Michael Martin Cohen, M.D. — Cruising Health for Seniors

Cruising has become an increasingly popular vacation option, especially among seniors who appreciate the convenience, comfort, and variety of activities offered on cruise ships. However, while cruising can be a fun and relaxing way to travel, it also presents unique health challenges that seniors should be aware of. In this article, we will explore some of the most common health issues associated with cruising and offer tips for seniors to stay healthy and safe while enjoying their time on the water.

Figure 1: Seniors enjoying an afternoon cocktail at sea. (Cruise Passenger)

But before we proceed, I want you to think about cruising health in two ways:

A. What are the specific health issues that seniors need to consider when planning a cruise? This is presumably why you are reading this article!

B. What should I be doing as a senior to be as healthy as possible regardless of cruising. In current terminology, am I doing what I should be doing to increase my Healthspan? If you have not heard of Healthspan, then you have some work to do. It refers to your years of healthy living as opposed to Lifespan which obviously represents your chronological years of life. By thinking of increasing your Healthspan you are basically saying “I want to be as healthy as possible until the end.” Later, I will discuss the 6 “boxes” that seniors should check to stay healthy – my Pick 6 so to speak – which are very similar to the other “orthodox” docs. The wonderful thing about cruising is that it is so conducive to checking all 6 boxes. Stay tuned.

But first, before delving into senior health and Healthspan, let’s look at some of the specific health-related concerns when planning a cruise:

Preparing for the trip

Consult with your healthcare provider: Seniors should schedule a pre-cruise appointment with their healthcare provider to discuss any health concerns or necessary vaccinations. If you are planning on a trip to unusual or obscure locations do your homework. Read: https://travel.state.gov/content/travel/en/international-travel/before-you-go/travelers-with-special-considerations/cruise-ship-passengers.html

If there remains any doubt whatsoever, you should schedule an appointment with a Travel Clinic. They are available at virtually all major medical centers. Having a copy of your medical history and records, including information about recent treatments and any allergies can be crucial if you need medical attention while on board.

Medication management: Ensure an adequate supply of prescription medications for the duration of the trip, along with a list of medications and dosages in case of emergencies. Keep controlled medications, like narcotics, in their original packaging, clearly labeled, and consider packing them in your carry-on luggage to avoid any issues with lost checked baggage. Controlled drugs are rated in the order of their abuse risk and placed in schedules by the Federal Drug Enforcement Administration (DEA). Even your mild anti-anxiety medication is scheduled.

If you require multiple routine, non-scheduled medications each day, a pill organizer can help keep track of daily medications.

I am reluctant to say this, but you could be a bit less lazy, and spend some time investigating and understanding your medications – learning just a bit about how they work, etc. You certainly should discuss with your PCP in advance the specifics of certain medications, such as diuretics (water pills). As we will see, water balance on the water can be tricky. What with the insensible water loss through the skin while sailing and the (sometimes excessive) use of alcohol, which will dehydrate you, the cruising senior needs to be on top of hydration. Another topic I began to pay attention to in the last few years is something called chronotherapy or chrono pharmacology. Essentially, you should know what time of day is best to take your medication.

If you purchase internet access and you are familiar with accessing your portal, then you presumably have access to all your records and medications. If you have no idea what a portal is or if you even have one, ask one of your kids.

Once you are aboard, you will be dealing with physicians and other health care professionals who know you even less than your current PCP. And do try to avoid narcotics and other scheduled medications unless you have a doctor’s note and are not going to Russia.

Purchase travel insurance: Seriously consider purchasing travel insurance that includes medical coverage to protect against unforeseen health issues. If you are a senior who is extremely healthy and checks all 6 boxes in the next section, then you may decide it’s not necessary. That is probably a mistake. If you need a helicopter evacuation, you are looking at perhaps 20k or more. Enough said. Modern cruise ships are well equipped with medical facilities that can handle minor emergencies to some serious issues. However, it’s important for seniors to understand the limitations of these facilities and the type of care available. Ensure that your travel insurance covers both medical treatments on board and medical evacuations if necessary.

2. Chronic Condition Management

Many seniors live with chronic health conditions that require ongoing management, such as diabetes, heart disease, or respiratory issues. The change in routine and environment during a cruise can disrupt their usual care regimen.

To effectively manage chronic conditions while cruising, seniors should:

Consult with their healthcare provider before the trip to discuss any necessary adjustments to their care plan.
Bring an adequate supply of medications.
Inform the cruise line of any special dietary needs as well as any food allergies (which they will forward to the ship’s medical center).
Know how to access medical care onboard and in ports of call.
Seniors with diabetes should carefully monitor blood sugar levels throughout the trip and have access to necessary supplies such as insulin and glucose monitoring devices.
Individuals with heart conditions should follow their doctor’s recommendations for physical activity and diet while onboard and be aware of medical facilities and services available on the ship.

Stick to your usual routine as much as possible, including regular mealtimes, medication schedules, and sleep patterns.

3. Infectious Disease

One of the most significant health risks associated with cruising is the spread of infectious diseases. With thousands of passengers living in close quarters, cruise ships can be breeding grounds for illnesses such as norovirus, influenza, and even COVID-19. Seniors, who may have weakened immune systems, are particularly vulnerable to these diseases.

To reduce the risk of infection, seniors should:

Wash their hands frequently with soap and water or use alcohol-based hand sanitizers.
Avoid close contact with passengers who appear ill (duh).
Stay up to date on vaccinations, including flu shots and COVID-19 vaccines.
If feeling unwell, seek medical attention promptly and follow the ship's quarantine procedures.

4. Motion Sickness

Many people, including seniors, experience motion sickness while cruising, particularly during rough seas. Symptoms may include nausea, vomiting, dizziness, and fatigue.

To proactively manage motion sickness (especially if you are prone), you can:

Book a cabin in the middle of the ship and on a lower deck, where there is less movement.
Spend time on deck, focusing on the horizon to help stabilize their visual field.
Avoid reading or using electronic devices while the ship is moving.
The use of over-the-counter motion sickness medications or natural remedies like ginger or acupressure wristbands have been recommended and seem to work for some (these are reasonable to try for those of you with mild seasickness but not for moderate to severe cases. There appears to be a large placebo effect for the bands; and ginger appears to quiet the GI tract but that is not where seasickness originates. If you have been seasick before and want to understand your options, see Chapter One of my book “Healthy Boating and Sailing” (Amazon $9.99). There is a complete discussion, including all of the best medications. You will need to read this and discuss the medications with your PCP well before embarkation. These are not over-the-counter medications and may have side effects and interactions with medications you are already taking. If you have been seasick in the past, then it may be prudent to try the medications well in advance to find the dose that’s right for you and minimize side effects.

5. Dehydration

Dehydration is a frequent problem among cruise ship passengers, especially seniors who may be more susceptible to fluid imbalances. Factors contributing to dehydration include air movement as the ship moves through the water (when water evaporates from the skin), warm temperatures, increased physical activity, and alcohol consumption.

To prevent dehydration, you should:

Drink plenty of water throughout the day, although you don’t need a full 8 glasses! But err on the side of drinking too much. And don’t forget to drink enough fluids during transportation to and from the cruise ship.
Limit alcohol intake and alternate alcoholic beverages with water.
Wear light, breathable clothing and protect yourself from excessive sun exposure.
One simple way of estimating your dehydration is by looking at the color of your urine. As you get increasingly dehydrated your urine color begins to darken.

Figure 3: Are you drinking enough water?

6. Accidents and Falls

Cruise ships are designed with safety in mind, but accidents and falls can still occur, particularly among seniors with mobility issues or balance problems. Wet decks, uneven surfaces, and the motion of the ship can all contribute to the risk of falls.

To minimize the risk of accidents, seniors should:

Use handrails and grab bars when navigating the ship.
Wear sturdy, non-slip shoes.
Be cautious when walking on wet surfaces or in low-light areas.
Avoid carrying too many items that may throw off your balance.
Participate in balance-enhancing activities like yoga or tai chi offered onboard – better yet as part of your healthy living (see below)
Cruise lines offer accommodations for passengers with mobility issues, such as wheelchair-accessible cabins and assistance with boarding and disembarking.

Ok, now that you are prepared to go cruising, are you prepared to be a healthy senior? Are you ready to address your “Healthspan?” It’s time to start thinking beyond the next port and begin thinking about the many ports ahead.

The concept of a healthy mind in a healthy body dates to the Greeks. Hippocrates said …” If we could give every individual the right amount of nourishment and exercise, not too much, we would have found the safest way to health”. A few years later Juvenal, the Roman author, would coin the phrase “Mens Sana In Corpore Sano” which translates as “A Healthy Mind in a Healthy Body” and in this age of the Alzheimer epidemic, that’s what we are after.

Until the current interest in healthy living – and there is now a newly formed “discipline” of medical practice known as “Lifestyle Medicine” – there have been sporadic attempts to get back to this holistic approach. Probably the most current popular attempt is the “Blue Zones” which like most everything else in our culture has become over commercialized and cultish.

I believe that we are all a product of our genetic endowment, the environment we grew up in (including our culture), and all that we do and have done. I further believe that if we address as best we can these six aspects of life that we have an optimal chance of maximizing our Healthspan and visiting the next port.

Of course, all of this is assuming that you are not doing drugs, do not smoke, and are not drinking to excess. Another way of thinking about it is pictured in this illustration:

In general, what’s good for the heart is good for the brain and vice versa. And what’s good for both is good for the whole body. So, if you want to be a healthy senior you need to begin to address all 6 categories.

Exercise

Let’s start with exercise since that’s the most straightforward. How much and what kind?

The National Institute of Aging (NIA) a branch of the National Institute of Health (NIH) is quite clear: there are four categories of exercise that you should incorporate into your workout: Aerobic activity, Resistance (weight) training, Stretching (flexibility), and Balance. If you need to understand how much of each, download the information from the NIA and if you are new to exercise, enlist the aid of a trainer. Importantly, each of the major Cruise Lines have extensive Fitness Facilities so you will have no difficulty continuing your exercise program at sea. Please do not neglect working on your balance, the last of the four categories to be added to the recommended exercise regimen for seniors.

Diet

What about diet, since that was also important a couple of millennia ago before we started processing and ultra-processing our food - see the Hippocrates quote above. There are so many different diets out there that sometimes I am reduced to the Michael Pollan quote that gets at the heart of problem:

Basically, any variation of the Mediterranean diet which is less of an actual diet than an eating lifestyle. Other similar diets which represent slight variations include the DASH Diet (developed for hypertensive people), and the MIND Diet (which is a hybrid of the Mediterranean and DASH diet developed to prevent neurodegenerative diseases like Alzheimer’s). All the major cruise lines offer a wide selection of healthy food.

Figure 7: Mediterranean, DASH, MIND, and Flexitarian

Sleep

Here is a senior paradox: Most of us of a certain age have some (or more than some) difficulty sleeping while at the same time it is now evident that we need sleep more than ever.

Recharging, memory consolidation, and waste management, all vital to making the most of our senior years. Cruising should, if anything, help with your sleep. Remember putting the kids in the car and driving them around the block a few times to put them to sleep (or is that like parking in the middle of the street, just a Philly thing?). In addition to the activity of cruising and perhaps some alcohol (not too much) you should sleep well on the ship. But don’t just abandon whatever else you normally do…meditation, relaxation, music, medication. One problem you might anticipate is some circadian difficulty if your flight to the ship is across too many time zones. Sometimes the judicious use of Melatonin can help but talk to your PCP or better yet your neurologist if you have one.

Socialization

It turns out that social isolation is a major predisposing factor in the development of dementia.

Look at Figure 3 and notice how these three people are sharing information and brain activity. Cruising is an excellent way to socialize. The most vivid example of sharing brain activity is at a concert as demonstrated in Figure 10.

Stress Reduction

Whether meditation, mindfulness, or medication is your preference, you need to deal with your chronic stress, or it will eat you alive. Literally, well, almost literally since chronic untreated stress will cause atrophy in important parts of your brain (portions of your frontal and temporal lobes) and increase the activity in your amygdala. You must deal with it. Get help if you need it. Hopefully, cruising will help you achieve a stress reduction state.

Cognition (thinking and doing)

Figure 12: https://lelephant-larevue.fr/

There are now innumerable studies demonstrating that as far as basic brain cognition is concerned, “Use it or lose it.” Period. Full Stop. If you don’t stay mentally active, learning and discovering new things, well, don’t say you weren’t warned. No, not those commercial ”brain games” that are basically useless. Rather look for games that challenge large portions of your brain such as chess or bridge. And of course, exploration of the world. You can’t beat that.

These are my “pick 6” and interestingly if you look at the graphic of the new medical “specialty” of Lifestyle Medicine it looks very similar, doesn’t it. Except they neglected to include Cognition (one of the most important and instead included “Avoid Risky Substances”. If you are reading this, I’m willing to bet that you figured that one out. Just watch the alcohol.

If you spend some time thinking about the 6 categories and what you still need to do, you can be your own “Lifestyle Physician”. And then of course… “Physician heal thyself.”

Happy and healthy cruising.

Cruising Health for Seniors

Preparing for the trip