How well do older persons tolerate moderate altitude?

New England Journal of Medicine, 2022

A s interest in adventure travel grows and transportation networks expand, more people are traveling to terrestrial high altitudes for active and sedentary endeavors, including hiking, skiing, sightseeing, religious pilgrimages, and work. 1 Often, travelers seek medical advice on trip safety, with the primary focus on prevention and treatment of acute altitude illnesses, including high-altitude headache, acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema. Given the prevalence of diseases such as asthma and hypertension, 2 many people planning high-altitude travel are likely to have a preexisting medical condition. In such cases, clinicians should broaden their pretravel counseling and consider how reductions in barometric pressure and subsequent decreases in the ambient partial pressure of oxygen (Po 2)-known as hypobaric hypoxia-will affect the underlying condition and the safety of a planned high-altitude excursion. Clinicians and patients may be unaware of these concerns, and patients may either proceed with travel in the face of unrecognized risks or be overly cautious and forgo travel when it is actually feasible. This review is intended to help clinicians by providing a framework for advising persons with medical conditions who are considering high-altitude travel. After reviewing the prevalence of common diseases among high-altitude travelers and the physiological responses to hypobaric hypoxia, we discuss the altitudes at which persons with medical issues are at risk for problems and offer general advice that clinicians can provide for all travelers. We then consider the safety of travel for persons with preexisting conditions and describe an approach to evaluation and counseling. Although some issues covered in this review have relevance for people traveling on commercial aircraft when the cabin altitude at cruising elevation ranges from 1500 to 2400 m, depending on the distance traveled, 3 the focus throughout is on unacclimatized lowlanders ascending to terrestrial high altitude. Commercial flight for persons with medical conditions is reviewed elsewhere. 4 Pr e va l ence of Medic a l C ondi t ions a mong High-A ltit ude Tr av eler s Although the number of unacclimatized lowlanders with medical conditions who travel to high altitude is unknown, it may be relatively high because of the increasing number of older persons who travel to high altitude. Whereas only about 10% of trekkers in Nepal were over 50 years of age in 1992, 5 a more recent survey of 670 trekkers in the Solukhumbu region of Nepal showed that 47% were over 50 years of age and 15% were over 60. 6 Of the survey respondents, 33% reported preexisting medical problems. The most common conditions were hypertension (in 9% of the respondents), thyroid disease (in 6%), asthma (in 5%), and diabetes mellitus (in 2%), but a noteworthy finding was the wide spectrum of less commonly reported problems, such as inflammatory bowel disease, systemic lupus

High Altitude Medicine & Biology, 2015

Richalet, Jean-Paul, and François J. Lhuissier. Aging, tolerance to high altitude, and cardiorespiratory response to hypoxia. High Alt Med Biol. 00:000-000, 2015.-It is generally accepted that aging is rather protective, at least at moderate altitude. Some anecdotal reports even mention successful ascent of peaks over 8000 m and even Everest by elderly people. However, very few studies have explored the influence of aging on tolerance to high altitude and prevalence of acute high altitude related diseases, taking into account all confounding factors such as speed of ascent, altitude reached, sex, training status, and chemo-responsiveness. Changes in physiological responses to hypoxia with aging were assessed through a cross-sectional 20-year study including 4675 subjects (2789 men, 1886 women; 14-85 yrs old) and a longitudinal study including 30 subjects explored at a mean 10.4-year interval. In men, ventilatory response to hypoxia increased, while desaturation was less pronounced with aging. Cardiac response to hypoxia was blunted with aging in both genders. Similar results were found in the longitudinal study, with a decrease in cardiac and an increase in ventilatory response to hypoxia with aging. These adaptive responses were less pronounced or absent in post-menopausal untrained women. In conclusion, in normal healthy and active subjects, aging has no deleterious effect on cardiac and ventilatory responses to hypoxia, at least up to the eighth decade. Aging is not a contraindication for high altitude, as far as no pathological condition interferes and physical fitness is compatible with the intensity of the expected physical demand of one's individual. Physiological evaluation through hypoxic exercise testing before going to high altitude is helpful to detect risk factors of severe high altitude-related diseases.

Mayo Clinic Proceedings, 1998

Altitude-related illnesses are a frequent cause of morbidity and occasional mortality in travelers to high altitudes in the United States and throughout the world. The primary altitude illnesses are acute mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema. The pathogenesis of these syndromes remains unclear despite considerable research. Altitude also has potential deleterious effects on common medical conditions including coronary artery disease, pulmonary disease, hemoglobinopathies, and pregnancy. Most of these problems A n estimated 30 million people are at risk for altituderelated illnesses in the western United States annually.' Many cases are unrecognized by the victims and by their physicians who may attribute symptoms to viral illness, "hangover," or fatigue. In addition, commercial airline travel exposes passengers to a cabin pressure equivalent of 2,500 m and allows them to travel rapidly to highaltitude destinations such as Aspen or Steamboat Springs, Colorado, where they may be exposed to even greater altitudes. Approximately 20% of tourists to Colorado ski resorts (elevation about 3,000 m) will experience acute mountain sickness (AMS)2 in comparison with 67% of climbers on Mount Rainier (elevation about 4,500 m).' Approximately 0.01 % of tourists to Colorado ski resorts will experience the serious symptoms of high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE).4 In addition to AMS, HAPE, and HACE, other medical problems may occur in lowlanders who ascend to high altitudes, including peripheral edema, retinopathy, thromboembolism," disordered sleep, high-altitude bronchitis," snowblindness (ultraviolet keratitis), and exacerbation of chronic illnesses. CLINICAL FEATURES Acute Mountain Sickness AMS is the most common of the acute altitude illnesses. In most cases, the symptoms are nonspecific and include

The American journal of emergency medicine, 2009

Objectives: Previous analyses of physiologic parameter changes during ascent to altitude have incorporated small numbers of well-trained climbers. The effects of altitude illness are more likely to occur and may come to medical attention more frequently in unacclimatized recreational individuals. We sought to evaluate acute changes in physiologic parameters during ascent to high altitude (14 100 ft) in recreational climbers. Methods: We performed a prospective naturalistic study of 221 recreational climbers at Mount Shasta (peak altitude of 14 162 ft). Baseline vital signs were recorded at 3500 ft (blood pressure, heart rate, respiratory rate, pulse oximetry, and peak flow). Subsequent measurements were obtained at 6700 ft, 10 400 ft, and at the summit. Mean vital signs and the amount they changed with altitude were estimated using mixed linear models. Results: One hundred twenty-five climbers (56.6%) reached the summit. Heart rate increased and pulse oximetry decreased with ascent (mean, 71.9, 79, 97, and 102.4 beats/min and 96.9%, 93.9%, 88.8%, and 80.8%, respectively), with estimates at each altitude differing statistically at P b .0001. Mean systolic and diastolic blood pressures varied significantly by altitude (not measured at summit), but the changes were not monotonic. Peak flow progressively declined with ascent, but the difference between 6700 and 10 400 was not statistically significant. Respiratory rate did not change significantly. Conclusions: Acute compensation for altitude-induced hypoxia involves numerous physiologic changes; this is supported by our data that demonstrate significant changes in blood pressure and stepwise changes in pulse oximetry, peak flow, and heart rate. Consideration of these changes can be incorporated in future studies of the affect of altitude on recreational climbers. (A.M. Napoli).

2012

Background. The aim of this prospective observational cohort study was to investigate relationships between acute mountain sickness (AMS) and physical and mental health during a high altitude expedition. Methods. Forty-four participants (mean age, 34 ± 13 y; body mass index, 23.6 ± 3.5 kg·m 2 ; 57% male) completed the Dhaulagiri base camp trek in Nepal, a 19-day expedition attaining 5,372 m. Participants self-reported the following daily physical and mental health: AMS (defined by Lake Louise diagnosis and individual and total symptom scores), upper respiratory symptoms, diarrhea, and anxiety, plus physiological and behavioral factors. Results. The rate of Lake Louise-defined AMS per 100 person days was 9.2 (95% CI: 7.2-11.7). All investigated illnesses except diarrhea increased with altitude (all p < 0.001 by analysis of variance). Total AMS symptom score was associated with a lower arterial oxygen saturation, higher resting heart rate, more upper respiratory and diarrhea symptoms, greater anxiety, and lower fluid intake (all p < 0.02 by longitudinal multiple regression analyses). However, only upper respiratory symptoms, heart rate, arterial oxygen saturation, and fluid intake predicted future AMS symptoms [eg, an increase in upper respiratory symptoms by 5 units predicted an increase in the following day's AMS total symptom score by 0.72 units (0.54-0.89)].

Wilderness & Environmental Medicine, 2017

Objective.-To continuously monitor oxygen saturation (SpO 2 ) by pulse oximeter and assess the development of acute mountain sickness (AMS) using the Lake Louise Score (LLS) during ascent from 1154 to 4559 m in 2 groups of subjects: 10 moderate-altitude residents (MAR; Z1000-r2500 m) and 34 low-altitude residents (LAR). MAR are reported to have a lower incidence of AMS during ascent to higher altitudes compared with LAR. Whether this is related to higher SpO 2 is still open to debate.

Annals of internal medicine

Objective: To determine the incidence of acute mountain sickness in a general population of visitors to moderate elevations, the characteristics associated with it, and its effect on physical activity. • Design: A cross-sectional study.

Journal of Travel Medicine, 2011

This survey evaluated the prevalence of cardiovascular diseases (CVD) among high-altitude mountaineers (n = 473). The prevalence of CVD amounted to 7.4% and increased with age. Hypertension was the most frequent type of CVD. However, the recorded frequency of CVD in high-altitude mountaineers is lower compared to hikers and alpine skiers. M ountain sports have become very popular, and the number of tourists visiting altitudes above 2,000 m worldwide is estimated to be more than 100 million per year. 1 The majority of them perform alpine skiing or hiking. High-altitude mountaineering represents a further popular mountain sport in high mountain areas. High-altitude mountaineering in this article is defined as (1) ascending on foot to altitudes >3,000 m and (2) crossing glaciers using harness, rope, and, if necessary, crampons. High-altitude mountaineers hike on trackless terrain (eg, snow, rocky passages, and glaciers) with rather heavy equipment. The characteristics of high-altitude mountaineering challenge the technical skills and endurance of the participants and can elicit high exercise intensities. Therefore, high-altitude mountaineering has to be distinguished from other mountain sports such as alpine skiing, hiking, or ski mountaineering. High-altitude mountaineering is associated with manifold risks (eg, slips and falls, breaking into crevasses), but about 50% of all fatalities during mountain sport activities are sudden cardiac deaths. 2 Although sojourns at moderate altitude are well tolerated by persons with cardiovascular diseases (CVD), 3 preexisting CVD are associated with an The results described in the article have been partly presented

High Altitude Medicine & Biology, 2009

Blood pressure responses in young adults first exposed to high altitude for 12 months at 3550 m. High Alt. Med. Biol. 10:329-335, 2009.-To determine the changes in blood pressure (BP) and related variables in sea-level young adults with chronic exposure to high altitude, a longitudinal study was performed in male army recruits (n ¼ 346; age 17.9 AE 0.1 yr; BMI, 22.5 AE 0.3 kg=m 2 ) first exposed to 3550-m altitude for 12 months. Fifty male recruits (age 17.8 AE 0.6 and BMI 22.6 AE 0.3 kg=m 2 ) never exposed to altitude were used as controls. A sustained higher mean diastolic BP (DBP) (82.1 AE 1.0 mmHg at month 3; 81.3 AE 0.9 mmHg at month 12) was observed, compared to first exposure and the control group ( p < 0.001). The BP values were always higher than those of the sea-level control group (systolic blood pressure (SBP) 109 AE 2.3 and DBP 67.4 AE 0.8; p < 0.001), and a large proportion of subjects steadily presented overoptimal values for either systolic BP (SBP) (64%) or DBP (77%) and hypertensive DBP values (40%). The higher DBP was associated with lower Sao 2 (OR ¼ 0.919; p < 0.05). In addition, the acute mountain sickness (AMS) score showed a slight decrease during re-exposure (3.9 AE 0.3 vs.3.4 AE 0.3; p < 0.001) and an inverse association to the before-descending Sao 2 at month 3 (OR ¼ 0.906, p < 0.01). These data suggest that BP stabilization can take longer than currently thought and that each parameter has a different profile of change. Further, a sustained high DBP should be a matter of epidemiological concern and emphasizes the need for BP monitoring among young lowlanders exposed to high altitude.

Annals of Internal Medicine, 2004