I agree: when a client with dementia needs to be relocated over a large distance to be closer to family, or for admission into a specialized care home, travel planning is not that straight forward. Especially if the journey involves one or more long haul flights, there is a list of potential challenges to consider. Needless to say that the better prepared you are, the greater the chance that your mission will not only be a success, but also an enjoyable experience for your client.

As a flight paramedic and professional travel companion on commercial flights, part of my job is to facilitate safe and comfortable transfers for people with dementia. I have found that being mindful about your choices, early on, when you are booking the flights, can make it so much easier for everyone involved.

Trust me on this one: ultra low cost carriers can be awesome for some, but certainly not for travelers with dementia.

– Rudy de Kort

Be picky about different flight options

As more flight options are becoming available this summer, it gets easier to pick an itinerary that will increase the chances of a smooth journey.

Let the flight fit your schedule and not the other way around. You already know at what time of the day your client functions best. So, do you want to avoid the exhaustion of a long travel day? Start in the early morning and take the first flight out. But if your client is not a morning person and needs a slow start with no pressure, pick an evening flight. If you want to reduce confusion and disorientation, don’t pick a red eye flight if you also have daytime options. Trans-continental flights into the East and the West will inevitably cross time zones: plan for this, by getting anxiolytics or melatonin prescribed.

Sometimes organizing a ground transfer to an airport further away is worth considering, instead of taking a terrible flight out of the closest hub. Also trust me on this one: ultra low cost carriers can be awesome for some, but certainly not for travelers with dementia!

If an itinerary involves a stopover, try to book a single ticket for all flights with airlines that are partners in an alliance, like SkyTeam, One World or Star Alliance. Do it for two reasons:

The first is to avoid the rush to get from one terminal to another in a limited time frame, as airline partners typically share the same terminal at an airport.

The second is to avoid getting stranded if a flight is delayed or cancelled and your client misses a connection. If this happens, the airline will offer an alternative solution, whereas no responsibility will be taken for a missed connection with the competition.

Manage your transits

If the itinerary includes an overnight layover or a long transit of a few hours, it’s not necessarily a problem. A layover can be the perfect opportunity to catch some sleep and have a shower at an airport hotel. It’s a different story if there is a long stopover during the day, and your client has to stay in the terminal. That is the perfect recipe for fatigue to kick in, with the associated increase in confusion and irritability. Now it gets tricky to manage behavior that can easily be misunderstood in an environment where everyone is hypervigilant to potential safety threats.

There is also the increased risk of your client having little accidents that will require a change of clothes, be it incontinence or food spills. So, make sure you don’t overlook the time that is spent at an airport between flights.

Mind you, there is another way of looking at airport transits: if you can build in short stops up to three hours between flights, it could actually be an effective strategy to reduce stress. Your client now has the opportunity to slow down, take a break and adapt to all those rapid changes that are typical for any large airport. Instead of grabbing a quick bite to eat on the go, your client will now have a bit of time to stretch the legs, visit a proper washroom and look around and say - What do I actually feel like eating?

What you should definitely avoid at all cost, are tight connections of less than 90 minutes, especially during peak times. Even if there is a wheelchair attendant waiting at the gate, your client doesn’t need the extra stress of eventually running out of time to board the next flight.

Make the seat work for you

What type of airplane is operating the flight, and where your client sits in the cabin can often make or break a positive flight experience. Sometimes there is nothing that you can do to help: if a destination is only served by smaller commuter aircraft like the Dash-8, CRJ-regional jets or the Embraer-series, any seat is going to give that feeling of being stuck in a can of sardines. You can only do so much by choosing a window seat for some privacy, or an aisle for easy access to the lavatories.

Selecting an emergency exit row for the extra leg room is out of the question too, because anyone sitting in those rows need to be physically and mentally able to open the emergency exit an assist the cabin crew if there is an emergency evacuation of the aircraft. Even if you are able to select the exit rows online, it will be changed at the airport. I recommend the bulk head seat instead, but be prepared to share the row with young families who requested a crib for their baby.

How about seats in the back of the cabin? Those offer more privacy and they are also closer to the washrooms. But if you are hoping that your client will take a nap to kill a few hours, the back is not a great option either. There is a lot of activity and it gets pretty noisy. There are flight attendants who are working and talking in the galley, there are passengers who are going in and out of the lavatories, and as if that’s not enough, the back will also take more bumps during turbulence, compared to the middle or the front of the airplane.

You might be thinking that somewhere in the front of the cabin is practical, because your client will be among the first to get off the plane after landing. Don’t bother. Especially if you have also requested wheelchair assistance. Your client will be asked by the flight attendants to stay seated until everyone else has left. The ground staff will then come onboard and help your client get off the plane.

Even if there is no wheelchair involved, tell your client to take it easy when it’s time to deplane and wait until most of the passengers are gone. Here is why: on every single flight, as soon as the plane stops at a parking position, half of the people on that plane are going to stand up and try to leave, as if the plane was on fire. For your client it is going to be a lot of stress for nothing, trying to grab all belongings in limited space, while other passengers are being impatient in the aisle. So where to sit then? Anywhere in the middle really. Besides, you’ll only know after the flight if it was a good seat or not.

Pick the best cabin class for the trip

In a small commuter plane, it won’t matter what cabin class you book, but on a long-haul flight, the added comfort of premium economy or business class will prove to be a wise decision for any client who can afford it. Here is why: the challenges of aging don’t really combine well with the limitations of economy class. The space is just to tight to be comfortable, if your client is coping with reduced mobility and cognitive challenges. Economy is also busier, with more unwanted stimuli.

Plus, the expensive premium ticket will likely include extra perks like priority boarding, more luggage allowance, flexibility to make a change to the reservation without a penalty or even the option of getting the ticket refunded if the trip needs to be cancelled. Often the ticket will also include access to an airline lounge at the airport. So give it some thought!