling to certain remote regions throughout the world, and patients should be encouraged to obtain background information on their proposed places of travel if their ventures extend beyond major urban settings.

Traveler’s diarrhea is another major concern, as it may not only ruin a vacation, but can also lead to severe dehydration and even death. Washing hands thoroughly is essential, as is the use of boiled or bottled water for drinking. One should make sure that all food is cooked to an appropriate temperature and raw foods should be avoided. Eating in restaurants in certain parts of the world may pose a problem, although food prepared by roadside vendors presents the greatest concern. Raw fruits and vegetables should not be eaten unless they can be peeled, and ice should be avoided in drinks. Discuss with your patients their need to take certain antibiotics with them “just in case,” as well as
antidiarrheals, depending on the location of their travels and the availability of medical care there.

Long periods of travel while being confined increases the risk of deep venous thrombosis and possible pulmonary embolism. Moving around decreases risk. In addition, taking aspirin before embarking on a long trip may also help prevent serious consequences.

Above all, advise your patients to use common sense. Many people engage in activities during their summer holidays that they normally would not consider the rest of the year, such as taking long hikes, climbing steep mountaintops, traveling to jungles and swamps, taking kayak trips in water rapids, among other physically challenging and often dangerous adventures. Advise you patients to think twice before making any travel plans that involve activities that tax their normal endurance. If significant physical activity is planned, such as climbing a steep mountain, a cardiac stress test may be warranted for some older adults.

Many travelers have no second thoughts about walking around neighborhoods in strange cities that they would clearly avoid if similar surroundings were in their own hometown. Robberies, rapes, and beatings, albeit rare, can often be prevented by being more aware of one’s surroundings and not taking unnecessary risks. It is always better to be safe than sorry!

Finally, depending on where your patients’ travel plans take them, discuss their need to obtain certain vaccinations. Whether it is a booster tetanus shot, a hepatitis A vaccine, or a more exotic vaccine, such as for yellow fever or typhoid, everything you need to know is listed in the Centers for Disease Control and Prevention’s Health Information for International Travel Guide, which is available in print and online at wwwnc.cdc.gov/travel. If in doubt, or if a special vaccine is required based on your patient’s travel destination, send him or her to a local travel clinic that specializes in such activities, as such facilities will have the necessary vaccines readily available.

Summer is a fun time of the year, but it does carry certain risks. Physicians should take a proactive role when seeing patients, asking them questions such as “What plans do you have for this summer?” and “Do you intend to travel?” By opening this dialogue and providing suggestions and referrals, physicians can make a difference in the quality of life of their patients, beyond what is offered with conventional medical care.