Older age, chronic medical conditions and polypharmacy in Himalayan trekkers in Nepal: an epidemiologic survey and case series

Background The number of tourists in Nepal doubled between 2003 and 2013 to 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. Additionally, we report cases that illustrate the potential complications of an aging 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 2,860 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 greater than 50 years) were more likely than younger ones to take medications, (OR = 2.17; 95% CI 1.57-3.00; p 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.