Received: 15 April 2018 Accepted: 18 July 2018

DOI: 10.1002/jtr.2232

RESEARCH ARTICLE

Definition of a new type of tourism niche—The geriatric

tourism
Stella Ioannis Tsartsara

Faculteit Geneeskunde en Farmacie,

Gerontology, Vrije Universiteit Brussel,
Brussels, Belgium
Correspondence
Stella Ioannis Tsartsara, Faculteit
Geneeskunde en Farmacie, Gerontology, Vrije
Universiteit Brussel, Brussels, Belgium.
Email: stsartsara@gmail.com
Abstract
In this paper, a new type of tourism, the geriatric tourism, will be initiated for further
research as a separate niche from health, medical, or wellness tourism, and it will be
proven that the most relevant active and healthy ageing and well‐being products
are touching upon more aspects than just wellness.
Geriatric tourism does not exist in bibliography nor to the market as such. The inno-
vative approach to the sales of the geriatric tourism packages is in the fact that geri-
atric tourism is promoted as a holistic approach of hospitality and possibly but not
necessarily, long term type of care to a person with multiple morbidity, frailty, and
possibly mild cognitive impairment while holidaying, however not for cure nor for care
but for leisure.
We will also prove that the term “senior traveller” based on any age limit above
50 years is not truly representative for any traveller's segment, as the same lifestyle
criteria for the intention to buy a certain tourism product also apply to other age seg-
ments as well. And that the only classification of the tourism segments above 65 years
as geriatric for the purpose of travel organization and management rather than mar-
keting can occur when the chronic conditions due to ageing are causing impairment
to a geriatric patient after chronicity onset but who has not nonetheless lost desire
to accumulate life experiences. This classification of the undistinguished so far seg-
ment to a geriatric one presupposes the existence of a support system at the destina-
tion, which is not the same as that of the medical or health tourism offer with the
intend to cure, but rather this of a long‐term care service.

KEY W ORDS

3rd age, active healthy ageing, geriatric tourism, health tourism, long‐term care, medical tourism,
quality of life, segment, senior tourism, subjective well‐being, wellness

1 | I N T RO D U CT I O N The stages of frailty are leading to some form of impairment when

Most people around the age of 50 start developing one or more
chronic conditions (Vogeli et al., 2007). The most usual multiple
chronic conditions are coronary disease and heart failure, blood
pressure, chronic obstructive pulmonary disease, diabetes mellitus of
type II, arthritis, osteopenia, forms of dementia, and musculoskeletal
problems that can lead to degrees of frailty impeding travelling for
leisure.
the condition is at early stage, later on at degrees of disability
compromising activities of daily living measured by the activities of
daily living (ADL) scale or eventually to different types of invalidity
depending on the disease and obstruction of quality of life and their
well‐being. This evolution plays a significant role in the intention to
travel (Erlandson, Schrack, Jankowski, Brown, & Campbell, 2014).
By well‐being, it is meant the subjective well‐being of a person in
the balance between external and internal factors determining the

Int J Tourism Res. 2018;1–4. wileyonlinelibrary.com/journal/jtr © 2018 John Wiley & Sons, Ltd. 1
2 TSARTSARA
level of their satisfaction, personal growth, and accomplishment (Gal-
lup Well‐being Index). Travel is an important factor for a person's
well‐being.
When this segment of 50+ with comorbidities travels exclusively
for elective health or wellness interventions they are travelling for
health or medical tourism.
The difference to the geriatric tourism and other similar types lies
on the willingness to travel, which is not for health reasons and the
product choice the segments after 50 years will make according to
their classification to various levels of frailty and impairment caused
by the evolution of their chronic conditions in time. However, people
with impairments due to chronicity are willing, and they continue to
travel provided that the right conditions enabling this are met at the
destination.
A tourist segment that is perfectly healthy and fit around 50 years
is very volatile and can change category abruptly, due to an incident
caused by the consequences of ageing, if the impairment caused is
permanent and severe such as in the case of a heart attack or stroke.
However, in healthy and active years, classifying the age group above
50 years under one segment as “seniors” does not represent the
reality to their capacities and level of frailty and impairment if this
exists at all.
1.1 | The difference of geriatric tourism with medical
tourism
The definition of medical tourism “as a concept it conveys both the
willingness to travel and willingness to treat as core processes
when consumers elect to travel across international borders with
the intention of receiving some form of medical treatment” (Lunt
et al., 2012).
The criteria for medical travel are in order of priority: technologi-
cal advances, better quality of medically necessary procedures, quicker
access to them, lower cost of these procedures, and lower cost of dis-
cretionary procedures (Lunt & Mannion, 2014). This is one of the main
factors that medical and geriatric tourism are not the same: the geriat-
ric patient travels mostly for leisure, away from hospital settings
(Masoud, Alireza, Mahmoud & Zahra, 2013).
Long‐term residents of a destination country that are mostly
above retirement age who are searching for new life experiences after
they retire would not be considered as “medical tourists.” EU citizens
over the last decades are retiring in countries other than their country
of social security provision, within the EU (Lunt et al., 2012). Those
long‐term residents will use health services reimbursed by the social
security system of their country of residence, their country of origin,
their own private insurance, or out of their own pocket but are not
travelling to a destination for health reasons.
Moreover, there is a distinction between medical and health
tourism in the types of intervention (biomedical vs. complimentary
medicine), in the facility setting (hospitalization vs. nonmedical facility),
and the care inputs (medicaments and surgery vs. other types of care).
The geriatric tourist may use the health tourism services such as
medical spa and rehabilitation if they are included in the travel offer;
however, they do not travel for health reasons primarily but for
leisure.
2 | I S R EA L L Y T H E S E G M E N T “S E NI OR
TOU RI ST” R E L E V A N T ?
In most people with chronic conditions, onset does not occur often
especially when they travel. Their condition when it is still at early
stages does not generate impairment, and it is manageable from them-
selves and their closest to them without compromising their quality of
life, and apart from occasional needs for care and health monitoring by
doctor, they are not considered as patients (Bernell & Howard, 2016)
but people with chronicity and their chronic condition is not consid-
ered an illness (Upshur & Tracy, 2008).
Before the age of 70 years, a limit after which travellers are not
insured during their travel and when this segment is not travelling
for medical reasons, acute or chronic, studies are arguing that the pref-
erences, motives, and principles of the segments of people above
50 years vary a lot not impeding classification of this segment under
one category. (Esichaikul, 2012).
Travel agents and tour operators treat this segment in marketing
and advertising with ageless (Greene, 1998) lifestyle criteria, princi-
ples, and motivations for travel.
There are some insurers that provide insurance to the age group
above 70 years, such as the SAGA Group in the United Kingdom
(https://www.saga.co.uk/), who are offering comprehensive lifestyle
package proposals to that age segment on the basis of health criteria,
offering solutions for exercising, healthy nutrition, leisure, and travel,
which is an important field for an active and healthy ageing (McPhee
et al., 2016) all in the sense to keep the person healthy and avoid unnec-
essary hospitalization. They call this type of tourism “Over 50s holidays.”
The segment from 50 to 70 years is mentioned as “senior” at the
bibliography for different socio‐economic reasons setting the limit at
50 years (Kim, Wei, & Ruys, 2003), at 55 years (Shim, Gehrt, & Siek,
2005), at 60 years (Horneman, Carter, Wei, & Ruys, 2002), and at
65–70 years (Zimmer, Braley, & Searle, 1995) without taking into
account that by categorizing different segments as “seniors” under one
age group they merge different lifestyle, physical, cognitive, and psycho-
logical conditions, something that might be even seen as stereotyping.
Another common characteristic in these methodologies is that the
authors do not mention what would be the results if they would apply
their methodological approach and surveys in younger age groups but
with same lifestyle criteria. The fact that tour operators are not
segmenting tourists of this age group by age but by lifestyle and travel
motivation choices may indicate that if younger age groups were also
included in the research groups, this would reveal similarities proving
amply that travel segmentation is done only by lifestyle criteria and
not by age and that the segment “seniors” in fact in healthy people
is not a representative term in the tourism industry.
This grouping of people after 50 years as “seniors” or “3rd Age”
where ageing happens at an individual and different pace is even more
problematic when the comorbidities start to provoke impairment or
even disability, creating not only an admitted segmentation problem
to the travel industry but also to the policy makers: How should we call
active and healthy people above a certain age especially after retire-
ment? The term applied by the American Medical Association is “older
person” or a “grown‐up” used by the American Association of Retired
Persons.
TSARTSARA
3 | DEFINITION OF THE GERIATRIC
T O U R I S M A N D T H E GE R I A T R I C T O U R I S T —
T H E DI F FE R E N C E I S A T T H E P R O D U C T
OFFER
After the age of 70 years, the tourist is faced with two important
phenomena that diminish sharply their intention to travel. The first is
a decrease in physical ability and subjective age plunge (Barrett
(2003) and the second that most insurers and operators do not insure
them anymore for travel. In daily living, depending on the severity of
their comorbidities and degree of impairment, this segment is consid-
ered in medicine as geriatric patients. Subjective age may provoke
such psychological frailty that may influence the otherwise good
physical ability, according to subjective perception of age changes.
This is the main differentiation of the geriatric tourism with others:
The geriatric tourism products and travel conditions would provide
assurance to the person who would not otherwise decide to travel.
The difference with medical and health tourism product offer has
been already stated: The geriatric patient is just in the need of some
sort of health monitoring and care support, neither for an elective
intervention nor for health rehabilitation or cure, but just for leisure,
and therefore can neither be considered as medical nor a health tour-
ism traveller. The point that differentiates sharply the geriatric tourist
than others is pricing. If price is at the end of the criteria to choose a
destination for medical or health tourism, it matters a lot for people
above the age of retirement, even more with frailty and impairment.
(Vigolo, 2017).
In geriatric tourism, travellers wish to enhance their physical and
mental health condition degraded due to ageing by rejuvenating experi-
ences but not necessarily treatments or wellness that might be included
in the offer but do not constitute the primary core product offer for
which they would travel and the motivation to travel does not really dif-
fer from the segment of same age (Darcy, 2010).
A geriatric tourist is then a geriatric patient with multiple
morbidities, with a certain degree of physical and psychological
frailty and possibly with mild cognitive impairment, which have
compromised its ability to conduct either advanced ADL (a‐ADL) in
full independence or instrumental ADL (i‐ADL) requiring some kind
of physical or mental support, with two significant characteristics:
This person's comorbidities are not in onset, and it is still capable
of mobility and with an avid desire to travel and live as much as
possible before the point where immobility becomes inevitable
and irreversible.
This definition of which aged group is geriatric and which is not
based on the level of impairment measured by ADL scale question
resulted from two anonymized surveys I conducted.
The first one was on the willingness to buy of geriatric patients
above the age of 50 and their motivation to travel, in 2015 and
2016 in a group of 100 habitants at the social housing block adjacent
to the Retirement Home and Care “Roger Decamp” in Evere, Brussels.
This social housing block was not dependent from the retirement
home organically nor organizationally. It is managed by social housing
cooperatives, and the care treatment of its habitants was provided by
various health professionals depending on the choice of each person
and their insurance type.
3
The four most important outcomes of this survey were the lower
price factor to book a travel, that they prefer to travel in groups, they
are interested in life enriching experiences, and they would be keener
to travel if a medically trained person was present at all times but dis-
creetly, during the journey to assure monitoring of their care plan
increasing their sense of safety in case of emergency in a remote area.
In another survey conducted at a destination during the summer
period of August and September 2017 to 150 people above 60 years
without apparent physical or motor impairment, at the Greek island of
Paros, the result was different. Not even one admitted that they
would need medically trained personnel to accompany them in their
travel, most them were fit travellers following an active and healthy
lifestyle.
The difference of the second survey group of Paros, to the
citizens of the social housing of Evere was their substantial income
and their general good health despite the presence of multiple but
latent chronic conditions, something that supports the thesis of other
researchers that income at this age increases the well‐being of their
subjective age (National Research Council US, 2001). Therefore, the
geriatric tourism offer may be addressed as well to social groups in
need of support in their travel more than other segments that can
pay out of pocket for this demand. Pricing, however, mattered to both
groups.
Another field that distinguishes geriatric tourism from other types
of similar tourism such as health and wellness is who provides the core
offer. Whereas the medical/health and wellness/medical spa tourism
product is provided by medical staffs, doctors, rehabilitators, nurses,
physiotherapists, therapists, exclusively, the geriatric tourism product
can be offered by travel agents and a nurse or just a medically trained
carer, who are also involved at the long‐term care provision of the
destination country.
Travel agents, however, do not seem willing to diversify their
products and address health needs of this segment due to the risk
and cost increase. The fact that insurance does not cover people
above 70 years of age simplifies their choice to restrict their target
audience. Some providers and insurers are trying to diversify their
offer to this segment, offering both insurance; however, there is no
provider that has incorporated possibility of health support during
travel.
The offer will determine the demand that will boost the rise of the
geriatric tourism and open new markets to this rapidly growing demo-
graphic group.
4 | ACTIVE AND HEALTHY AGEING/WELL‐
B E I N G P R O D U C T S A R E T HE BE S T SU I T E D
F O R G E R I A T R I C T O U R I S M — DI F FE R E N C E
WI T H WE LLNE SS P R O DUC T S
Well‐being as defined by the World Health Organization is a multifac-
tor state of mind, including health (Taylor et al., 2017), whereas well-
ness tourism services are mainly about health enhancement.
Although wellness provision can only be observed in a setting of a
spa resort or other facilities where wellness services are offered, well‐
being tourism products are related to the exogenous factors that
4 TSARTSARA
affect a person's well‐being: income, environment, social environment,
national attitude, religion/principles, and general good health that can
be included in packages of geriatric tourism but also to endogenous,
such as individual development activities, satisfaction from the life of
the person, and mental functioning. It is important to make this dis-
tinction as there are efforts in the market to distort the well‐being
methodology by monopolizing well‐being ecosystem's elements as
those of wellness, which is a contradiction in terms but also in
substance.
Well‐being tourists are people that pursue an active and healthy
lifestyle and are looking for experiences to submerge to a destination's
culture and tradition and prefer packages including a vast array of
well‐being activities including, or not, wellness, health improvement,
spa, and so on.
This kind of tourism offer exists but it should be marketed with
emphasis on general aspects this age group prefers such as safety,
learning, socializing, longer stays in a destination, slower pace of living,
and healthier living, along with other well‐being enhancing activities.
(Bausch, 2016).
ORCID
Stella Ioannis Tsartsara http://orcid.org/0000-0002-3638-1867
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How to cite this article: Tsartsara SI. Definition of a new type
of tourism niche—The geriatric tourism. Int J Tourism Res.
2018;1–4. https://doi.org/10.1002/jtr.2232