Are assistance providers ready for our ageing population?

A holiday in the Australian outback can quickly become a serious and complex medical emergency.

Three months in the outback

From a road trip to a regional hospital, after spending three months caravanning with his partner, a man in his late 70s contracted a urinary tract infection. Within 24 hours, his condition worsened quickly: he developed a fever, low blood pressure, and acute confusion. He was admitted to a regional hospital, but his delirium lasted well beyond the first day. By the end of his week-long stay, he was severely deconditioned. His mobility declined, and his care team noted significant cognitive issues that had peaked during his acute illness.

More than “just dementia” – even as the infection cleared and his thinking improved, bedside assessments still revealed signs of cognitive vulnerability. The clinical team faced an increasingly common dilemma: was this simply reversible delirium, mild cognitive impairment, or the first clear indication of dementia?

For assistance providers, this kind of uncertainty impacts coordinators and insurers. It influences how we approach risk assessment, obtain patient consent, and ensure the practical safety of travel – especially when the patient’s long-term cognitive outlook remains unclear.

Planning a phased repatriation. With no local family nearby and his partner needing to stay with the caravan, the patient required a medical escort to return home. Due to his complex clinical condition and the distances involved, we arranged a staged transfer. Initially, a smaller aircraft flew him from the regional airport, connecting him to a larger wide-body aircraft for the international leg.

Assessing fitness to fly

Before wheels up, our pre-positioned medical team assessed his fitness to fly. First, the clinicians took a personcentred approach, aiming to understand the patient’s values and goals for his care during the journey home. Then they stabilised his medication regimen, optimised his hydration, set up mobility supports, and aligned the admission pathway with the receiving hospital back home.

This combination of clinical syndromes reveals several overlapping issues:

• Clinical risks:  Careful management of his hypotension, hypoxia at altitude, fall risk, pressure care, and pain on long flights

• Delirium triggers: Airports and aircraft environments are stressful, noisy, unfamiliar, and disruptive, which can overstimulate a vulnerable patient

• Medication strategy: We established clinical thresholds for escalating medication, ensuring targeted nonpharmacological interventions were always the first line

• Seamless continuity: Structured handovers were critical.

Get to know the person, not just the diagnosis

Ultimately, our most effective tool wasn’t pharmaceutical. The retrieval team took the time to learn about what mattered most to him. We found out he had spent decades working on a farm and was highly motivated to return to his animals. Whenever he became stressed or disoriented during the journey, talking about his farm served as the perfect anchor, reassuring him and gaining his cooperation. Never losing sight of the clinical assessment in those moments.

An ageing population

As the population ages and travel patterns change, more older travellers – often living with frailty or complex health histories - are embarking on their “trips of a lifetime.” The industry must be prepared for:

• Delirium that occurs during an illness or hospital stay complicates transport. Being conscious that incidental delirium in hospital stays increases dementia risk

• Fluctuating cognitive levels

• Complicated logistical loads span different aircraft types, care systems, and international borders

• The absolute necessity for retrieval pathways that actively manage delirium risks while preserving patient dignity.

The outcome – with a two-clinician medical team, the patient was safely repatriated and admitted to a hospital near his home. Three months later, he had regained his independence, and his cognitive function had significantly improved since the acute phase of his illness.

At Retrieval Medics International, we blend person-centred care and evidencebased clinical governance with accurate logistics and transparent communication. Preparing for an ageing population involves creating systems that handle complexity, predict delirium, and still deliver what matters most: quality care.