Over the years, I’ve been lucky enough to live and work in some of the world’s most fascinating places. I spent a decade in Papua New Guinea, and I’m currently writing this from Fiji, watching the sun dip below the horizon after a day of diving. Travel, to me, is one of life’s greatest teachers—opening our eyes to new cultures, landscapes, and histories.
But it’s not without its challenges. And one of the more complex issues I’ve encountered as a travel doctor involves older travellers—specifically those living with dementia or early cognitive decline—and a phenomenon known as sundowning.
This blog is part reflection, part practical advice, sparked by an in-flight experience that’s stayed with me.
A Flight to Dubai and a Man in Distress
It was a long-haul flight from Sydney to Dubai. The usual call went out over the cabin PA: “Is there a doctor on board?”—a phrase no one ever wants to hear at 40,000 feet.
An older man, confused and agitated, was attempting to open the aircraft door. He didn’t speak English, and I don’t speak German, which made communication challenging. Thankfully, another doctor onboard, a German-speaking obstetrician, responded too.
What followed was a 13-hour stretch of gentle distraction, reassurance, and monitoring. We walked laps of the cabin. We calmed him through visible distress. It was exhausting, but necessary.
This wasn’t simply an unruly passenger—it was sundowning.
What Is Sundowning, and Why Does It Matter for Travellers?
Sundowning refers to late-day confusion and agitation experienced by people with dementia. It can happen on the ground, but the disorientation and sensory overload of international air travel can make it significantly worse.
For travellers with mild memory loss, diagnosed dementia, or even just slowed cognition due to ageing, the unfamiliar sights, sounds, time zones, and low lighting on planes can be incredibly destabilising.
And that’s where travel health advice becomes essential.
How You Can Help an Older Traveller Prepare
I’ve drawn on advice from the US Alzheimer’s Association and added my own experience to the mix. If you or a loved one is over 65 and planning travel—especially long-haul flights—consider the following:
Prepare with Your GP
Before booking, visit your regular GP. A good travel medicine doctor will ask memory-screening questions and assess overall health. Some travellers may need a more in-depth check before being declared “fit to fly.”
Minimise Stress and Overstimulation
- Request aisle or extra-legroom seating.
- Travel with familiar comforts (iPads with TV shows, family photos, books).
- Inform the airline and cabin crew in advance—they can help, and early rapport goes a long way.
Be Strategic About Your Itinerary
- Avoid back-to-back flights when crossing time zones. Stopovers (e.g. Hawaii en route to the US) can ease the adjustment.
- Daytime flights often work better than overnight ones. Artificial cabin lighting during night flights can worsen confusion.
Encourage Movement and Hydration
- Walk the cabin during flight if it helps reduce restlessness.
- Stay well-hydrated (and no, alcohol doesn’t count).
- Encourage rest before and during the flight.
Plan for the Unexpected
Airline medical kits are surprisingly basic—even on the A380 I was on, there was little appropriate medication for confusion or agitation. If someone you care for has dementia, speak to a doctor ahead of travel about what might be needed in-flight.
Destinations Like PNG and Fiji Still Need Medical Planning
Papua New Guinea—where I lived for ten years—is breathtaking. From its wild rainforests and mountain ranges to its fascinating cultural diversity (over 800 language groups!), it’s truly worth the visit. But PNG also comes with serious health risks, such as malaria, that require proactive planning and vaccinations.
Even “safe” destinations like Fiji can bring unexpected medical complications—whether it’s a mild stomach bug or a more serious issue. That’s why travel health advice matters no matter where you’re going.
Helpful Resources for Families and Carers
If you’re supporting a parent, spouse or loved one with dementia in planning a trip, I recommend the following:
Final Thoughts: Prevention is Better Than Panic at 30,000 Feet
I share this story not to dramatise the situation, but to highlight the importance of preparation. That passenger on my flight to Dubai was lucky—there were two doctors onboard, one of whom spoke his language. But that won’t always be the case.
If you or someone close to you is travelling with dementia—or even subtle signs of cognitive decline—please take the time to seek professional travel health advice. It can make all the difference between a stressful ordeal and a smooth, enjoyable journey.
Visit your local TMA clinic to speak with an experienced travel doctor. We’ll help you navigate everything from memory checks to vaccinations and ensure your travel plans are medically sound.
Safe travels,
Dr Daniel Priest
Travel Doctor – TMA
P.S. I recently visited Prague—absolutely worth the hype. The castle, the fruit markets, and the illusion museum were all highlights.