Exploring the ‘grey nomad’ travelling population of Australia and its health: an integrative literature review

Keywords: grey nomad, health, systematic review, travellers, women.

Growing numbers of Australians are reported to travel domestically for extended periods of time. According to the Caravan Industry Association of Australia, the number of caravan and campervan registrations grew by 30% and 20% respectively between 2011 and 2016, totalling 615 301 combined registrations for the year to January 2016 (Williams 2017). A significant number of people owning these vehicles were likely ‘grey nomads’, a term commonly used to describe retired or semiretired individuals, ≥50 years of age, who tour within Australia in caravans, campervans, motorhomes and the like for a minimum of 3 months (Onyx and Leonard 2007). However, there is no indication what proportion are long-term travellers versus short-term holidaymakers. More recently, the number of women traveller members of groups on social media has increased; for example, the Facebook groups Women Caravanning Camping and Travelling Solo Australia (8100 members), Solo Women Campers (4100 members), Chicks Camping Crew (6600 members) and Wheels Around Oz Women and Children Only (343 members). These membership numbers, posted in October 2020, reflect a more than doubling (225% increase) in the total numbers posted for these four groups in the previous year. Although the situation with COVID-19 lockdowns may reflect greater than usual vicarious travelling, a 48% increase was noted in the 5 months before COVID-19 (October 2019–February 2020). This suggests a reasonable number of Internet-enabled women are travelling. The proportion of women travellers who do not access the Internet is not reflected in these numbers and is therefore unknown. Other groups, such as travelling families who home school, are also growing, but the characteristics and travel patterns of the Australian domestic travelling population is largely unknown.

The sole review of grey nomad literature undertaken to date found only a small number of predominantly qualitative studies (Raven 2016), which cannot represent the characteristics or needs of the Australian travelling population. Although a wider body of literature discusses the North American equivalent travelling population, often referred to as ‘snowbirds’ and ‘sunseekers’, a comparison of the characteristics and activities found this population was ‘quite different…despite superficial similarities’ (Onyx and Leonard 2005). Onyx and Leonard (2005) identified that the North Americans have distinctly different travel and lifestyle characteristics to Australian grey nomads, tending to travel to and stay at a single destination, contrasting with the ‘nomadic’ Australians.

The relatively limited health infrastructure of regional, rural and remote Australia is well known. Increasing numbers of grey nomads, including women, may place a burden on already thinly spread healthcare services, but relatively little is known about travellers’ health care needs and health care-seeking practices, or whether these may differ for women travellers. Given the size and growth of this whole itinerant population, it is clearly important to understand their characteristics, the reasons they travel and what it means to them, their activities, health status, health care needs and health service-seeking behaviours. Therefore, the aim of this review was to identify and appraise the available literature about this contemporary topic.

An integrative literature review was undertaken (Whittemore and Knapfl 2005). This form of review was chosen because it can accommodate different types of data derived from different research designs and methods.

The aim of this review was to identify the characteristics reported of ‘grey nomads’ travelling across Australia and their experiences in relation to their health and social needs, as well as access to health care when travelling.

Three questions guided the review:

1. What are the characteristics of ‘grey nomads’, people who travel Australia for weeks, months or years, including their motivation for travel, distances travelled, the duration of their trips and the destinations chosen?

2. Prior to travelling, what planning is conducted by travellers in relation to their social and health care needs, such as for medications and self-management of chronic disease?

3. What are travellers’ experiences in relation to their health and health care provision during their travels?

In creating the search strategy, terms were organised in relation to ‘Population’ and ‘Situation’ (DiCenso et al. 2005).

For the purpose of this review, ‘grey nomads’ were defined as older people who choose to travel across Australia with self-contained mobile accommodation for prolonged periods of time. Onyx and Leonard (2005) determined that the population of similar domestic travellers in North America referred to as ‘snowbirds’ and ‘sunseekers’ have distinctly different travel and lifestyle characteristics to Australian grey nomads. However, one earlier paper referred to Australians using these terms (Mings 1997), which were therefore included in the search strategy.

‘Situation’ refers to the descriptive characteristics of this population, and all aspects of their health, health care needs and services accessed.

The inclusion criteria were that papers addressed grey nomads or travellers, adult populations, males and females, and health and wellbeing topics, and that data were collected in Australia. No age criteria were set, other than that the majority of participants or mean age should be >45 years or that individuals should be described as ‘retired’ (chosen to exclude the younger population of backpackers and holidaymakers). Papers were required to be English language publications, published during the previous 20 years (1999–January 2020).

Literature related to religious pilgrims and short-term holidaymakers or vacationers was excluded. No travel duration criteria were set other than, where reported, the duration should, on average, be months. Publications other than primary research were excluded (e.g. conference abstracts, discussions, commentaries, editorials, literature reviews), but the reference lists in such publications were searched for any relevant articles.

The search strategy was set up as indicated in Table 1 and run, with some minor modifications to meet individual database requirements, on five databases (Ovid Emcare, Medline and PreMedline, Embase, PsychINFO and Academic Search Complete) and the search engine Google Scholar. Search output was filtered to include the years 1999–2020.

Table 1.  Search strategy example for Ovid PsychINFO

The final search output of each database was exported to Endnote X9 (Fig. 1) and duplicates were identified and deleted. Records were then screened for eligibility, checking the title, abstract and keywords. Records not meeting the inclusion criteria or meeting the exclusion criteria were removed. All remaining full-text publications were read and discussed by two researchers (MY, LP) to reach consensus and to assess an individual publication’s relevance to the research questions. Reference lists of relevant publications were hand-searched for additional studies. Papers that referred to ‘snowbirds’ or ‘sunseekers’ in North America were excluded. Fourteen articles were retained for inclusion in this study.

Fig. 1.  Flow diagram of literature searching and screening. From Moher et al. (2009).

A data extraction table was created with headings identifying the main characteristics of each article (Table 2). Data were extracted in relation to the research questions (Table 3).

Table 2.  Publications included in this study
HCP, healthcare professionals

Table 3.  Findings from the included publications
BMI, body mass index; BP, blood pressure; ED, emergency department; DVT, deep vein thrombosis; QoL, quality of life

Conventional content analysis was used because this approach is suitable where there is little theory or prior literature (Hsieh and Shannon 2005). Included papers were repeatedly read and initial categories in relation to the research questions emerged from the data. Data were coded in relation to these categories. Coded data were then reviewed to identify patterns and any discrepant data, collated and summarised.

Qualitative papers were critically appraised using the appropriate Critical Appraisal Skills Program (CASP) checklist (CASP 2020; Table 4) and for survey studies a modified version of this tool was used. Two authors (MY, LP) worked separately and compared findings in relation to screening and data extraction. A 20% sample of included publications was independently appraised by the second author (LP). Throughout the process of data extraction and content analysis, coding and analyses were discussed and consensus agreement reached among authors.

Table 4.  Critical appraisal of included publications using the CASP tool
N/A, not applicable

Fourteen records based on 11 studies were included in the review. Two publications were doctoral theses, one using face-to-face interviews (Holloway 2009) and the other using a paper-based survey and face-to-face interviews (Cridland 2008). Five publications took an ethnographic approach (White and White 2004; Onyx and Leonard 2005, 2007; Holloway 2009; Patterson et al. 2011), one used grounded theory (Hillman 2013) and another two described a qualitative approach (Calma et al. 2018; Stephens et al. 2018). Six publications used surveys (Prideaux and McClymont 2006; Tate et al. 2006; Cridland 2008; Obst et al. 2008; Brayley and Obst 2010; Halcomb et al. 2017). Several studies combined approaches, such as participant observation, semistructured or ethnographic interviews and telephone surveys (Table 2).

Various sampling methods were used. One study used face-to-face interviews and relied on participants ‘snowballing’ from one couple to another (Hillman 2013). Two studies used paper-based surveys distributed by caravan park managers (Prideaux and McClymont 2006) or at a caravan show (Obst et al. 2008). An online survey (Halcomb et al. 2017) was also used to recruit participants to two further telephone interview studies (Calma et al. 2018; Stephens et al. 2018; Table 2). None of these papers made any claim to be representative of this population; sampling strategies achieved, at best, a snapshot from one or more locations and time. Overall, study quality was mixed (Table 4).

Seven research teams travelled themselves: five were peripatetic (White and White 2004; Onyx and Leonard 2005; Cridland 2008; Holloway 2009; Patterson et al. 2011) and two stayed at single locations (Tate et al. 2006; Hillman 2013). The geographic settings of these studies ranged across much of Australia. Four ethnographic studies were conducted in camping sites, caravan parks, free rest areas and national parks in Western Australia, the Northern Territory and Queensland (Onyx and Leonard 2005; Cridland 2008; Holloway 2009; Patterson et al. 2011). One paper-based survey was distributed at recreational vehicle events and rallies, as well as at caravan parks, in six states in addition to being delivered as an electronic survey of the membership of camping and caravan clubs (Brayley and Obst 2010). Other paper-based surveys were distributed at a caravan show in Brisbane (Obst et al. 2008) and at caravan parks in Goondiwindi, on the New South Wales–Queensland border (Prideaux and McClymont 2006). Interviews were performed in the Kimberley District of Western Australia (Tate et al. 2006) and in multiple caravan parks and camping sites above the Tropic of Capricorn (Cridland 2008). For the online survey and subsequent telephone interviews, participants’ locations were unknown (Halcomb et al. 2017; Calma et al. 2018; Stephens et al. 2018).

Ten of the 14 publications were published between 2004 and 2011, and focused primarily on defining and describing grey nomads, their motivations, the logistics of a travelling lifestyle, the meanings derived from their experiences, their sense of social identity and community and their experience of road safety (Onyx and Leonard 2005, 2007; Prideaux and McClymont 2006; Tate et al. 2006; Cridland 2008; Holloway 2009; Brayley and Obst 2010). Health status was part of the description of the participants. The more recent cluster of papers (Hillman 2013; Halcomb et al. 2017; Calma et al. 2018; Stephens et al. 2018) shifted the focus to people who travel with chronic illness and how they manage their health on the road.

The first question this study addressed was about the characteristics of older people who travel Australia for extended periods. Responses in the 14 papers came from a total of 3273 participants.

Eight studies set participant age as a recruitment criterion (Onyx and Leonard 2005, 2007; Tate et al. 2006; Cridland 2008; Obst et al. 2008; Holloway 2009; Brayley and Obst 2010; Calma et al. 2018) and subsequently identified grey nomads as people >50 years of age. In one thesis, the target population was aged ≥55 years, collated in three categories: ‘young’ (55–65 years), ‘intermediate’ (65–70 years) and ‘older’ (≥70 years; Holloway 2009). In the other thesis, a minimum age of 50 years was set; however, 15 females and two males were younger (Cridland 2008).

Other studies simply reported the ages of their participants. One study reported all participants as being ≥56 years of age (Hillman 2013). Prideaux and McClymont (2006) found that most participants (89%) were in the 45- to 74-year age group. A more recent study included travellers who were younger or travelling with a family in addition to grey nomads and referred to the whole group as ‘domestic self-drive travellers’. These participants ranged in age from 26 to 89 years, with a mean age of 60.2 years for travellers and 59.8 years for their travel companions (Halcomb et al. 2017).

Onyx and Leonard (2005) recruited 215 male and 203 female participants, Prideaux and McClymont (2006) identified 92 male (62.2%) and 56 female (37.8%) participants and Halcomb et al. (2017) reported that 52.8% of their participants were women. Brayley and Obst (2010) found that of their 631 participants, 440 were male and 139 were female, with 52 not reporting their gender. No other study identified participants by gender.

Of the 3273 participants in these 14 papers and 11 studies over 14 years, only two solo women were identified (Onyx and Leonard 2005; Holloway 2009). None of the 14 publications identified or outlined any specific information or findings on women, whether travelling alone, with other women or without men.

Darley et al. (2017) found that although most travellers aged ≥55 years travelled as couples, whether any were same-sex relationships was not stated. Cridland (2008) found most grey nomads were heterosexual couples (95%), with 5% de facto couples, 3% singles and <2% same-sex couples. Most single men travelled independently, whereas single women travelled in small parties of two or more vehicles with other singles or couples. Onyx and Leonard (2007) found that most participants travelled as couples. According to Brayley and Obst (2010), older recreational road travellers considered ‘couple’ as their primary social identifier, with other social group identity, such as grey nomads, as secondary.

Not all studies sought or reported details of the participants’ relationships, and referred only to ‘participants’ and ‘travel companions’ (Tate et al. 2006; Hillman 2013; Stephens et al. 2018). Several papers reported participants as ‘couples’ (Onyx and Leonard 2005; Prideaux and McClymont 2006; Cridland 2008; Holloway 2009; Brayley and Obst 2010; Patterson et al. 2011). In other studies where participants also primarily travelled in couples, almost all were heterosexual couples (Onyx and Leonard 2005; Prideaux and McClymont 2006; Cridland 2008), where the males were employed in trade or management positions and the females were housewives or employed in clerical duties (Cridland 2008).

Halcomb et al. (2017) reported travellers with widely ranging ages (26–89 years), but most (62.3%) were retired; 28% received the aged pension, 11.4% received the disability pension and 7.3% were employed but on paid leave. Distinctions were noted by Cridland (2008), with marked differences between camping grey nomads and those staying in caravan parks. These reflected differences in trip expenditure, retirement income, health and length of retirement. Preferences were also expressed for camping grounds or caravan parks based on the type of vehicle driven, whether pet-friendly caravan parks were needed or available and the types of activities at the destinations.

Onyx and Leonard (2005) found that 83% of participants were Anglo-Australian, 12% were Australians born in the UK and 3% were from Northern Europe, with all having lived most of their working lives in Australia. Few were of another ethnicity, although Cridland (2008) identified a small number of participants from New Zealand. Obst et al. (2008) reported that 80% of participants were born in Australia, with 7% born in the UK, 5% born in New Zealand and the remainder being from Africa, Europe and the US. The remaining papers did not mention ethnic origin; neither Aboriginal status nor country of birth was recorded in any paper.

The definition of ‘grey nomad’ included travel for prolonged periods of time, ranging from at least months to longer. In the papers included in this study, participants were described as travelling with self-sufficient accommodation, including caravans (74%), motorhomes (7%), camper trailers, campervans and other arrangements (19%); 66% had four-wheel drive vehicles (Onyx and Leonard 2005). Holloway (2009) described the caravan or motorhome as an extension of the family home, where grey nomads continued their everyday home activities on a smaller scale. Cridland (2008) reported grey nomads travelling on average 126 days (median 115 days); 14.8% travelled <60 days, 19% travelled for 61–89 days, <16% travelled for 131–179 days and 14.3% travelled for >180 days. More than one-third (36%) were away from their usual place of residence for 90–130 days per trip. For participants of an online survey (Halcomb et al. 2017), the average trip duration was 24.6 weeks; 19.9% had travelled for more than 46 weeks in the preceding year and 53.3% planned to travel 10 months or more, including indefinitely.

According to Cridland (2008), over 42% of participants travelled to northern Australia during winter to escape the cold; for many grey nomads this was described as a ‘must do’ (Hillman 2013). Cridland (2008) also said that 22% wanted to see Australia, its historical sites and landscapes, 10% wanted adventure and to get away and others desired a sense of freedom. Patterson et al. (2011) found that many wanted to see more of Australia while young and healthy enough to enjoy travelling with friends, exploring new places and meeting new people. Onyx and Leonard (2005) found a consistent pattern of motivation to travel for adventure: to discover places never seen before, to enjoy the beauty and wonder of the scenery, to be independent, to have the freedom of time that is not duty-bound, to have a less-organised, more-relaxed life, moving slowly, noticing, appreciating and learning, heightening their senses and expanding their understanding and appreciation of the country as a whole.

Taking a different approach, White and White (2004) discussed ‘endings’ as a motivation to travel: changed family circumstances, such as children leaving home, the death of a partner, anticipation of the end of good health and work changes. They focused on travel as a transitional experience between one thing and another, and its effect on personal identity. Regardless of their motivation and age, participants considered travel a rite of passage.

One of the most positive aspects of travelling was the experience of meeting other people on the road, some of whom remained lifelong friends (Onyx and Leonard 2005). Grey nomads are part of a larger age-related cohort of people who have retired from the workforce; social interaction among them is pronounced because retirement has separated them from work-related interactions and social connections (Holloway 2009). New social networks developed with new-found friends who were fellow travellers (Patterson et al. 2011). Alongside this, travel was also seen in terms of extension of domesticity, with everyday home activities conducted on a smaller scale (Holloway 2009). In addition, Halcomb et al. (2017) reported that most travellers used a mobile telephone, email or social media to maintain contact with family and friends at home.

Travellers recounted a range of planning before departure in relation to their social and health care needs. Tate et al. (2006) found that 9% carried health summaries from their GPs. Eleven years later, 23.7% carried a list of medications, which was either self-prepared (44%) or came from a doctor (42.7%; Halcomb et al. 2017). This latter study focused on the health needs of those with chronic illness, their health preparedness and well-being while travelling, whereas an offshoot study focused on people with a diagnosis of cancer, reporting that they travelled regardless and because of their diagnosis (Stephens et al. 2018). The participants in the study of Calma et al. (2018), all aged >60 years and with at least one chronic disease, described a high level of awareness of their health needs, limitations and health management strategies, with expertise developing through their travel experience.

Brayley and Obst (2010) explored how health status may impact road safety, such as a deterioration in visual acuity and a slowing of cognitive processing as part of the aging process. They made the point that grey nomads’ experience of road travel can be considerably different to that generally experienced by older drivers. Many grey nomads embark on extended road trips, driving and towing heavy vehicles in rural and remote areas. They may have limited experience or training relevant to the conditions in those areas, such as driving on dirt or narrow bitumen roads, safely negotiating road trains, dealing with wildlife on the road and strong cross-winds while towing. There is also the potential impact of fatigue due to driving long distances. The combination of unfamiliar environmental hazards and stressors alongside health-related aging effects may result in additional health and road safety risks and incidents with undesirable outcomes.

Many of the participants had one or more age-related or chronic illnesses. Tate et al. (2006) found that 55% of travellers had chronic disease and 61.9% took regular medication. Halcomb et al. (2017) reported 40.2% of long-term travellers had hypertension, 22.8% had arthritis, 13% had diabetes and 17.1% had other health conditions. Of these, 11.1% had ceased work due to illness or disability, and 42.7% reported that their illness affected their daily life. Almost one-quarter (23.7%) required ongoing prescription medication. However, the health of these grey nomads was not dissimilar to that reported by this age group in the Australian community generally (Australian Bureau of Statistics (ABS) 2013).

Onyx and Leonard (2007) considered the health of grey nomads in relation to the dominant decline model of aging as opposed to what many participants wanted: adventure, freedom, learning and positive aging. These authors proposed that grey nomads were illustrating a ‘Ulyssean’ model of aging that entails the exploration of new ideas, activities and learning, as well as intellectual, psychological and emotional growth. This theme was picked up by others (Cridland 2008; Holloway 2009; Hillman 2013), who reported grey nomads with similar expressions of improving health and greater well-being when travelling. Participants reported their health improved as a consequence of living the grey nomad lifestyle, which they explained as resulting from no responsibility, therefore no stress and better health. Over 80% of grey nomads reported good to excellent health (Onyx and Leonard 2007).

A minority of participants experienced acute events. Obst et al. (2008) found that 5% had a medical emergency while travelling, such as falls (three had resulted in broken arms and one in a damaged knee). Another medical emergency in a remote area related to painful kidney stones, requiring a 1-h trip to reach help. A further 14% had experienced a health scare including severe chest pains, back injuries, deep vein thrombosis, severe arthritis, cervical cancer diagnosis, pneumonia and fainting. Onyx and Leonard (2007) reported that 32% of men and 21% of women had experienced a major health scare in the previous 2 years and had been treated locally at regional hospitals or by GPs.

One study set in a very remote area of the Kimberley Ranges proposed that grey nomads could be an impost on local healthcare services (Tate et al. 2006); this was the only study to recruit healthcare professionals. Another study flagged this same point as an implication of the study findings (Calma et al. 2018). Despite studies reporting improvements in participants’ health as they lived a nomadic lifestyle (Cridland 2008; Holloway 2009; Hillman 2013), there were reports of health service need and usage. Of online survey participants, 24% had sought medical attention to obtain a prescription, 57% reported having prescriptions filled during their travel and 8.9% had returned home from their travels due to poor health (Halcomb et al. 2017). Calma et al. (2018) reported the difficulties experienced by grey nomads in relation to accessing health services and medication and achieving continuity of care while travelling. Calma et al. (2018) and Stephens et al. (2018) conducted telephone interviews with eight and 14 participants with chronic disease and cancer respectively, and reported how these participants became experts in managing their health while travelling.

Onyx and Leonard (2005) referred to the emergence of grey nomads in Australia as a phenomenon: a remarkable occurrence. Grey nomads became a topic of interest because of the aging population (ABS 2019) and the increasing number of retired people with the time and resources to travel the country (Holloway 2009). Australian grey nomads are a unique peripatetic group, many motivated by the desire for travel, adventure and freedom and actively avoiding structured activity. This contrasts North American ‘snowbirds’ and ‘sunseekers’, who travel to one destination where there are in-park recreational facilities and where they stay for prolonged periods (Onyx and Leonard 2005; Prideaux and McClymont 2006; Halcomb et al. 2017).

The grey nomad literature originates from a diverse range of academic fields: social sciences, media studies, psychology, marketing tourism and business, environmental science and health. Consequently, the reported perspectives on the grey nomad experience are broad, including identity, purpose, social capital, well-being and healthy aging, as well as health and illness management, translating and transcending daily living into a peripatetic lifestyle.

The studies included in this review fell primarily into two groups. Publications before 2011 were mainly concerned with a broad description of travelling people. While predominantly recruiting relatively smaller samples, these early studies focused on identifying the travelling population (White and White 2004; Onyx and Leonard 2005, 2007; Prideaux and McClymont 2006; Tate et al. 2006; Cridland 2008; Obst et al. 2008; Holloway 2009). Although small scale, these were the first studies from this population and they examined why grey nomads travelled. After 2011, health emerged as a specific consideration, from health and illness as social characteristics as part of healthy aging to a more medical view of people living with chronic disease and how they manage this while travelling (Halcomb et al. 2017; Calma et al. 2018; Stephens et al. 2018). Included studies were published in health or aging-related journals and were anticipated to inform the social trends of an aging population and early retirement (Onyx and Leonard 2007).

A defining characteristic of these participant groups was that they were predominantly older (i.e. >50 years). Other age groups were little described, and often excluded. Even in the most recent large survey, which focused on health (Halcomb et al. 2017) and did not apply age criteria, only 15.1% of recruited participants were aged <50 years. Although papers did not consistently report participants’ demographic characteristics and recruitment criteria were not always clearly articulated, this population is clearly predominantly older in age. An important theme emerging from this literature is that of aging as a continuance of choice, activity and pursuit of interests. This contributes to the growing literature that challenges the stereotype of older people as increasingly inactive and passive with necessarily deteriorating health (Aronson 2020). Participants also talked of making new and often enduring friendships on the road. The social networks they established contrast with the picture of loneliness and isolation conventionally expected for this age group (von Soest et al. 2020). The travelling population clearly described their lives as active and engaged, further supporting the claim made by Onyx and Leonard (2007) that they are ‘rewriting the script of aging’, to continuing personal growth and social engagement rather than retreat and decline.

Despite the increasing proportion of women in the older population (ABS 2019), relatively few women are evident in this literature. Of the 3273 participants in the included studies, only 644 were identified as female (not all studies reported gender). Almost all women were travelling in heterosexual relationships (Onyx and Leonard 2005; Prideaux and McClymont 2006; Halcomb et al. 2017). Across all 14 publications, only two solo women were identified (Onyx and Leonard 2005; Holloway 2009). However, social media platforms, including Facebook, indicate many women are currently travelling Australia. At least eight Facebook closed groups are exclusively for women travelling domestically in self-contained vehicles, sharing their experiences and destinations with photographs and discussions.

Ten of the 14 included publications reported on the travellers’ health and their health planning. Most studies identified the elements of planning as having health checks before trips, carrying letters from their GP regarding their health status and needs, lists of current medications and a sufficient supply of prescriptions, medication and the necessary storage requirements (Tate et al. 2006; Cridland 2008; Holloway 2009; Hillman 2013; Calma et al. 2018). Some travellers planned their travel route to be at specific destinations to access relevant health care or stayed at destinations close to healthcare services (Cridland 2008; Hillman 2013; Stephens et al. 2018). Two studies whose participants were chosen because they were either living with chronic conditions (Calma et al. 2018) or were cancer survivors (Stephens et al. 2018) discussed, in detail, their planning and organisation for self-management of their condition while travelling. This contrasts the relatively less-prepared picture of the broader population sample from Fitzroy Crossing some 12 years earlier (Tate et al. 2006). Some had a plan for potential medical emergencies including communication devices such as UHF or CB radios, and notifying local homesteads on the route of more risky adventures (Onyx and Leonard 2005; Hillman 2013; Halcomb et al. 2017).

Most grey nomads have their care planned by healthcare professionals in metropolitan Australia, raising implications for both the education of urban healthcare providers on rural service availability and the integration of care delivery between metropolitan, regional, rural and remote areas. Health care that is planned in metropolitan areas may not be available in non-metropolitan locations. The care planned for travellers must be suitable for delivery at their various destinations (e.g. the availability of medications). The educational needs of both travellers and their healthcare providers as they relate to care planning for prolonged domestic travel should be clarified.

Only one study included health practitioners’ views, reporting that travellers should carry and make available to clinicians information such as healthcare summaries, allergies, previous medical history and lists of active problems and medications, radiology and pathology results and hospital admissions (Tate et al. 2006). Tate et al. (2006) discuss grey nomads in terms of the burden they place on remote health infrastructure but without quantifying what this may entail. Clearly, the capacity of regional, rural and remote services to meet travellers’ needs warrants review. Many but not all participants prepared for their trips in relation to their health by addressing items of the healthcare practitioners’ wish list. A universal electronic medical record was suggested to address the availability of health information; this has yet to be fully achieved in Australia. Halcomb et al. (2017) and Calma et al. (2018) refer to the introduction of the voluntary national electronic health record system My Heath Record, but also acknowledge its limitations in terms of uptake, incomplete and potentially out-of-date data. These authors also suggest telehealth and telephone help lines as ways to enhance healthcare access for travellers. As long ago as 2009, Holloway (2009) recommended better policy resourcing and infrastructure to improve healthcare services in rural and remote Australia. It is not clear from this literature what improvements have occurred beyond the introduction of My Health Record as the limited health infrastructure in regional rural and remote Australia remains an issue (Australian Institute of Health and Welfare (AIHW) 2019). Tate et al. (2006), Holloway (2009) and, more recently, Raven (2016), Halcomb et al. (2017), Calma et al. (2018) and Stephens et al. (2018) all recognise and flag the topic as a priority for policy review and further research.

Some participants accessed healthcare services without difficulty (Onyx and Leonard 2005; Obst et al. 2008; Hillman 2013; Calma et al. 2018). A few reported a lack of shared medical information and limited access to prescription medications at some pharmacies (Calma et al. 2018). Although most reported improved health, a small number terminated their trip because of health problems (Halcomb et al. 2017). The number of people visiting regional, rural and remote areas makes it imperative to better understand these travellers, particularly those on the road for longer periods and further from their home services. The implications of this travelling population for the provision of health services, policy, health infrastructure, education and workforce planning in rural and remote communities can only be surmised and research is urgently needed.

The search strategy used ‘grey nomad’, ‘traveller’ and related terms, including their mode of travel, but may have missed literature if none of these specific words was used. The search was run on five health-related databases and Google Scholar, but searching reference lists identified some further studies, including some published in travel and tourism journals not indexed in health databases. These papers solely reported demographic characteristics of travellers but were excluded because it was not possible to differentiate holidaymakers from longer-term travellers. Nonetheless, it is possible that material may have been missed from tourism-related databases.

This review found only a small body of relevant literature, predominantly qualitative studies. Table 4 demonstrates the mixed quality of reporting in which the trustworthiness of the work was seldom addressed. It demonstrates how little is known about grey nomads, especially women travellers, and the health and other needs of this population.

In summary, research about grey nomads in the early 2000s explored their characteristics and experiences, including their health status and motivations to travel. Identified as primarily older and almost exclusively heterosexual couples, their patterns of chronic illnesses were similar to the age-matched general population, but their health was reported as improved by the less-stressful lifestyle. After 2011, fewer studies were published and the emphasis changed from the broader experience of grey nomads’ lifestyle to travellers managing chronic illness. The older person demographic (i.e. those >50 years) remained predominant. No state or national statistics are available for grey nomad populations.

Where this was raised, a few studies reported participants’ minimal use of healthcare services while travelling. Although the sole study to recruit healthcare practitioners, at a single remote site, argued that grey nomads adversely impacted local healthcare services, no detail was provided. This gap poses a substantial challenge for health policy and service development, as well as health resource allocation to non-metropolitan Australia. The significant number of people visiting regional, rural and remote areas makes it imperative to better understand these travellers, particularly those on the road for longer periods and further from their home services. The implications for policy and strategy, infrastructure and workforce planning and education and training for healthcare services in rural and remote communities can only be surmised, although the need for better policy and infrastructure to improve the provision of healthcare services has been argued. Discussion has been ongoing for many years, particularly in the community, about the limited health infrastructure in regional, rural and remote Australia (AIHW 2019). The information deficits revealed by the paucity of material available for inclusion in this review only serve to highlight this issue further, and research is desperately needed.

The authors declare no conflicts of interest.