title: Older age, chronic medical conditions and polypharmacy in Himalayan trekkers in Nepal: an epidemiologic survey and case series.
abstract: BACKGROUND
  The number of tourists in Nepal doubled between 2003 and 2013 is nearly 800 000. With the increased popularity of trekking, the number of those with pre-existing medical conditions requiring access to healthcare is likely to increase. We therefore sought to characterize the demographics and health status of trekkers on the Everest Base Camp route in the Solukhumbu Valley. In addition, we report cases that illustrate the potential complications of an ageing and medicated population of trekkers with underlying diseases.
  
  
  METHODS
  Trekkers over 18 years were enrolled in a larger observational cohort study on blood pressure at high altitude at 2860 m. They answered a questionnaire regarding demographics, medical history and current medications. Acute medical problems relating to medication use that were brought to the attention of investigators were documented and are presented as case reports.
  
  
  RESULTS
  We enrolled 670 trekkers, 394 (59%) male, with a mean age of 48 years (range 18-76). Pre-existing medical conditions were reported by 223 participants (33%). The most frequent conditions included hypertension, hypercholesterolemia, migraines and thyroid dysfunction. A total of 276 participants (41%) reported taking one or more medications. The most common medications were acetazolamide (79, 12%), antihypertensives (50, 8%) and NSAIDs (47, 7%), with 30 classes of drugs represented. Excluding acetazolamide, older trekkers (age >50 years) were more likely than younger ones to take medications (OR = 2.17; 95% CI 1.57-3.00; P <0.05). Acetazolamide use was not related to age.
  
  
  CONCLUSIONS
  Our findings illustrate a wide variety of medical conditions present in trekkers in Nepal with wide-ranging potential complications that could pose difficulties in areas where medical care is scarce and evacuation difficult. Our cases illustrate the potential problems polypharmacy poses in trekkers, and the need for local and expedition healthcare workers to be aware of, and prepared for the common medical conditions present.
authors: Department of Emergency Medicine, University of Colorado, Aurora, CO, USA Longmont United Hospital, Longmont, CO, USA linda.keyes@aya.yale.edu.
authors: Linda E
authors: LE
authors: Keyes
authors: Family Medicine Residency of Idaho, Boise, ID, USA University of Washington School of Medicine, Seattle, WA, USA.
authors: Luke
authors: L
authors: Mather
authors: University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA.
authors: Charles
authors: C
authors: Duke
authors: Mountain Medicine Society of Nepal, Kathmandu, Nepal.
authors: Nirajan
authors: N
authors: Regmi
authors: Department of Emergency Medicine, Dalhousie University, Halifax, NS, USA.
authors: Benoit
authors: B
authors: Phelan
authors: Mountain Medicine Society of Nepal and Khunde Hospital, Kathmandu, Nepal.
authors: Sushil
authors: S
authors: Pant
authors: Department of Emergency Medicine, University of Colorado, Aurora, CO, USA Colorado Permanente Medical Group, Saint Joseph Hospital, Denver, CO, USA.
authors: Jennifer
authors: J
authors: Starling
authors: Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors: Matthew
authors: M
authors: McElwee
authors: Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors: Devlin
authors: D
authors: Cole
authors: McGill University, Montréal, Canada.
authors: Theodore
authors: T
authors: McConnell
authors: Mountain Medical Society of Nepal and District Hospital, Dhading, Nepal.
authors: Purshotam
authors: P
authors: Paudel
authors: Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.
authors: T Douglas
authors: TD
authors: Sallade
authors: Longmont United Hospital, Longmont, CO, USA.
authors: Alison
authors: A
authors: Sheets
authors: Department of Emergency Medicine, University of Colorado, Aurora, CO, USA.
authors: David
authors: D
authors: Twillman
authors: Department of Emergency Medicine, University of Colorado, Aurora, CO, USA.
authors: David S
authors: DS
authors: Young
authors: Oxford University Clinical Research Unit-Nepal, International Society of Mountain Medicine, Mountain Medicine Society of Nepal, Kathmandu, Nepal Himalayan Rescue Association, Kathmandu, Nepal.
authors: Buddha
authors: B
authors: Basnyat
mesh_terms: D000328:Adult; D000532:Altitude Sickness / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009051:Mountaineering / Q000706:statistics & numerical data*; D009390:Nepal; D009784:Occupational Diseases / Q000453:epidemiology*; D019338:Polypharmacy; D012307:Risk Factors; D012651:Self Medication; D055815:Young Adult
keywords: Aged; Nepal; South Asia; Travel medicine; chronic medical conditions; high altitude; medication adverse effects