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Preplanning when traveling with elderly and/or disabled individuals is essential. There are many considerations, depending on the individual’s specific health needs and the chosen modes of travel (e.g., auto, airplane, train, cruise, etc.). This post will primarily address air travel. Caregivers will want to begin well in advance.

Involve the care receivers in the planning, provided that they are capable of participating and doing so won’t provoke undue distress. Their ideas and questions are often helpful. It’s great fun to see their excitement.

If a passport is required for travel, make sure that an existing one is valid beyond your planned return trip date. If your care receiver doesn’t have one, allow plenty of lead time for application and processing. If a passport is not needed, make sure that an alternate form of photo identification is available
(e.g., driver’s license or state ID card).

My elderly mother and disabled sister will soon be flying a few states away to visit family friends for a long weekend. So I’ll refer to some specific examples of planning that we are doing throughout.

Medical Clearance
A check-up, discussion, and clearance for travel with the individual’s health care provider will get the process off to a good start. You will want to have an up-to-date summary or list of medical diagnoses, medications and supplements, allergies, any specific treatment plan unique to that person, plus provider
contact information.  

Individuals with episodic or chronic pain conditions will want to carry medical documentation with them, as well as, a supply of their pain medication(s). As a former Emergency Department nurse, I know that drug-seeking patients often present with complaints of migraine headaches or kidney stones to try and obtain opioids. Whenever I traveled with a family member who had kidney stones, we always took these precautions. My sister has complex regional pain syndrome, type 1 (CRPS1), more commonly known as reflex sympathetic dystrophy syndrome (RSDS). Her baseline pain is severe…and then there are times when it is unimaginable torture. Should she need an Emergency Department visit for any reason, there are specifics about her condition, treatments that are more likely to help, and contraindications detailed in a letter from her physician. http://www.rsds.org/2/what_is_rsd_crps/index.html

A copy of advanced directives should be carried unless they are available for download through a state or national registry. http://www.uslivingwillregistry.com/

Prescriptions
You will also want to have sufficient quantity of routine prescription medications, plus those used on an as-needed or PRN basis. Some episodic conditions that immediately come to mind include: angina, asthma, migraine headaches, and kidney stones. My mother has recurrent urinary tract infections, so we will be bringing a full course of antibiotics, since we will be some distance from a pharmacy. Mom is susceptible to motion sickness; she prefers to use ginger capsules, therapeutic-grade essential oils, and acupressure. However some affected individuals may want to use other OTC or prescription meds for that purpose.  

Medications should be in their original labeled containers rather than in pill minder trays or strips. They should be easily accessible at all times, so do not pack them in checked luggage that may be delayed or even lost. My sister needs to carry EpiPens with her. They are allowed on airplanes because they are life-saving medication for severe allergic reactions. If needed, ask your doctor how many you should carry with you. Safety seals on the syringes must be intact. You may want to notify the airline in advance, just as you would make any other special arrangements. Wearing a MedicAlert braclet or necklace is recommended for anyone with significant health conditions and allergies. Individuals with dementia can be enrolled in both the MedicAlert and Safe Return (Alzheimer’s Association) programs. It’s also a good idea to pack a travel-size first aid kit that is customized for you and your care receiver’s needs. http://www.alz.org/we_can_help_medicalert_safereturn.asp

My sister takes a liquid pain medication, so her pharmacist provided a three-ounce bottle for air travel convenience and carrying in her purse. She also uses a topical compounded prescription cream. Larger quantities of medically necesary liquids, creams, or gels are permitted on board an airplane–refer to the following TSA advisory for details. Of course, all diabetic medications and supplies are permitted.
http://www.tsa.gov/travelers/airtravel/specialneeds/editorial_1059.shtm

If eyeglasses or contact lenses are worn, that prescription should also be accessible in case of breakage or loss.

Medical Devices
Medical devices may include external, and internal or implanted appliances or devices. They may or may not be visible or obvious to others. My mother uses a hearing aid. We will make sure that the airport personnel know; it is perfectly safe and appropriate for her to go through electromagnetic screening while wearing it. She has also had a hip replacement. Based on a 2007 study that details what orthopedic hardware is most apt to trigger airport metal detectors, her single hip prosthesis is unlikely to be an issue. However it’s good to advise TSA personnel at the time of preboarding screening. http://www6.aaos.org/news/Pemr/press_release.cfm?PRNumber=592

Other individuals with pacemakers, implanted cardioverter-defibrillators, spinal cord stimulators, and other implanted pumps and ports may be concerned about electromagnetic interference from airport metal detectors. Physicians and manufacturers have routinely warned of potential problems such as inappropriate sensing, pacing, or inadvertent reprogramming. A recent German study of individuals with implanted pacemakers and cardioverter-defibrillators offers credible reassurance; I recommend discussing it with your healthcare provider. http://www.medscape.com/viewarticle/456785  http://www.ncbi.nlm.nih.gov/pubmed/12798581?dopt=Abstract

Durable medical equipment such as canes, crutches, and walkers (especially the collapsible ones) are all allowed on board an airplane. Personal manual wheelchairs may be checked at the gate. In our situation, both people will need wheelchair or electric cart transportation to the gate. It’s another item on our list to arrange in advance with airline personnel. We will be renting a wheelchair at our destination for ease of mobility and conserving personal energy. We will also be taking each person’s handicapped parking placard along. Mobility International USA has even more airline travel tips to assist you. http://www.miusa.org/ncde/tipsheets/airlinetips 

I recently discovered a supplier of travel products, especially geared to disabled travelers. The portable grab bars seem especially useful for many folks. http://disabledtravelers.com/ Their website has many resources and links to individual airlines and agencies of interest to disabled travelers. I learned through this site, that the Department of Transportation (DOT) has a toll-free hotline to assist travelers with disabilities.  

Booking Flights
At the outset, you may want to check into flight insurance and determine if coverage is available for you and/or your care receiver. Consideration may also be given to purchasing refundable tickets. Know terms and fees for making changes, regardless of the type of ticket used (even frequent flyer awards). 

Deciding on length of flights and number of connections is important. Some travelers will do better on shorter flights rather than longer ones. Others will prefer direct flights. If your itinerary includes connections or layovers, be sure to allow at least 90 minutes for each. Also take into account the size of the airport, number of terminals, and likelihood of delays or cancellations based on time of day, or seasonal weather issues. If your care receiver is wheelchair-bound, remember that only double-aisle airplanes have accessible lavatories, when booking your flights. Speaking of lavatories, the companion or family restrooms in airports and shopping malls are truly appreciated by caregivers. We plan on using incontinence briefs on travel days for a little extra protection just in case of a prolonged wait.

Oxygen
Arrangements must be made at least 72 hours in advance for anyone traveling by air needing supplemental oxygen, CPAP, or other respiratory equipment. I recommend reading the Johns Hopkins Health Alert on “Traveling Smart With Oxygen,” if your care receiver has any kind of lung condition, even if they are not routinely receiving oxygen therapy at home. Your health care provider may want to do preflight testing to determine the need for inflight oxygen or at a higher flow rate than usual. http://snipurl.com/2pl77  http://johnshopkinshealthalerts.com/alerts/

Packing & Day of Travel Considerations 
We are trying to limit our luggage for ease of travel and because of the surcharges that now apply. We plan to use the curbside check-in service. Care will be given to selecting clothing to wear. Jackets, sweaters, and shoes need to be easy to remove for security screening. Layered clothing offers more flexibility and comfort with varying temperatures. We will carry on snacks such as nuts or trail mix. A protein source is especially important for those with diabetes or prone to hypoglycemia. Reading material, small travel puzzles, or games are helpful given any potential delays. Of course, we will be taking a camera to document our trip. After forgetting a cell phone charger on a previous trip, a spare is now always kept in my luggage.

We plan to use personal nasal inhalers with therapeutic-grade essential oils (such as Young Living’s Thieves blend and R.C.) to keep our upper respiratory tracts healthy and decrease sinus pressure and congestion. We use them before flying and when we reach our destination.     https://youngliving.org/pschro

Even though our direct flight is under three hours, mom will probably need to stand up once or twice and probably walk a short distance to prevent stiffness and joint pain. She will travel by car about 1.5 hours to the airport and another 1 hour from the airport. That’s a lot of travel time for her, in one day. Mom usually has dependent edema in her legs and wears compression hose. So she plans to do some foot and leg exercises to further minimize any risk of developing blood clots. She will drink water to keep hydrated, but we have to balance that with the need to use the lavatory. 

On the emotional level, we have talked about “packing” flexibility, patience, and humor. I am looking forward to experiencing the trip through my care receivers’ eyes, not just my own. I know that I will need to be assertive while advocating for their needs. Hopefully the most challenging part of our trip is the advance planning, which is almost complete. This post details much of the research I’ve recently done to prepare for traveling with elderly and disabled care receivers. I hope that it will be helpful to you. I invite readers to share any other ideas and resources that you believe will assist us and other caregivers.

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