Multiday Hiking for Seniors Part 2: Managing Health and Chronic Conditions
Atop the Acropolis, Tasmania, and my first multiday hike without wearing a breast prosthesis. All physical health challenges contain a psychological component and your best chance of success comes when you manage both.
You’re an older hiker, you’ve read Part One, and now think that a multiday hike is definitely doable! But you have a few other health niggles: how will they impact your hike? What issues can you control to ensure you have the best possible experience?
We can’t possibly cover every chronic condition but rest assured that, for very many of them, someone with the exact same thing has done a multiday hike!
12. Stay Well Hydrated
Staying well hydrated while enjoying the views on the Laugavegur Trail in Iceland
Proper hydration cures a multitude of ills and is worth managing well, but the switch regulating hydration by telling us that we are thirsty also gets stickier as we age. Not only that, the diuretic medications many of us are on result in faster dehydration – another reason to check with your doctor before starting something new.
How often have you reached camp and realised you haven’t peed since breakfast? Or your pee is dark yellow? People who squat to pee are less likely to notice this, but it’s worth leaning forward to look. Pee should be a pale straw yellow, with only a hint of colour.
Proper hydration improves heat regulation, energy levels, circulatory and kidney health, and numerous other bodily functions. It improves muscle recovery and aids healing: I always struggle in heat, but feel much worse when poorly hydrated.
Camelling up upon rising, well before you begin hiking, helps, as does drinking water regularly throughout the day. One of the most useful changes we made to our hiking practice was a five minute break every hour, because it reminded us both to have a drink.
Assessing water supply points in dry environments is essential during planning so you neither dehydrate nor carry more water than necessary. Many modern hiking apps include water points, or you can try relevant hiking groups, forums and clubs for people who have recently completed the route.
We older folk need to drink before we are thirsty. This means good hydration the night before and yes, unfortunately that usually also means a midnight pee trip... or two, or three! Although minimising fluid intake two hours before bedtime helps, under-hydrating during the day because you don’t want to get up during the night is a really bad idea!
A number of P-style device designs are available. If you have trouble squatting, don’t give up if the first kind doesn’t work; try a different brand. (Image www.thepstyle.com/)
Older hikers who possess a prostate are likely to need more night time pees than younger ones. Pee bottles (clearly marked!) for people with a penis, with the addition of a P-style device for people with vaginas, are worth a try if you hate the idea of multiple visits outside the tent. You should definitely practise at home first: some brands don’t handle Niagara Falls as well as others! Urination devices are also handy for those who find squatting difficult due to creaky joints: you simply unzip your pants (some people need to pull them down just a little) and pee standing up – convenient and easy!
If peeing outside and not using a pee rag, those who squat should have a Ziploc bag ready beside their toilet paper, hand sanitiser/water and head torch so that, when you get up during the night, you can pop the used paper straight into the bag. It’s best to do this during the day too and to carry out your used pee paper, rather than burying it.
The Kula cloth, an excellent LNT and sustainable, convenient and surprisingly hygienic alternative to pee paper. Once you’ve tried them, you’ll never go back to pee paper. (Image credit Kula)
If hiking in wet weather, some people swear by lightweight umbrellas for toilet stops: no need to don raingear at night, and you stay dry even with your pants down!
Caffeine can have a diuretic effect if consumed in large quantities - 500mg/day, or equivalent to around 4-5 strong coffees - but moderate consumption is fine. Consult your doctor if you’re also on diuretic medication. For those who read our trip reports, you’ll know we love our cuppas, but we always just wave the teabag over the water. If tea or coffee makes up a significant part of your fluid intake, keep doing so if stopping means you’re likely to drink less. And of course, if you’re having trouble sleeping in your new environment, limit these drinks after midday.
Geoff and I love our cuppas. It’s the first thing that happens when we get into camp for the night!
When you hike for an hour or two, or in cool weather, it’s easy to stay hydrated, but you need more water than you think when hiking all day for consecutive days. In hot weather, you also lose more salts through sweat.
Water is sufficient in most situations, and most people get plenty of electrolytes from the food they’re eating, but electrolyte drinks can help replace lost minerals on longer, strenuous hikes in hot weather, especially if you find yourself overly fatigued for the level of exercise you’re doing, or your muscles are more sore than expected the next day.
Geoff’s shirt showing salty tide marks after a hot three day hike in the Gammon Ranges
Choose hydration supplements carefully – many are loaded with sugar but not much else. If you need to replenish both, this may be useful in some situations, but ask your pharmacist to check their ingredients if you’re curious. If you’re on any medications, always check with your pharmacist, because potassium and other ingredients in electrolyte drinks can interact with them.
You may prefer to manage sugar and electrolyte balance separately, rather than using supplements that contain both.
Leisurely older hikers are much less likely to need the same level of electrolyte replacement as professional athletes like marathon runners, but Geoff and I use the sugar-free Bix Recovery Supplement at the end of the day when we get into camp. If you’re sweating a lot and drinking a lot of water, Bix Active and Hydralyte are other alternatives but are higher in potassium, so unsuitable in combination with certain medications.
Always check with your own pharmacist or doctor if you have any chronic condition or are taking medications before adding electrolytes to your daily hiking routine (Image credit Bix Hydration).
Gear Skeptic has in depth, detailed videos on Hydration and Electrolyte Balance.
13. Ensure Good Nutrition
As always, diet is a highly personal thing and what works for one may not work for another. Be flexible and try new approaches if what you’re using isn’t working for you. Having said that, certain generalities hold true for many.
Older hikers often lose their appetite while hiking (although Geoff certainly never loses his!) so ensure you carry high calorie, nutrient dense foods. Regular snacks keep those muscles fuelled.
Good food is heavy and on long distance hikes or hikes lasting more than ten days it can be tempting to take heavily processed junk food loaded with fat, salt and sugar. This is a poor choice for those who already have hypertension, high cholesterol or pre-diabetes, but can be perfectly okay for others to get the calories they need for multiday hiking. On long multiday hikes and especially thru-hikes, dehydrating your own food or choosing healthy commercial brands is important.
Two minute noodles are the staple of hikers everywhere and are okay for a day or two, but most older folk will do much better with a bit more protein on extended multiday hikes.
On the other hand, eating simple sugars such as snack bars during vigorous exercise is less likely to cause a blood sugar peak, and good fats can provide essential calorie boosts on long distance hikes.
Sports dietician Erin Colebatch points out that snack bars vary hugely in their nutritional content. Added sugar is not a great choice outside of exercise but can be a really useful way to maintain glucose levels on long days. Also, some people get gastrointestinal issues if relying on lots of high-fibre, high-volume carbohydrate sources during exercise. Therefore, check with your dietician if this is relevant to you and be guided by their dietary advice. Stay tuned for our post on Nutrition for Older Hikers!
If you’re carrying dehydrated food, do a test run at home: some people find certain meals or brands cause tummy upsets. Always fully rehydrate meals for the recommended time: we now soak our own home dehydrated meals for 25 minutes, which thankfully eliminates the eye-watering effects on Geoff’s digestive system!
As testosterone levels drop with age, particularly in older women who have lower levels to begin with, plus a decrease in oestrogen, our ability to build muscle decreases. A correct balance of proteins, carbs, fats, minerals and vitamins is less important on short day hikes, but becomes increasingly important the longer the hike.
Because everyone’s diet and body is different, we highly recommend that you consult a sports dietitian if you are an older person planning a long distance thru-hike that will last several months.
Two minute noodles with dehydrated vegetables plus chicken mince (dried tofu, jerky, bean curd sheets, miso and edamame are other terrific additions).
A lack of protein combined with inadequate calorie intake on a long thru-hike meant that Geoff lost a large amount of muscle mass, whereas I lost weight but gained little strength: those famous “trail legs” never really happened for me and I assumed this was an inevitable effect of ageing. I was wrong. After consulting Erin upon our return and altering my diet, I gained more strength and stamina in five weeks than I had on the entire trail. I was gobsmacked by the impact. We’ve since tweaked the recipes on our website, and now also take protein supplements on multiday hikes.
Erin says,
“Radix meals are a good commercial freeze-dried option for many hikers as they provide higher amounts of protein which is necessary for older people, especially if they are highly active. Another key issue I find with pretty much all athletes (yes, hikers are athletes too!) is that they seriously underfuel total calories and carbohydrates. If this is not addressed, the protein consumed will end up being used for energy, rather than repairing damage to muscle and other tissues. It is a logistical challenge with limited cooking and storage facilities and the weight of food and fluid in your pack. But it can definitely be done with practice and good planning!” Geoff and I prefer our own dehydrated meals but, for those who don’t, it’s worth reading the ingredients list on commercial packs.
Although your diet over several days is unlikely to impact your health long term, a thruhike of many months is different. If, as for most long distance hikers, your diet is low in fresh fruits and vegetables, consider multivitamin tablets for the duration. Before starting any new medication such as multivitamins, check in with your doctor or pharmacist if you have any chronic conditions.
See also Gear Junkie’s excellent, in-depth videos on nutrition:
Performance Nutrition for Backpacking, Part 1: Optimal Trail Fuel
Performance Nutrition for Backpacking, Part 2: Optimal Hike Recovery
Planning an Ultralight Backpacking Menu for Optimal Trail Nutrition
A lunch stop with a friend, tuna and Geoff’s home-made sourdough crackers
14. Pulling in at the Train Station, aka Poo Stops:
Many hikers, not just older ones, lose their appetite when hiking and develop gut issues. Drinking less, exercising more and eating dehydrated food can cause constipation and gut irritability, both of which are uncomfortable, sometimes very much so. If this is something you’re prone to, stay well hydrated and eat smaller amounts more often throughout the day. For constipation, include prunes daily as snacks and always go when the need strikes rather than holding on. Include Laxettes (for constipation) and Imodium (for diarrhoea) in your first aid kit.
Those with creaky knees and hips may find squatting for a time uncomfortable. There are several ways to poop in the woods other than squatting. One of the best is sitting on a log or rock with your butt hanging over the back. Alternatively, you can lean back slightly and use your hands to help support your weight, or grab hold of a sapling in front of you. Experiment to see what works best (and make sure the sapling is strong enough, or things will go horribly, horribly wrong!).
15. Calcium and Bone Health
Consult your healthcare professional: as an older hiker, you may need calcium tablets, or plan your pack weight or for tricky terrain if you have osteopenia or osteoporosis. Ensure your daily calcium intake is adequate, especially on thru-hikes where your diet may be lower in dairy and leafy greens for months on end, so it’s tricky to get sufficient from your meals. High-calcium foods suitable for hiking include
white beans (great dehyhdrated with spices as hummus)
almonds
whey protein
milk powder
hard cheese, freeze-dried cheese, shelf-stable parmesan
sardines
home dehydrated wing beans
fortified or calcium-set tofu (can be dehydrated at home)
fortified breakfast cereals
fortified tuna (can be dehydrated), or try the version in olive oil for more calories
roasted or dehydrated edamame
dried figs
wakame (great added to soup)
sesame seeds
16. Listen to Your Body
If your body tells you something, listen. Take a rest or regular breaks, particularly on thru-hikes: hourly is ideal. Sit down, take off your pack, have a drink. On this website, we are not in a hurry!
Cooling tired feet in an icy stream, New Zealand
Your body recovers less quickly nowadays too, so give it time not just during a multiday hike, but afterwards as well. We all learn to live with little aches and pains as we age, but you almost certainly know by now that acute injuries can become chronic if ignored. If something feels off, deal with it at the first opportunity. Some injuries, such as minor muscular and tendon issues or medical conditions can wait till you get home from a multiday hike, or until you see a pharmacist in a nearby town, but others may need addressing sooner.
17. Medical Emergencies
You’ll certainly be carrying a PLB and/or a satellite messenger if you’re hiking solo and/or remotely and, though these are used most often for hiking accidents, they are equally valid for medical emergencies.
Satellite messengers such as the Inreach that allow two-way communication may be preferable to a PLB, especially if you think you might be reluctant to press the SOS in case it’s a false alarm. Being able to describe your symptoms with a medic at the other end will determine whether you need evacuation without second guessing yourself.
My camera on my left shoulder, and the tiny Inreach mini on my right above the shoulder pouch. The Inreach is like a satellite phone, using text instead of voice. You can text friends and family, download weather forecasts and, of course, there’s the SOS button. Once you’ve pressed it, you have two-way comms to explain your symptoms.
Here are situations when you press that SOS button immediately (the equivalent of calling Triple 0).
If you or your hiking partner are experiencing any of the following:
central or crushing chest pain lasting more than 10 minutes
unconsciousness or a seizure (fit)
severe difficulty breathing or turning blue at lips and nail beds
severe bleeding or inability to control bleeding with pressure
sudden inability to move or speak, or sudden facial drooping
the effects of a severe accident.
sudden significant changes in vision, especially if you are short-sighted
confusion, disorientation: these can all have serious causes that a lay person can’t diagnose. Press that SOS button.
heat stroke; also heat exhaustion if patient is vomiting or not recovering after first aid
blood in the urine (very dark or discoloured)
Often, though, you may be in a more ambiguous position. Should you press that button, or not? This excellent blog explains very clearly when to press that SOS button in less obvious situations.
This hiker required a medical evacuation on the Bibbulmun track and was choppered out.
18. Communicate
If you’re on any medications for chronic conditions, tell your hiking partner about them, where your meds are stored in your pack, as well as relevant symptoms. This is no time for false pride or reticence. And it is important to be honest and transparent with a hiking buddy so there are no scary surprises that might put both of you or your relationship at risk. Wear a MedicAlert bracelet on hikes if hiking solo. Fill out medical details on your PLB and Inreach plans and notify your contacts of medical conditions.
Medic Alert bracelets and pendants are practical and useful if you have a life-threatening condition, or one that first aid respondents or subsequent carers need to know when you are unable to tell them.
( Image credit Medic Alert)
19. Managing Serious Chronic Conditions, especially on Long Distance Thru-Hikes
First, discuss with your health professional. If you very much want to try a multiday hike and your professional is enthusiastic, go. If your health professional is negative, consider getting a second or third opinion. If it is split, or your health professional(s) are ambivalent, then it is your choice. A good doctor will help you achieve your goals in ways that are most advantageous to your health. They will also be aware of resources to help you manage your condition on long distance hikes.
Whatever your condition, you will need to own it: this is no time to be a passive recipient of healthcare, but to be a proactive participant. Understand your condition inside out: inform yourself so that you can make sensible decisions on the track.
Many people hike with a chronic condition such as diabetes, but it needs to be well managed. Other diseases, such as chronic inflammatory ones (lupus, rheumatoid arthritis, fibromyalgia and many others) may flare up when you change your daily routine, or subject your body to new or challenging experiences.
If your consultations with your health professionals have resulted in a “your choice” situation, you have a decision to make and that may be more difficult than the actual hike. The fear of a painful flareup has the potential to circumscribe your life more than the flareup itself, but you are the only one who can count the cost.
Ask yourself:
Which would I *regret* more in five years’ time: going and getting a flare up, or not going at all? Not the regret while I’m in the flare up, but in the years afterwards. It’s often the things we don’t do that we regret the most, rather than the things we do.
Is a flare up longterm, permanent or temporary? Expensive? Difficult to resolve? Horrifically painful? Equally likely to happen at home?
Are there implications for my employment? Personal relationships?
If I knew I was definitely going to get a flare up, would I still go? Some people might think it’s still worth it, and that’s another way to view the decision. It’s not only the walk itself that is precious, it’s the memories you build and they last a lifetime. Such experiential memories are priceless and often it is worth the effort and sacrifices to make them. On a thru-hike we met an amazing hiker who had a considerable degree of pain and discomfort but their joy in hiking outweighed that. Weigh up joy and memories, vs potential pain. There is much good medicine in following your dreams.
Will I be happy if I don’t complete the entire hike? If you approach your hike as enjoying each day, and making it about the journey rather than the destination, you will create numerous precious memories. If you focus only on that last Katahdin finish, it has the potential to devalue all that has come before. Yet the finish is nothing without the journey, or you would just drive the 3,500km (2,200mi) and climb the hill: it truly is the journey that’s important in long distance hiking. In that mind space, you won’t be disappointed however far you hike. And remember, you can most likely complete it later, in however many stages you want.
This image brings us both instantly back to an unforgettable pass in the Dolomites, Italy. We literally could hardly believe our eyes: a wonderful memory.
If you decide to go, you may need to organise or manage medications, especially those that must be kept cool. This is much easier in Australia and Europe with our public health systems, and where insurance is less of an issue than in the US.
Check your travel insurance for its ambulance cover and the rules that apply in the relevant country because they vary as to who foots the bill should you require evacuation or rescue in remote areas.
Options for managing medications and treatments include:
Prior arrangements with pharmacists near the track if they are otherwise unlikely to stock your medication
Getting long term prescriptions with multiple repeats
Cooling pockets to keep heat sensitive medications at room temperature
Asking your doctor to liaise with a prescribing pharmacist in a track town, so you can get your shot when you resupply on long hikes.
Arranging infusions or treatments ahead of time via your doctor with local clinics if you are far from home
Changing medication to ones that are less cold or heat sensitive (of course try this before the hike in consultation with your doctor)
Asking family members to post your medication if it has a limited shelf life when non-refrigerated.
On the trail, start slowly and increase very gradually so your body has time to acclimatise. Remain flexible. Stay in towns longer if necessary. Shorten days, skip overly difficult sections. Don’t push excessively. Listen to your body, even when it whispers. Deal with flareups if they arise. Enjoy each day.
Helen and Patrick’s Story
We would often pass each other having ‘second breakfast’ or lunch on the track. Here are Patrick and Helen enjoying a cuppa and Western Australia’s stunning southern coastline on the Bibbulmun Track
We met experienced hikers Patrick and Helen on the Bibbulmun Track and were particularly taken with their inventiveness, can-do attitude and the way they took ownership of and managed chronic conditions. Unsurprisingly, solid preparation and attention to detail were key components of their success.
Helen writes,
“My husband Patrick and I decided to train for, and then do, the Bibbulmun Track End to End as our lockdown project. We were 56 years of age.
“To overcome muscle imbalances, aches and pains, we engaged the advice of a physiotherapist one year before we planned to walk. The reason we chose Alex from Hexa Health Hub was based on references, his methodical approach and his positivity. His approach is to help the body heal itself with exercise. Yes, we were older and had gained souvenirs from previous adventures, e.g. I had had a disc bulge, nerve damage in my back and issues with my feet, but that was not a barrier. It just needed the appropriate training plan to manage.
“We got a training plan from him and stuck to it. We gave each other support and went to the gym religiously. We did a lot of whole-body exercises that worked upper and lower body at once.
“I also trained with Rowan from Summit Strength where I got hiking-specific advice on nutrition, managing injuries on the trail and gear. We also did a survival training weekend with the Bibbulmun Track Foundation. I visited my podiatrist to discuss my feet and pain management.
“By the time we went on the trail our bodies were strong and raring to go. I had developed strategies to manage my boot insoles and metatarsal support if the insole got wet or damaged: I had a spare insole, support padding and tape. In our resupply boxes, we had back-up everything. In the end we didn’t need most of it but it was good to know we had it.
Helen’s quick and easy DIY metatarsal dome.
“In my first aid I had anti-inflammatories, spare foam for my feet, lots of fixamol for running repairs as well as snake bite kit, antihistamines etc.
“I also got advice from people my own age who had done the hike. Biggest and best advice: take an extra day to rest in track towns. One day to wash etc, one day to rest properly, do yoga and massage with a ball. The second-best advice: weigh everything. I had done lots of hiking and thought I knew myself, food and gear. But planning for an end to end is very different. Suddenly, everything has to be carried and be useful for months, not days or even weeks.
“We also decided to stay at every hut. This meant that we could manage our fatigue and any aches. We knew that we could build up slowly without undue and unnecessary pressure. The Bibbulmum Track distances are terrific for allowing the slow build up. At either end of the track there are a lot of 10km day options. Then you slowly build up to 22-25km days in the middle sections. We felt that we had time to relax and enjoy our journey. Those hiking legs kicked in by day ten.
“My cork ball was my best friend on the hike. I massaged my feet, hamstrings and glutes every night. I stretched my calves, feet and glutes. In towns, I added in extra mobility stretches for back, glutes, and legs. I stress mobility as you do not want to over-stretch either.
“My only regret was not booking professional massages in the track towns in advance. They were all booked out when we arrived in town as this was peak season for both hikers and cyclists.”
Patrick and Helen, all smiles at the happy completion of their Bibbulmun Track E2E. Image credit Pat and Helen
Multiday hiking is enormously satisfying and empowering. Age in and of itself is no barrier. Hike on!
Many thanks to Community Health Nurse/avid hiker Teresa, Dr B, Paramedic N, and Sports Dietician Erin for checking multiple drafts.
Inspiring and Useful Links:
One of the most experienced, long-established providers of hiking information in Australia, Australian Hiker
Caro Ryan aka lotsafreshair
Dan Cousin’s website contains a wealth of information
Todd Dietz’s excellent video for thoughts on hiking from all age groups
