The impact of Dementia and Alzheimer’s on air travel is a ticking time bomb medical research and travel industry are yet to address.
Alzheimer’s is a condition usually associated to the elderly. However, according to an estimate of the Alzheimer's Society there are more than 17,000 younger people with dementia in the UK alone. However, Alzheimer's Society believe this number is likely to be an under-estimate, and the true figure may be up to three times higher.
Alzheimer's Research UK’s concerning outlook puts the number of Dementia sufferers at a ratio of one in 20 people over the age of 60.
Despite recurring optimistic announcements, research is yet to clearly identify causes and effects of Dementia. Studies often contradict each other, like the following example of recently published research suggests.
According to a study conducted by researchers from the University Hospital Madrid and Columbia University in New York, over 65s who sleep on average nine hours or more per day show a more rapid decline in cognitive function over 3 years than counterparts who sleep an average of six to eight hours.
However, Researchers from The Johns Hopkins Bloomberg School of Health say that previous research has linked reduced sleep and poor sleep quality to cognitive impairment in older individuals who sleep between five and seven hours per night.
Reduced Mobility Rights monitoring of airports’ passengers flow and air travel patterns identified numerous cases of severe disorientation in 2013. The number of incident reports related to passengers with Alzheimer’s and Dementia is also on the increase.
On Friday, May 3rd 2013, 83-year-old Dementia sufferer Victoria Kong walked past the assistance agent waiting to meet her at the gate of her flight from Barbados to Washington D.C.
CCTV footage shows the elderly as one of the first passengers to deplane. Footage also shows Mrs Kong talking with people and sitting calmly on a bench. Reagan National Airport officials said the woman was not visibly in distress or disoriented.
Victoria Kong's body was found the following Monday in wooded area about 200 yards from the airport perimeter. Her relatives said the elderly probably died from the chilly weather.
The U.S. Alzheimer's Association explains that it is common for a person with dementia to wander and become lost. More than 60% of individuals with Alzheimer's will wander at some stage. A new, largely unknown location or a crowded terminal building can cause the onset of severe disorientation.
On board the aircraft, factors such as cabin pressurization, a crowded cabin, and seating restrictions (safety belts) may also trigger unexpected behaviours.
Airlines do not require passengers diagnosed with conditions like dementia to travel with a companion. "There are no set rules on customers travelling with dementia as it covers such a wide-spectrum of abilities," a spokesperson for British Airways told Reduced Mobility Rights. "We will look at individual circumstances, but as a general rule, if an individual can tend to their own needs, respond to commands and does not require a carer in their daily activities, then it is likely that they will be accepted for travel unaccompanied."
Last August, Reduced Mobility Rights sat down with the medical team of Virgin Atlantic Airways to discuss how the airline addresses the problem. Denial and omission are still major problems when it comes to identify a passenger with Dementia. Younger Alzheimer’s sufferers are often in denial for a number of reasons ranging from unawareness to refusing to accept reality.
Virgin Atlantic Airways medical services developed procedures to help cabin crew identify passengers who may be in denial. Trained Flight attendants are usually recommended to have a behavioural approach rather than follow procedure when interacting with Dementia sufferers. In other words, cabin crew is trained to focus on service and care rather than compliance.
In cases of medical disturbance cabin crew make use of the on board first aid kit which contains over the counter medicines. Prescription medicines can be administered on MedLink advice only, as the manner in which a medicine is administered will determine whether or not the patient gains any clinical benefit, and whether they suffer any adverse effect from their medicines.
When a medical situation arises during a flight, MedLink provides crew members ready access to an emergency department doctor for advice and assistance.
In case of physical situation cabin crew procedure starts from a verbal approach which can escalate to kind physical approach in restraint mode and evolve into full restraint mode based on the subject’s reaction. However, full restraint is the last resort and is used in most severe cases only.
The following Checklist for Flying With Dementia, the first ever of its kind, is the result of Reduced Mobility Rights research on ways to facilitate air travel for passengers with Alzheimer’s.
Flying With Dementia Checklist
If you have been diagnosed with Alzheimer’s or Dementia
If you are over 60 and have low or high blood pressure, diabetes, high Cholesterol (LDL), high estrogen levels (females), are depressed, obese, a heavy drinker, a heavy smoker you may wish to make use of this checklist to improve the quality of your journey.
Before you fly
1) If you have been diagnosed with Dementia or Alzheimer’s, or you suspect you may be developing the condition, inform the airline at the time of booking and request the level of assistance that may best suit your needs, by example escort service through the airport. Make sure you write down and make at least three copies of a list containing your information and address, medicines you take regularly and their intake schedule, substances you are allergic to, the name and phone number of an emergency contact person, your flight schedule, your final destination, name and contact details of the people that will meet you at your destination. It is useful to make at least three copies of your Passport and any other travel document. Keep one copy of the list and ID with you, place a second copy in your carry on luggage, and the third in your checked luggage.
2) If you are confident you can function independently throughout the journey, or do not feel you need assistance at this time make sure to write down and make a minimum of three copies of a list containing the following information: your name and address, medicines you take regularly and their intake schedule, substances you are allergic to, emergency contact name and contact details, your travel plans, name and contact details of the people you will meet at destination. It is useful to make at least three copies of your Passport and any other travel document. Keep one copy of the list and ID with you, place a second copy in your carry on luggage, and the third in your checked luggage.
3) Visit the airline website and familiarise with the aircraft cabin layout and features. In case of long haul flights choose to seat no less than three rows and no more than six rows away from the lavatory.
4) Visit the airport website and familiarise with the terminal building layout and features. Some airport websites allow visitors to print maps. If available, print a map of all airports your will be traveling through your journey (departure, transit, destination).
5) If noise upsets you, make sure to have a music player loaded with your favourite tracks and headsets with you. Preferably, try to have an easy listening music list among your choices.
6) Prepare your carry on luggage making sure you have items you need to feel comfortable like a full set of clothes and daily medications in case your flight is delayed or your checked luggage is lost.
7) Make sure your carry on, checked luggage, and any other bags you may be traveling with like a laptop case are tagged with your name and contact information.
8) Where possible, check in online to minimise the hassle of airport check in process and proceed directly to the bag drop off area if you have checked luggage or straight through security if you only have carry on luggage.
At the airport (departure)
9) Avoid arriving at the airport too early or too late. If you can check in online, arrive at the airport two and half hours before an intercontinental flight, two hours before an international flight, one and half hour before a domestic flight. The shorter the wait time, the less likely you will be to experience disorientation or irritation.
10) Don’t be shy. If you experience disorientation, immediately seek assistance from airport staff. If you feel appropriate, ask to be escorted to your departure gate.
11) Make your way to your departure gate as quickly as possible. If appropriate, purchase food and drinks after you cleared security to make your wait at departure gate more comfortable.
12) If you need to make use of the airport toilets, take note of the location of your departure gate before you leave the waiting area.
13) If appropriate, make gate staff aware of your condition and ask them to assist you boarding the aircraft.
On board the aircraft
14) Try to make yourself as comfortable as possible. Most modern aircraft offer state-of-the –art entertainment systems.
15) Keep well hydrated making sure to avoid the intake of alcohol, tea, and coffee.
16) On long haul flights, try to take a short walk about the cabin every two hours.
17) If you become disoriented inform cabin crew immediately, making them aware of your condition. Most airlines’ flight attendants are trained to take good care of passengers with Alzheimer’s or Dementia.
18) If you feel tired, disoriented or irritable at least one hour before landing, ask cabin crew to arrange for assistance at the arrival gate.
19) Wait to deplane after all other passengers have left the aircraft. An empty cabin is a friendlier environment to check that you have all your personal belongings before you get off the aircraft.
At the airport (transit)
20) If you have a layover of two hours or less, make you way from the arrival gate to the departure gate of your connecting flight straight away.
21) If you have a layover of two hours or more, ask arrival gate staff to direct you to the nearest special assistance lounge, where available. From the lounge, coordinate with lounge staff to make your way to your connecting gate.
22) In the unlikely event a special assistance lounge is not available, proceed to the food court nearest to your departure gate.
23) If you need to make use of the airport toilets, take note of the location of your departure gate before you leave the waiting area.
24) When appropriate, make gate staff aware of your condition and ask them to assist you accordingly.
At the airport (destination)
25) Proceed immediately from the arrival gate to Passport Control and baggage reclaim area.
26) When taking your luggage from the delivery belt, double check tags to make sure it is indeed your checked baggage.
27) Arrival halls can be crowded and disorienting for all passengers. If you are meeting someone, arrange for a meeting point before you travel. This can be a concession located in the arrivals hall. Make sure the concession you choose is the only one with that name in the arrivals area.
28) If you are not meeting someone at the airport, proceed immediately to your chosen mean of transportation (Taxi, Bus, Train, or Underground).
Over 65s, currently representing 18% of the 503 million Europeans, will increase to over 30% by 2060, according to projections of the European statistical analysis agency Eurostat. EU projections mirror ageing population trends of developed nations worldwide. In the future, over 65s will be more likely to use air transport.
Looking forward, a broader understanding of dementia and specific training are key elements to cope with the growing number of passengers with Alzheimer's traveling by air. Perhaps, the introduction of a new Special Category of Passenger, the Unaccompanied Adult, could be the answer to assist those able to perform basic safety tasks, yet in need of constant monitoring and guidance throughout the journey.