With the growing number of Israelis living to 80 and beyond, many with enough energy and income want to travel. But what if they suffer from chronic diseases or physical disabilities? While the Health Ministry's district health offices offer vaccinations for travelers, while some of the health funds and hospitals have opened travel medicine clinics - all for a fee - no one offers comprehensive checkups and advice specifically geared to elderly, ill and disabled would-be wayfarers. Dr. Efraim Jaul, who has toured numerous countries including China, India and Croatia, has written a Hebrew-language booklet called The Mature Traveler's Guide which has been translated into English (the Hebrew volume is available for NIS 13 in Akadamon book shops; the English version has not yet been published, but he can be contacted about it at [email protected]). The geriatrician hopes he will have the opportunity to launch a travel medicine clinic that would specialize in advising and examining the elderly. Four years ago, he wrote a 223-page Hebrew book published by ESHEL on The Geriatric Nursing Patient, which focuses on his experiences taking care of his own parents. On his trips, he naturally pays attention to how the elderly would manage. JAUL, DIRECTOR of geriatric nursing care at Jerusalem's Herzog Hospital and a lecturer at the Hebrew University-Hadassah School of Medicine who has a master's degree in public health, spends all his days with old people. But chronically attached to tubes and monitors and suffering from severe disability, they are not candidates for overseas travel. The elderly, he says, prefer to travel in organized groups, get package deals and make arrangements through a travel agency. But they must tell travel agents if they have medical conditions, physical limitations or use special medical equipment. They need a comprehensive assessment according to what kind of trip they plan - how long, how much exertion is necessary, what topographical conditions, as well as the individual medical conditions. "Travel agents can't advise you," says Kaul in an interview in his Herzog Hospital office. "They want to sell tickets; they aren't qualified to tell you what you can physically do and how to protect your health." In his new guide to senior tourism, Jaul says it's natural for this age group to want to travel for relaxation, new experiences, meeting people, getting to know other cultures or tasting new challenges. "It's a myth," he writes, "to suggest that the senior population is sedentary, housebound or has no particular needs or wants. On the contrary, this age group has well-defined needs and wishes, and older people can sometimes surprise their younger colleagues with their energy and persistence." Still, older people can't do everything they used to - or at least as fast as they used to - and have to be aware of their limitations. "Listen to your body," Jaul advises. Mature travelers are advised to take only the essentials when they travel. But, depending on the destination and activities, don't forget comfortable walking shoes with slip-resistant soles, a backpack to keep your hands free, a broad-brimmed hat, sunglasses and an extra pair of prescription glasses. Dress appropriately for the weather and adjust your activities gradually, taking the weather into account. An annual flu vaccine and a once-in-five-years pneumonia shot are recommended, along with any vaccinations necessary due to diseases prevalent in your destination. Regular medications that older travelers take have to be packed - preferably in hand luggage. Jaul notes that many medications are known in Israel by different commercial names than those used abroad, so travellers should make a list of generic names if they need prescriptions abroad. But it's preferable to come with a good supply from home. Other basics include paracetamol for pain or fever, and anti-inflammatory drugs if you suffer from back pains and your doctor approves. If you suffer from seasickness or are nauseous during flights, ask your doctor for medications for this, as well as tablets for diarrhea or constipation. If you suffer from time to time from respiratory or urinary infections, ask your physician about taking antibiotics. First-aid items are also recommended if your activity will go beyond eating in hotel dining rooms. "It is a good idea to carry a letter from the doctor along with the medication, and to keep the medication in its original packaging," advises Jaul. This will avoid problems with customs and simplify medical care if you need it. To minimize the risk of blood clots (deep vein thrombosis) in a cramped aircraft, try to drink plenty of fluids, avoid alcohol and get up from your seat regularly to stretch your legs. Everyone - and not only the elderly - must take out medical and flight insurance appropriate for their age and medical condition. Jaul recommends coverage for all possible situations, including ambulatory medical care, through in-patient care and even the possibility of an air ambulance for flying you home. Make lists of important names and numbers. IF YOU NEED a walker, crutches or wheelchair, inform your travel agent, airline and hotel in advance, and take along an inhalation unit, glucose-testing device or other equipment if you need it. As older people tend to have more fragile skeletons and weaker muscles, avoid carrying or lifting heavy suitcases; instead, use suitcases and bags with wheels. Put small purchases and vital objects in your backpack so your hands are free to protect you if you fall. Both men and women should make it a habit to use the bathroom before they travel or leave the hotel, and avoid drinks that have a diuretic effect such as coffee, tea and cola before they leave. But drink plenty of water during your travels. As reflexes slow with the years, Jaul says, avoid sitting on a chair or stool without a back support. Lift your feet as you walk to avoid tripping on rough or uneven ground. Be extremely careful where you step when going out at night or using stairs and escalators (firmly grasp the moving rails on both sides). Keep a flashlight with you and leave a light on in the bathroom. Open markets, bus stops, subways and public bathrooms can be dangerous places in some countries. Keep your bags, wallet and money belt close to your body and a few bills and small change in your pocket for purchases and transportation. In some places, pickpockets will prey on older people, push them and steal their wallets or purses, breaking an arm or hip while doing so. People must be aware of such dangers and be alert, the Herzog Hospital doctor warns. To avoid getting lost in unknown surroundings, remember the name of your hotel and its immediate neighborhood, and ask for the hotel's business card written in the local language, as well as a city map with the hotel's location marked. When you arrive at the tourist site, make note of the transportation schedule and designate a meeting place in case you get lost. It's advisable to keep a cell phone with you at all times. Marble and other shiny floors in hotels reflect sunlight, creating a blinding glare. They can also be slippery. Watch out! Hotel bathrooms often lack bars to grasp and slip-preventing bathtub mats. Great care is required when placing one's foot inside the tub and when exiting: Put a mat on the bathroom floor to prevent slipping and grasp a fixed object when entering and exiting the tub. Get out of bed gradually, first to a sitting and then standing position, as a fifth of the elderly suffer from orthostatic hypotension that can result in falling, Jaul advises. If you have an urge to go to a spa, Jaul warns that people with heart problems, high blood pressure or breathing problems should avoid both wet and dry saunas and jacuzzis. Mud baths and therapeutic mud treatment should be undertaken only on a doctor's recommendation. He recommends that the elderly avoid driving abroad, even with a GPS device, unless they are fit and familiar with the location, as being behind the wheel in a strange place can be difficult even at home. A heavy meal can lead to sleepiness - an added risk factor for drivers. Driving is also made difficult if older people suffer from a hearing loss. Avoid overeating, which is always a problem when facing overloaded hotel buffets. Suit your diet to your health. Diabetics should limit their total dietary carbohydrate intake and prefer complex ones (especially fiber) while minimizing intake of simple ones such as sugar and starch. Those who suffer from congestive heart failure, whether due to hypertension or coronary insufficiency, should reduce their salt intake. Travelers with high cholesterol should limit their dietary fat intake from animal sources. Breakfast is the most important meal of the day for older people on the go, so they will have enough energy to meet the day's requirements. If any sudden acute medical problem arises, from chest pains and vomiting to fever and uncontrolled sweating, don't be embarrassed or fear "spoiling the trip," says Jaul. Tell your spouse, tour guide or even the person sitting next to you on the bus. BUT DON'T let all these warnings deter you from packing your suitcase. Most mature travelers will do fine if they prepare properly. And they do go on vacation: According to a Tourism Ministry survey, 32% of elderly Israelis leave their homes during the year to go on vacation for at least one night, and their preferred vacation sites are Eilat (22%), Tiberias and the Dead Sea (20%), with the remaining percentages distributed among Jerusalem, the Galilee and the Carmel region. Fully 28% chose to travel abroad, with a third going to Western Europe or the US, 26% to Eastern Europe, and 37% to Turkey, Greece, Cyprus and other nearby locations. Jaul stresses that an older person's ability to travel should be assessed by his or her physiological and not chronological age. There are active 80-year-olds who have the cardiac function of a couch potato in his 50s, he says. Most mature Israelis function without assistance, and only 14% are limited in one or more of the basic activities of living. Even if they have chronic illnesses, "the elderly are in general medically stable and able to travel without restrictions; as long as they take their medications, they should not be prevented from traveling." Bon voyage!