Geriatric-Tourism PMR and Thermal Treatments in The Third Age

University of South Florida (USF) M3 Publishing
Co-Editors
Dr. Levent Altınay
Business School, Oxford Brooks University, UK
Dr. Osman. M. Karatepe
Faculty of Tourism, Eastern Mediterranean University, North Cyprus
Dr. Muharrem Tuna
Faculty of Tourism, Ankara Haci Bayram Veli University, Turkey
ADVANCES IN MANAGING TOURISM ACROSS CONTINENTS

VOLUME 2
ISBN 978-1-955833-08-0
https://digitalcommons.usf.edu/m3publishing/vol16/iss9781955833080/7
DOI: https://www.doi.org/10.5038/9781955833080
Buyuk and Akkus: Geriatric-tourism, PMR, and thermal treatments in the third age
Co-Editors
Dr. Levent Altınay
Business School, Oxford Brooks University, UK
Dr. Osman. M. Karatepe
Faculty of Tourism, Eastern Mediterranean University, North Cyprus
Dr. Muharrem Tuna
Faculty of Tourism, Ankara Haci Bayram Veli University, Turkey
ISBN 978-1-955833-08-0
*Authors are fully responsible for corrections of any typographical, copyrighted materials,
technical and content errors.
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Assistant Editors
Dr. Alaattin Başoda
Faculty of Tourism, Aksaray University, Turkey
Dr. Seden Doğan, Faculty of Tourism
Ondokuz Mayis University, Turkey
Dr. Muhittin Cavusoglu
The W. A. Franke College of Business, Northern Arizona University, USA
Editor Assistants
Gokhan Sener
Faculty of Tourism, Necmettin Erbakan University, Turkey
Basak Ozyurt
Faculty of Applied Science, Trakya University, Turkey
Ipek Itır Can
Faculty of Tourism, Anadolu University, Turkey
Sinan Baran Bayar
Institute of Social Sciences, Kirklareli University, Turkey
ISBN 978-1-955833-08-0
https://digitalcommons.usf.edu/m3publishing/vol16/iss9781955833080/7
Geriatric-Tourism, PMR, and Thermal Treatments in the Third Age

Özge Büyük1 and Gülşah Akkuş2
1
Faculty of Tourism
Çanakkale Onsekiz Mart University, Turkey
2
Faculty of Tourism
İzmir Kâtip Çelebi University, Turkey
Abstract
This study aims to reveal the situation of geriatric-tourism (gerontourism) in Turkey with
longitudinal data obtained from digital and social media. As a result of the study i) geriatric-tourists
visiting Turkey mostly benefit from thermal treatments in complementary medicine and PMR in
traditional medicine, and also resort to hair transplantation among aesthetic interventions, ii) they
come mostly from Iraq and Libya (Middle East), Germany (Europe), Azerbaijan (the Turkic
Republics), and Ukraine and Russia (CIS), iii) they mostly prefer big cities such as Izmir, Ankara,
Istanbul, Antalya, Bursa, iv) motivation factors are cost, thermal resource richness, medical service
quality and additional touristic trips, and v) most of the social media sharing is done by travel
agencies and health institutions.
Keywords: geriatric-tourism, PMR, medical tourism, thermal tourism, third age tourism
Recommended Citation: Büyük, Ö., & Akkuş, G. (2022). Geriatric-tourism, PMR, and thermal
treatments in the third age. In L. Altinay, O. M. Karatepe, & M. Tuna (Eds.), Advances in
managing tourism across continents (Vol. 2, pp. 1–13). USF M3 Publishing.
https://www.doi.org/10.5038/9781955833080
Introduction
In an aging world, the life expectancy of the human population is also increasing day by day. Many
indicators point out that the life expectancy of adults has increased, and the age structure of the
population has changed in developed countries since the middle of the twentieth century. Today,
8% of the world's population is over 65 years old (Ritchie and Roser, 2019), and it is recorded that
the number of people reaching the age of 100 has reached the highest level in its history (Robine,
2021). The main purpose of the study is to determine the types of medical tourism that come to
the fore in relation to geriatric-tourism and the relationships between them. After the main
difference between 3rd age tourism and geriatric-tourism was revealed, the effects of physical
medicine and rehabilitation (PMR), which is among the traditional treatment methods, and thermal
treatments, which are among the complementary treatment methods, on geriatric-tourism were
examined. There is no other study in the literature that examines PMR, thermal and geriatric issues
in the context of tourism. It is thought that the study will contribute to both tourism and health
industries in terms of revealing the importance of geriatric-tourism.
1
Literature Review
Geriatric-tourism
Risks that shorten the life expectancy of elderly individuals are various diseases and disabilities.
Therefore, the increase in life expectancy is associated with being healthier in old age. In this
century, due to the increased level of education, the awareness of healthy living has become
widespread (Huang and Tsai, 2003) and it has become a trend among the elderly (Zsarnoczky,
2017), improving nutritional trends (Ritchie and Roser, 2019) and medical-technological advances
thanks to the developing diagnosis, treatment, and prevention methods, the average age in the
world is increasing day by day. On the other hand, the World Health Organization's world report
on ageing and health (WHO, 2015) emphasizes that although the life expectancy of elderly
individuals is prolonged, they still do not lead a healthier and active life, and governments should
develop various policies and programs to increase the quality of life of elderly individuals and
improve their care needs. As the age ratio of the world population has increased, the number of
studies on old age has also increased. Developments have made gerontology in the field of health,
third age tourism in the field of tourism and geriatric-tourism among the types of health tourism
attended by this age group even more visible.
Different age classifications are made for third age tourism, which is also named as "silver tourism"
(See Zsarnoczky, 2016; Puscasu, 2017; Aleksandrova and Neykova, 2018; Talos et al, 2021) in
the literature. This is because the third age is associated with the onset of retirement age. However,
the retirement age may differ from country to country. It is not possible to present a general aging
model depending on the numbers, because it is known that the most important factor affecting the
quality of life and the age felt is diseases (Zsarnoczky et al., 2016). According to Rowe and Kahn's
(1997) Successful Aging Model, getting away from diseases and disabilities, increasing mental
and physical functions, as well as being intertwined with life are among the factors that delay aging
and reduce the felt age. Therefore, considering the retirement age differences, the definition of
“tourism activities in which individuals who come to a certain age level participate” should be
accepted for third age tourism. The general characteristics of third age tourists are listed as
(Anderson & Langmeyer, 1982; Huang & Tsai, 2003; Möller et al., 2007; Zsarnoczky, 2016): i)
having sufficient disposable income, ii) being mostly women, iii) prioritizing safety, iv) tending
to prolong their stay in destinations, v) being able to travel all seasons because of free time, vi)
being considered “curious” tourists vii) caring about communication, viii) being influenced by
each other's advice, ix) caring more about access than transportation, and x) travelling for medical
care and healthcare. Third age tourists' participation in health tourism activities can be considered
as geriatric-tourism or elderly care tourism. Geriatric-tourism is a new and rising trend that has
emerged with the functional combination of third age tourism and health tourism applications. It
is possible to consider geriatric-tourism treatments in two groups as (i) medical services for
diagnosis and treatment and (ii) auxiliary services for health promotion, including benefiting
thermal facilities.
Physical Medicine and Rehabilitation (PMR)
A known fact of aging is the constant deterioration in health and physical abilities (Hsu et al.,
2007). Elderly individuals benefit from traditional medicine, alternative medicine, and
complementary medicine to maintain their mental and physical health, prevent and/or delay
https://digitalcommons.usf.edu/m3publishing/vol16/iss9781955833080/7 2
potential diseases. It can be said that geriatric-tourism benefits from traditional medicine including
medical diagnosis and treatment methods, complementary medicine including treatments such as
hydrotherapy, balneotherapy, thermal and alternative medicine including applications such as
acupuncture, ayurveda, chiropractic, and osteopathy in ensuring and maintaining the health and
well-being of these individuals (Figure 1). Studies show that the elderly feel more active and
happier when they participate in tourism activities (Hsu et al., 2007). Thanks to geriatric-tourism,
tourism activities that will be enriched by getting support from alternative and complementary
treatments and professional medical interventions will have an impact on the development and
maintenance of physical health as well as mental health for this age group.
MSDs are among the important causes of morbidity in geriatric individuals. Advancing age
increases the incidence of the aforementioned diseases and increases the rate of benefiting basic
health services (Dilekçi and Özkuk, 2020). PMR, which is shown at the top of MSD treatments, is
effective in reducing pain and increasing quality of life in musculoskeletal diseases. In particular,
spa treatments carried out with PMR have been used in MSDs for centuries. It is even noted that
balneotherapy performed under appropriate conditions can increase the effectiveness of PMR
(Özdogan et al., 2010; Dilekçi and Özkuk, 2020). Geriatric-tourism combines medical, alternative
and complementary medicine methods with tourism activities and brings the two sectors together
in eliminating an important problem in a functional way.
Figure 1. Health Tourism Tulip Model - The Relationships Between Tourism and Medicine
The Tulip model (Figure 2) reveals the types of health tourism in terms of the relationship between
tourism and medicine, and the place of geriatric-tourism in these relations. Accordingly, medical
tourism includes activities related to traditional and complementary medicine, thermal tourism
includes activities related to complementary and alternative medicine, tourism for the disabled and
geriatric-tourism cover all three activities related to traditional, alternative, and complementary
medicine at the same time. Despite the fact that there are separate studies on thermal tourism
(Aklanoğlu, 2008; Önder et al., 2010; Paksoy and Akkurt, 2015), the place of thermals in health
tourism (İçöz, 2009; Çiçek and Avderen, 2013; Şengül and Bulut, 2019), third age tourism
(Kılıçlar et al., 2017; Tufan et al., 2017; Arıci, 2019; Sert, 2019) and the terms "geriatric tourist"
(Öztürk and Bayat, 2011; Tsartsara, 2018) or "geriatric-tourism" (Yıldız et al., 2013; Öksüz &
Altıntaş, 2017; Özkan, 2019) are used in some studies, no study has been found that examines
medical tourism for the third age in terms of the relationship between PMR and thermal treatment,
under the name of "geriatric-tourism". This study deals with PMR and thermal treatments within
3
the scope of geriatric-tourism and aims to determine the situation in Turkey through the reflections
of related practices in social and digital media. This longitudinal study fills an important gap in
terms of its subject and method.
Method
This research, which aims to determine the situation of geriatric-tourism in Turkey within the
scope of medical tourism through its relationship with PMR and thermal treatments, is a backward
and forward longitudinal, exploratory and qualitative study carried out with the screening model.
Sample
The universe of the research is digital tourism news sites (digital media) in Turkey and Twitter
(social media), which is among the popular social sharing platforms. Purposeful sampling
technique was preferred in the study to enable the situations, facts and events, which are thought
to contain rich information, to be examined in depth (Büyüköztürk, et al., 2010). The research data
is based on all the (retrospective) news about health tourism in the last ten years (2011-2021) by
the first 20 tourism news sites listed in the Google search engine in Turkey, and the (forward)
health tourism messages on Twitter in the last quarter of 2021. The last two news sites
(www.turizmgm.com and www.turizmplanet.com) were not evaluated due to their limited
retrospective archives (Figure 1). To make a sound evaluation, only six-year archives were scanned
for the remaining news sites.
Figure 2. Data Sets

Digital Media Social Media
The screenings were carried out in a three-month period between September and December 2021.
As a result of searches made with the word "health tourism" in DM, a total of 1,144 newspaper
contents (news-column-interview) were obtained from digital media, and 15,551 open codings
were made. In SM, a total of 2,989 messages were obtained by scanning health tourism and related
words, and a total of 9,853 open coding was carried out for all types of health tourism.
Data Collection
Content analysis was performed on DM and SM data separately with the MaxQDA 2020
qualitative analysis program (VERBI Software, 2019). First, codes related to health tourism were
gathered under certain themes in order to determine the situation of geriatric-tourism in Turkey
and its relationship with PMR and thermal treatments (Table 1). In the theme of treatment
preferences in DM data (1031), thermal treatments (62.15%; 353) rank first, geriatrics (16.20%;
92) followed by third and PMR (13.0%; 74) fifth. Among the SM data (68), thermal treatments
(47.06%; 32) take the first place, PMR (26.47%; 18) is the seventh, and geriatrics (22.06%; 15) is
the ninth. The numbers in parentheses refer to frequencies.
Table 1. Code Distributions of Treatment Preferences

DIGITAL MEDIA SOCIAL MEDIA
Treatment N. of % N. of doc. % Treatment N. of % N. of %
Preferences codes Preferences codes doc.
1. Thermal Tr. 428 35.20 353 62.15 Thermal Tr. 461 45.11 32 47.06
2. Med. Aesth. 115 9.46 111 19.54 Dental Med. 142 13.89 30 44.12
3. Geriatrics 108 8.88 92 16.20 Med. Aesth. 79 7.73 38 55.88
4. Dental Med. 101 8.31 77 13.56 H.Nutr.& D. 73 7.14 8 11.76
5. PTR 81 6.66 74 13.03 Oncology 68 6.65 24 35.29
6. Oncology 68 5.59 60 10.56 Eye Diseases 51 4.99 12 17.65
7. Cardiology 50 4.11 47 8.27 PTR 48 4.70 18 26.47
8. Surgical 42 3.45 33 5.81 Cardiology 34 3.33 10 14.71
9. Eye Diseases 41 3.37 41 7.22 Geriatrics 28 2.74 15 22.06
10. H.Nutr.& D. 40 3.29 34 5.99 Int. Diseases 16 1.57 12 17.65
11. Trad. Med. 35 2.88 23 4.05 Check-up 9 0.88 3 4.41
12. Int. Diseases 31 2.55 19 3.35 Surgical 7 0.68 5 7.35
13. Disabled Care 31 2.55 31 5.46 Alt. Med. 3 0.29 3 4.41
14. Alt. Med. 23 1.89 16 2.82 Disabled Care 3 0.29 2 2.94
15. Neurology 9 0.74 9 1.58
16. Check-Up 8 0.66 7 1.23
17. Inten. Care 5 0.41 4 0.70
Total 1216 100 1031 100 Total 1022 100 68 100
The codes under the categories of PMR, geriatrics and thermal therapy are shown in Table 2.
Among the DM data, orthopedics (56.8%; 46) under the PMR category, elderly care (86.11%;
93%) under the geriatrics category and benefiting thermal resources (78.73%; 337) under the
thermal therapy category, were the most frequently coded under the PMR category among the SM
data. Physiotherapy (25%; 12), elderly care (32.14%; 9%) under geriatrics category, and utilization
of thermal resources (76.35%; 352) under thermal therapy category were determined as the most
repeated codes. In all figures and tables in the study, dashed lines indicate sub-codes, and filled
circles show categories.
Reliability and Validity
In this study, validity was tried to be ensured in various ways (Whittemore, et al., 2001): i) the use
of purposive sampling method, ii) articulating data collection, iii) prolonged (longitudinal) data
collection, iv) use of programs such as MaxQDA, v) drawing data reduction tables/figures. It is
known that Twitter messages create a more reliable cause-effect relationship than the data
collected through self-response report surveys, as they reflect the natural and real reactions of
individuals (Çevik et al., 2015). It is assumed that news sites that have been in the media for many
years and broadcasting open to the public will act within the framework of the principle of
responsible publishing. Therefore, it shows the reliability of both data sets that make up this study.
Ethics committee approval of the study was obtained from Izmir Kâtip Çelebi University Social
Research Ethics Committee with the decision numbers 2021/22-12 and 2021/22-15.
5
Figure 3. Sub-Codes of Treatment Preferences

DIGITAL MEDIA SOCIAL MEDIA
Findings
Findings on Geriatrics Treatments
Figure 4 shows the interrelationships of gerontology subcodes and their connections with other
treatment methods. In DM contents, the elderly care is mostly mentioned. Other treatment methods
used by the geriatric-tourists coming to Turkey in relation to elderly care, are thermal resources
(78.49%; 73%), disability care (27.95%; 26), hair transplantation (15.05; 14%), PMR (12.90%;
12), and dental treatments (10.75; 10). In SM content, the elderly care is also mostly mentioned.
When evaluated in terms of relationship with other treatment methods, four out of every nine
content (44.44%) related to elderly care also mentioned benefiting thermal sources. Other
treatment modalities related to elderly care are disability care (33.33%; 3), physiotherapy,
orthopedics and oncology (22.22%; 2), respectively. When both data sets are evaluated together,
it is seen that tourists coming to our country for geriatric-tourism are mostly related to thermal
treatments in complementary medicine and PMR, which is included in traditional medicine.
Figure 4. Geriatric-Associated Treatments

DIGITAL MEDIA
SOCIAL MEDIA
Findings on PMR & Thermal Treatments Associated With Geriatrics
Detailed analysis results for thermal therapy, PMR and geriatrics sub-codes, among which intense
correlations were detected, are shown in Figure 5 (f>3). In DM data following codes were found
to be associated: i) elderly care under the geriatrics category with benefiting thermal resources
(78.49%; 73%), SPA (26.88%; 25), physical therapy (12.90%, 12) and orthopedics (4.30%; 4); ii)
orthopedics under the category of PMR, with benefiting thermal sources (26.08%; 12), SPA and
thalassotherapy (13.04%; 6); iii) physiotherapy under the category of PMR with benefiting thermal
7
resources (76.47%; 26), hydrotherapy (11.76; 4) and SPA (8.82%; 3). In SM data, following codes
were found to be associated: i) elderly care under the Geriatrics category, with benefiting thermal
resources (44.44%; 4); ii) physiotherapy under PMR category, with benefiting thermal springs
under thermal treatments category, healing water, balneotherapy, climatotherapy and drinking
cures (25%; 3); iii) rehabilitation under the category of PMR, with benefiting thermal springs,
healing water, balneotherapy, climatotherapy, drinking cures (37.5%; 3).
Figure 5. Geriatrics-Thermal Tourism-PMR Relations

DIGITAL MEDIA
SOCIAL MEDIA
Findings on Geriatric Tourist Sending Countries, Destinations & User Profiles
Among the DM data, the countries that sent the most geriatric tourists for orthopedic treatment
were Iraq (45.65%; 21), Libya and Germany (36.95%; 17), Ukraine (34.78%; 16) and Azerbaijan
(30.43%; 14), and for thermal treatments Russia (10.38%; 35), Germany (3.2%; 11), Azerbaijan
(2.96%; 10), Iraq (2.67%; 9) and China (2.37%; 8). There was no significant finding on the source
markets in the SM data (f<3).
Within the DM data: i) the most preferred cities for benefiting thermal resources are İzmir
(32.04%; 108), Ankara (18.99%; 64), Denizli (15.13%; 51), Bursa (11.57%; 39), Istanbul (
11.27%; 38); and Afyonkarahisar (10.38%; 35); ii) the most preferred cities for SPA are,
respectively, Istanbul (25%; 17), Nevşehir (Cappadocia) (16.17%; 11), Bursa and Afyonkarahisar
(11.76%; 8) and Antalya (10.29%; 7); iii) İzmir (14.70%; 5) is the most preferred province for
physiotherapy evaluated under PMR; iv) for orthopedics, Istanbul (36.95%; 17), Antalya (28.26%;
13) and Izmir (17.39%; 8), respectively; v) the cities most preferred for elderly care under
geriatrics are Antalya (32.25%; 30), Istanbul (10.75%; 10), Ankara (9.67%; 9), İzmir and
Afyonkarahisar (7.52%; 7). In this group, all three treatments are concentrated in big cities such
as Izmir, Ankara, Istanbul, Antalya and Bursa. Within the SM data: i) the preferred cities for
benefiting thermal resources are Ankara (90.90%; 320) and Bursa (1.7%; 6); ii) The cities most
preferred for physiotherapy evaluated under PMR are Bursa and Istanbul (50%; 6), Kocaeli,
Ankara and Samsun (41.66%; 5); iii) Ankara for orthopedics (66.66%; 4); Istanbul, Bursa, Samsun
and Kocaeli for rehabilitation (33.33%; 3); iv) Ankara (71.42%; 5) for rheumatism.
When the messages about geriatric-tourism in SM were analyzed, it was determined that agencies
(52.03%; 64), and health institutions (31.70%; 36) were the user profiles that shared the most
messages. Agencies shared the most about benefiting thermal springs (14.06%; 9), while health
institutions shared the most about thermal springs (92.30%; 9).
Findings on Motivation Factors of Geriatric-Tourism
To make a healthier assessment of geriatric-tourism in our country, which is a niche market within
the scope of medical tourism, and which has the expectation of creating a large economic activity
due to its size, motivational factors should also be determined. Figure 6 shows the motivations for
geriatrics and related PMR and thermal treatments within the scope of this study. Data on this
subject have been obtained from DM only. As a result of the code intersection analyses: i)
motivations related only to orthopedics were identified under the PMR category: cost (26.08%;
12), medical service quality (19.56%; 9) and geographical proximity (10.86%; 5); ii) under the
geriatrics category, only elderly care motivations were identified: cost (6.45%; 6), low waiting
time (4.30%; 4), and medical service quality and climate (3.22%; 3); iii) the motivations for
benefiting thermal resources and SPA were determined under the thermal treatment category.
These motivations for utilizing thermal resources are, respectively, cost (4.15%; 14), medical
service quality and additional tourist trips (2.07%; 7) and infrastructure (1.18%; 4), while for SPA
cost (11.76%; 8), medical service quality (7.35%; 5) and infrastructure (5.88%; 4).
9
Conclusions
Third age tourism is the name given to all tourism activities in which individuals who come to a
certain age level and are considered old participate. The third age tourists traveling for the purpose
of benefiting health services and participating in medical tourism should be evaluated under
geriatric-tourism, in other words, elderly care tourism. Geriatric-tourism is a new type of tourism
with a new and rising trend that has emerged thanks to the functional combination of third age
tourism and health tourism applications, and due to the aging trends in the world, it reveals an
expectation of creating significant economic activity for all countries. On the other hand, geriatric-
tourism brings together the health and tourism sectors by combining medical, alternative and
complementary medicine methods and tourism activities, which are considered beneficial for
ensuring and maintaining the health and well-being of the elderly.
Figure 6. Geriatric-Tourism Motivation Factors

DIGITAL MEDIA
This research shows that geriatric-tourists visiting Turkey are most associated with thermal
treatments (complementary medicine) and PMR (traditional medicine). These visitors also mostly
benefit from SPAs and participate in hair transplant operations. From this point of view, it is
possible to say that geriatric-tourism significantly benefits from traditional medicine, which
includes medical diagnosis and treatment methods, and from complementary medicine, which
includes treatments such as thermal, SPA, hydrotherapy, and balneotherapy. It is also confirmed
in the medical literature that thermal treatments can increase the effectiveness of PMR (Özdogan
et al., 2010; Dilekçi and Özkuk, 2020).
The state of being healthy is a condition that is considered not only with physical health but also
with mental health. Hair loss significantly affects the health of men and women of all ages, both
socially and psychologically (Springer et al., 2003). Although it is not the only factor, many
conditions such as the number of hair follicles, growth rate and diameter of the hair are affected
by age (Ramos-e-Silva et al., 2008), hair loss is common in both men and women in this age group,
people who have hair transplantation are as common as men, and the number of female patients is
also increasing (Famenini et al., 2015). This finding that aesthetic interventions are also applied in
this age group and mostly hair transplantation is preferred due to its psychological effects, is also
in line with the literature.
According to the findings, geriatric-tourists visiting Turkey mostly come from the Middle East
market such as Iraq and Libya, from Germany, which is among the countries with a high rate of
old age in Europe (Ritchie and Roser, 2019), from the Turkic Republics, especially Azerbaijan,
and CIS countries such as Ukraine and Russia. The results reveal that the interest of the Chinese
market is also at an initial level, which can be attributed to the country's rapid aging rate (Hsu et
al., 2007). Conducting more comprehensive research on the specific cultural and social structures
of these markets and determining the motivational elements of geriatric-tourism in terms of target
markets will constitute an important data source for marketing studies on geriatric-tourism, which
is on the rise. It has been determined that geriatric tourists mostly prefer big cities such as Izmir,
Ankara, Istanbul, Antalya, Bursa to benefit from PMR and thermal springs. On the other hand, the
preference of cities such as Afyonkarahisar, Nevşehir and Samsun, which stand out with their
thermal resources, is higher than other cities. Therefore, the establishment of PMR centers that
support the existing thermal health facilities in these cities contribute positively to the development
of geriatric-tourism.
The highest motivation factor for geriatric-tourists to choose our country is the cost. Since the cost
factor is at the forefront in almost all types of health tourism (Cohen, 2008; Özçelik et al., 2021),
the relevant data overlap with the literature. On the other hand, since elderly individuals need more
medical assistance, avoid long journeys, avoid operations with long waiting times due to being in
the last quarter of their lives, and are more easily affected by climatic conditions, it is seen that the
results obtained from the analyzes reflect the current situation. Additional touristic trips are among
the motivation elements of geriatric tourists who visit Turkey, especially for the use of thermal
resources. Participation in cultural activities is valid for all touristic activities related to the third
age group (Anderson and Langmeyer, 1982; Huang and Tsai, 2003; Möller et al., 2007;
Zsarnoczky, 2016).
The analyzes on Twitter (SM data) users in this study revealed that travel agencies and health
institutions shared the most about geriatric-tourism. This result shows that both the tourism sector
and the health sector make predictions about the potential growth trend in the relevant markets,
include geriatric-tourism in their strategic marketing plans, and add social media to their
communication tools. The constraints encountered in this study were that the archives of all
tourism news sites in the DM data could not be accessed, and the ones that were accessed did not
contain records of sufficiently old dates. A second and very important limitation is the absence of
statistical data on the medical treatments applied by third age health tourists in the statistics of the
Ministry of Health and the Ministry of Tourism and/or not being shared with the public. Therefore,
the results obtained in this study could not be compared with the relevant statistics. Considering
the potential growth share of geriatric-tourism, increasing the projections for the future, and
conducting more quantitative and qualitative studies by both tourism and medical researchers will
contribute to the field.
11
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Geriatric-Tourism PMR and Thermal Treatments in The Third Age

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Geriatric-Tourism, PMR, and Thermal Treatments in the Third Age

Physical Medicine and Rehabilitation (PMR)

Figure 2. Data Sets

Table 1. Code Distributions of Treatment Preferences

Reliability and Validity

Figure 3. Sub-Codes of Treatment Preferences

Findings on Geriatrics Treatments

Figure 4. Geriatric-Associated Treatments

Findings on PMR & Thermal Treatments Associated With Geriatrics

Figure 5. Geriatrics-Thermal Tourism-PMR Relations

Findings on Geriatric Tourist Sending Countries, Destinations & User Profiles

Findings on Motivation Factors of Geriatric-Tourism

Figure 6. Geriatric-Tourism Motivation Factors

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