As we get older, we gain more life experience, but our fitness inevitably declines. A paper by Michael B. Strauss, MD, Jeremy A. Busch, DPM and Stuart Miller, MD, recently published in Undersea & Hyperbaric Medical magazine, helps us to ponder the question of when, indeed, we should hang up our fins.
The authors make the point: It is essential to appreciate the distinction between chronological and physiological age. Three factors, namely fitness, disease, and mobility and strength, are fundamental when deciding whether to continue scuba diving. We are living longer and want to continue to do things that were once considered inappropriate for our age. Scuba diving is one of these activities.
Chronological age is easy to establish. Physiological age is more akin to the functional (physical and mental) activities that the average person would be doing at a different age. If infirm, for example, the physiological age may be older than the chronological age; if more active, the physiological age may be younger than the chronological age.
The authors designed a series of assessments, including 1) the ability to perform the activities of daily living, 2) ambulation, 3) comorbidities of disease, 4) smoking or steroid history, and 5) neurological deficits.
Our Bodies Change as We Get Older
As we get older, the function of our organs and organ systems changes. Appreciating these changes help will help one decide about participating in, modifying or discontinuing diving.
These include musculoskeletal changes that mean diving has become too hard.
Cardiovascular and pulmonary changes may mean a person gets tired faster and may not have the reserve capacity for emergencies.
Nervous system and sensory organ degradation, for example, may make it too hard to read gauges.
Endocrine/metabolic changes may mean reduced activity and perhaps getting chilled more quickly in cool water.
Dietary restrictions might mean that traveling to exotic sites is no longer possible.
Fit to Dive?
Physical fitness is the readiness or ability, especially in cardiovascular, respiratory and musculoskeletal systems, to perform tasks requiring increased energy such as extrication in a diving emergency. Regardless, there are no standards for the recreational scuba diver.
So, divers should select activities that are commensurate with their levels of fitness, mobility, strength and anticipated swimming needs for the dive. "Soft" criteria for these decisions can be based on limiting the depth of a dive to the distance that can be easily swum underwater after a single breath, or equating expected swimming distances on the dive to the distance the diver can comfortably swim in a pool using fins.
Generally speaking, fitness to dive should be based on physiological age and the ability to do sustained aerobic activities rather than chronological age.
The older diver should adhere to appropriate safety practices. For example: use the most conservative option on the dive computer; always use slow ascent rates and take a 15-foot (5m) three-minute safety stop; carry safety/signaling equipment; dive only under optimal conditions; and take a break from diving after several days of continuous multiple dives per day.
Balance fitness with diving conditions. For example, good fitness is required for open ocean current dives, drift dives, repetitive dives deeper than 60 feet (20m), diving in poor visibility or cold water, and making beach entries. Diving within lagoons or atolls, diving from an anchored boat with a descent line, making shallow dives in good visibility and warm water with little or no current require a lesser degree of fitness.
Disease, Mobility, and Strength
The significant question regarding disease and scuba diving (regardless of age) concerns conditions that are relative contraindications for diving. Examples
include asthma, impaired but not decompensated cardiac function, diabetes mellitus, kidney disease, blindness, residuals of stroke, paraplegia, Raynaud's disease, cerebral palsy, extremity amputations, myopathies, cognitive function deficits, and residual impairments from a previous episode of decompression illness. Despite these conditions, individuals affected can safely scuba dive, with appropriate guidance and dive buddies.
Strength for scuba diving requires being able to lift and carry equipment and make safe entries and exits from the water. For open-water dives, this may require shimmying onto a rubber dinghy. Although many of the age-related changes in performance and medical contraindications for diving have mobility and strength ramifications, only in their most extreme manifestations are they contraindications to scuba diving.
For scuba diving, physiological age is a far more important consideration than chronological age. So, what criteria should be used when deciding whether to continue?
Fitness and the comorbidities of disease, mobility, and strength are the decision criteria. When comorbidities of disease present contraindications to diving, whether to continue requires an evaluation by a physician knowledgeable in diving medicine. Safety is the primary concern.
Regardless, the decision ultimately comes down to the diver, and often it comes down to one thing: scuba diving is no longer fun.
Abridged from UHM 2017 Vol 44 No 1 and an article first published in Wound Care & Hyperbaric Medicine Vol 4 Issue 3. Scuba in Older-Age Divers - Strauss/Busch/Miller.