The role of transport and mobility in the health of older people
Charles Musselwhite, Carol Holland, Ian Walker
The world’s population is ageing. Older people are healthier and more active than previous generations. Living in a hypermobile world, people want to stay connected to dispersed communities as they age.
Staying connected to communities and social networks enables older people to contribute and connect with society and is associated with positive mental and physical health, facilitating independence and physical activity while reducing social isolation. Changes in physiology and cognition associated with later life mean longer journeys may have to be curtailed. A shift in focus is needed to fully explore older people, transport and health; a need to be multidisciplinary in approach and to embrace social sciences and arts and humanities.
A need to embrace different types of mobilities is needed for a full understanding of ageing, transport and health, moving from literal or corporeal through virtual and potential to imaginative mobility, taking into account aspirations and emotions. Mobility in later life is more than a means of getting to destinations and includes more affective or emotive associations. Cycling and walking are facilitated not just by improving safety but through social and cultural norms.
Car driving can be continued safely in later life if people make appropriate and informed decisions about when and how to stop driving; stringent testing of driver ability and skill has as yet had little effect on safety. Bus use facilitates physical activity and keeps people connected but there are concerns for the future viability of buses. The future of transport may be more community led and involve more sharing of transport modes.
- Older people make a significant economic contribution to society.
- Improving their access would enable them to increase their contribution.
- The policy of free off-peak bus travel for older people in Britain is a good example.
- The economic contribution of older people to society will increase in future.
This paper explores the contribution of older people to society, the role of mobility in the quality of life of older people, and whether making it easier for older people to travel would enable them to increase their contribution.
The paper commences by considering evidence on the economic value of older people to society. This shows that older people make a net contribution through expenditure in shops, employment, voluntary work, childcare and taxation which exceeds their cost to the taxpayer. The assumptions underlying the calculations are examined and found to be robust. The patterns of travel of older people are examined and found to be consistent with the estimates of the economic contribution of older people.
Mobility provides many intrinsic benefits for older people, facilitating independence, reducing social isolation and physical activity. Evidence from the examples of the ability to drive and providing free bus travel is considered. Then the contribution of older people to society in future is examined and how travel contributes to this. It is shown that changes in older people׳s mobility would affect their contribution to society. Ways in which the mobility of older people could be increased are identified.
Different types of out-of-home activities and well-being amongst urban residing old persons with mobility impediments
Anu Siren, Randi Hjorthol, Lena Levin
- Two activity types were examined: ‘utilitarian’ and ‘discretionary’ activities.
- Both activity types contributed to well-being by representing different sides of being.
- Utilitarian activities were important in maintaining independence and fulfilling basal needs.
- Discretionary activities were important in existing in relation to the surroundings.
Independent mobility has been proposed to be a precondition for leading an independent, non-institutionalized life. Supporting independent mobility for the growing senior segment thus has societal importance. The question of how to maintain well-being through mobility in older age is, however, a complex one.
The present study explicates this by focusing on how utilitarian and discretionary activities—representing different types out-of-home activities—contribute to well-being, using data from individual interviews with persons aged 80–95, living in Copenhagen, Denmark. We structured the material by the two activity types and found both to contribute to participants׳ well-being by representing different sides of ‘being’. Utilitarian activities were important in maintaining independence and fulfilling basic needs, while discretionary activities were important for the individual existing in relation to the surroundings.
Mobility-related well-being appears constructed both through independent separateness and through sense of community. This finding implies that supporting mobility in the sense of mere fulfilment of basic needs may not be enough.
Claude Marin-Lamellet, Sonja Haustein
- Practices to manage the safe mobility of older road users were reviewed.
- 29 good practice examples in 6 categories were identified.
- Practices were matched with the needs of different segments of older people.
- Current practices are not targeted to the user groups that would benefit most.
- Areas that are not covered by existing practices were identified.
Against the background of an ageing population, the management of older people׳s safe mobility is becoming an increasingly important issue. Mobility is vital for older people׳s quality of life and several examples of good practice that support older people׳s safe mobility already exist. However, the older population is increasingly diverse and its different segments have different mobility needs and expectations.
This paper has reviewed practices to manage older people׳s safe mobility and identified 29 examples of good practice which fall into six categories. The different kinds of practices were assessed with regard to their suitability for different segments of the older population as identified in previous studies. In addition, we considered whether the needs of certain segments remain unmet.
Our study found that most practices target individuals with mobility restrictions and mainly attract groups who are already users and improve their (safe) use of the preferred transport mode. However, they do not seem to succeed in increasing mobility options, e.g. by encouraging car-reliant users to cycle or use public transport or by helping older women to continue to drive. We advise that existing practices should more directly target those segments that would benefit from them the most and be adapted more specifically to these segments׳ needs and preferences.
We have identified a complete failure to provide awareness programs to inform older users about the potential benefits of driver assistance systems, a lack of programmes to increase perceived security, as well as a comprehensive scheme for older drivers who have to stop driving.
Potential impacts of subsidised bus travel for older people
Anthony A. Laverty, Christopher Millett
- England has a national policy which enables persons over the age of 60 to travel free of charge on buses.
- The scheme is unusual internationally, and early evidence suggests the scheme may be linked to a number of benefits for older people.
- Nonetheless, in the context of pressure on public spending, we need to know more about the cost-effectiveness of the scheme, and further research is warranted.
In this viewpoint we will reflect on the concessionary bus pass system in use in England and how this may affect the health and wellbeing of older persons. We will consider these issues in light of controversy over whether any benefits from such schemes can justify their costs.
Transit use and walking as potential mediators of the association between accessibility to services and amenities and social participation among urban-dwelling older adults: Insights from the VoisiNuAge study
Dominic Julien, Lucie Richard, Lise Gauvin, Michel Fournier, Yan Kestens, Bryna Shatenstein, Mark Daniel, Geneviève Mercille, Hélène Payette.
- Two mediators of links between accessibility and social participation were tested.
- Transit use mediated this association in multiple and separate mediation analyses.
- Walking frequency was not a significant mediator in multiple mediation analyses.
- Conflicting results were observed for separate mediation analyses involving walking.
- Walking purposes were not measured, which may explain these mixed results.
Accessibility to services and amenities is related to social participation in older adults. However, the mechanisms underlying this association are not clear. Transit use and walking may be potential mediating variables.
The aim of this study was to investigate whether frequency of transit use and frequency of walking mediated the relationship between accessibility to services and amenities conducive to social participation (SACSP) and social participation itself among a sample of older adults.
Participants were 519 older adults from the VoisiNuAge study. Multiple mediation and separate mediation analyses were conducted to investigate whether frequency of transit use and frequency of walking mediated the association between accessibility to SACSP and social participation, controlling for sociodemographic variables. Results showed that transit use was a significant mediator in multiple and separate mediation analyses.
Walking frequency was not a significant mediator in multiple mediation analyses, and conflicting results were observed for separate mediation analyses involving walking. We conclude that the association between accessibility to SACSP and social participation seems to be partly mediated by transit use, but results involving walking should be interpreted cautiously.
Kenji Tsunoda, Naruki Kitano, Yuko Kai, Taishi Tsuji, Yuki Soma, Takashi Jindo, Jieun Yoon, Tomohiro Okura.
- About 50% and 10% of older adults seldom used bicycle and vehicles, respectively.
- Bicycle and vehicle travel were positively associated with various health measures.
- Older adults who stayed in walking areas were more likely to have poor health.
The purpose of this study was to cross-sectionally examine associations between frequencies of bicycle and motor vehicle travel, physical and mental statuses and social networks.
This study was conducted from 2009 to 2012 with 629 community-dwelling older adults (73.3±5.2 years old, female 53.7%) in Kasama City, Rural Japan. Travel status, physical activity scale for the elderly, Lubben social network scale and geriatric depression scale were collected via a self-administrated questionnaire. We also calculated a standardized physical function score through physical performance tests.
After adjusting for age, gender, education, living arrangement, body mass index and clinical history, we found a positive association between frequency of bicycle and motor vehicle travel and physical activity, social networks and mental status (Trend P<0.05). Physical function was also significantly associated with motor vehicle travel (Trend P<0.05). Additional analysis revealed that older adults who mainly stayed within a walking area were more likely to experience less physical activity and social networking and have diminished mental status and physical function (Trend P<0.05).
Extending the travel area through use of transportation modes might provide health benefits. Assessing transportation mode usage could improve screening and assistance strategies for people who are physically or mentally frail or lonely.
Anna M. Chudyk, Meghan Winters, Md Moniruzzaman, Maureen C. Ashe, Joanie Sims Gouldd Heather McKay.
Prospective travel diary data gathered on the seven-day travel behavior (destinations visited, trip frequency, purpose and mode) of older adults with low income.
- Destinations most relevant to older adults were grocery stores, malls, restaurants/cafés.
- Living in neighborhoods with a high prevalence of destinations may encourage older adults to walk more frequently.
The positive effect of physical activity in the prevention and treatment of many chronic diseases and age-related disabilities, such as mobility-disability, are widely accepted.
Mobility is broadly defined as the ability of individuals to move themselves within community environments. These two concepts – physical activity and mobility – are closely linked and together contribute to older adults living healthy, independent lives.
Neighborhood destinations may encourage mobility, as older adults typically leave their homes to travel to specific destinations. Thus, neighborhoods with a high prevalence of destinations may provide older adults an attractive opportunity to walk, instead of drive, and thereby obtain incidental physical activity.
We know surprisingly little about the specific types of destinations older adults deem relevant and even less about destinations that support the mobility of older adults with low income. Accessible neighborhood destinations may be especially important to older adults with low income as they are more likely to walk as a primary travel mode. Conversely, this population may also be at increased risk of functional impairments that negatively affect their ability to walk.
As a means to fill this information gap we aimed to better understand the mobility habits of older adults with low income. Thus, our specific objectives were to:
- describe the types of destinations older adults with low income most commonly travel to in one week
- determine the association between the prevalence of neighborhood destinations and the number of transportation walking trips these individuals make (average per day).
We conducted a cross-sectional study of community-dwelling older adults with low income residing within Metro Vancouver, Canada. We assessed participant travel behavior (frequency, purpose, mode, destination) using seven-day travel diaries and measured the prevalence of neighborhood destinations using the Street Smart Walk Score. We also assessed participants’ sociodemographic characteristics and mobility (physical function, car access, confidence walking). We used a negative binomial model to determine the association between Street Smart Walk Score and number of transportation walking trips (average per day).
Our sample was comprised of 150 participants (median age 74 years; 51 men) from who we acquired at least one day of travel diary data (range=1–7 days). Participants made three trips per day (2, 5; median P25, P75) and travelled to six different destination types per week (5, 9; median P25, P75). Destinations most relevant to older adults were grocery stores, malls, and restaurants/cafés. Each 10-point increase in Street Smart Walk Score was associated with a 20% increase in the number of transportation walking trips (average per day, incidence rate ratio=1.20, 95% CI=1.12, 1.29).
Our findings provide preliminary evidence regarding destinations that may be most relevant to older adults. They also suggest that the prevalence of these neighborhood destinations may encourage walking. As we approach a new era of healthy city benchmarks, our findings guide policy makers and developers to retrofit and develop communities that support the mobility, health, and independence of older adults.
- Little cycling research has focused on the older adults, a rapidly growing population.
- Cycling rates were high for older adults who live in Downtown Vancouver, a bicycle-friendly area in Canada.
- Older adults identified safety, environment, social and history of activity as travel influences.
A large proportion of the growing population of older adults have low levels of physical activity and face ensuing health and mobility problems. Cycling is a health-promoting and widely accessible transportation option.
However, throughout North America cycling rates amongst older adults are extremely low. Evidence from European countries suggests that cycling for older adults is possible and can be a popular travel choice. Therefore, we aimed to assess factors that contribute to cycling trends amongst North American older adults.
We used a mixed methods approach to describe cycling behaviors, and facilitators and barriers to cycling in a highly bikeable area of Vancouver, Canada. We conducted a cross-sectional study of older adults (age ≥60 years) who lived in Vancouver’s downtown core. During September–October 2012, participants (n=191) recorded travel in 7-day diaries and completed questionnaires on cycling behaviors and perceptions of their neighborhood environments.
We conducted in depth interviews with a subset of older adults (n=27) to better understand how they travelled in and around their neighborhoods. Participants demonstrated relatively high levels of cycling; one in four participants reported cycling in a usual week.
Cycling mode share was 3.2% (182/5730 reported trips). Notably, this cycling mode share is three times higher than the mode share for older adults living in the region and double the mode share for the general (all-ages) population. Based on a framework analysis of the interviews, factors that facilitate cycling include supportive infrastructure, a history of activity and the social aspects of cycling.
Factors that were barriers to cycling, both amongst those who reported cycling and those who did not, focused on safety, including motor vehicle traffic, cyclist behavior and theft. Our results suggest that should favorable policy and environmental conditions exist, cycling as a form of active transportation may be a viable option for older adults.
Driving licences and medical screening in old age: Review of literature and European licensing policies
Anu Siren, Sonja Haustein
- We investigate the evidence for and against having an age-based driver screening.
- We map and compare the current driving licensing policies in EU countries.
- We draw conclusions based on the literature and the policy mapping.
- The benefits from age-based screening are unlikely to outweigh the disadvantages.
- Many European policies are coercive and not evidence based.
Chronological age, per se, seems to be, in the case of mature drivers, only a weak predictor of safe driving performance. However, screening policies based on chronological age are widely used. Nevertheless, lately, more evidence-based policies have been called for.
In this paper we:
first, investigate the evidence for and against having an age-based driver screening policy in place
second, we map and compare the current driving licensing policies in European Union (EU) member states in order to examine the variation
third, we draw conclusions based on the literature and the policy mapping and provide policy recommendations.
We find no evidence from the literature demonstrating that the benefits from age-based driver screening would outweigh the disadvantages, and we find the European policies, to a large extent, coercive and not evidence based. Based on research evidence, the policies are likely to limit the mobility and potentially worsen the safety of older persons.
Understanding travel patterns to support safe active transport for older adults
Steve O׳Hern, Jennifer Oxley.
- Identified characteristics of active transport use among older and younger adults.
- Approximately one-fifth of trips involve active transport modes.
- Are differences in travel needs, reasons for and time of travel.
- Ways to improve participation in active transport and offer good mobility solutions for older adults are discussed.
Transport and mobility needs for all aged road users are diverse and may change with increasing age. With an increasing ageing population throughout much of the developed world combined with increasing life expectancies, there is a growing need to understand the transportation requirements of older adults. Moreover, while car use is still the most popular form of transport for older adults, alternative transport modes are offered and promoted, and their use is increasing.
This paper explores the characteristics of active transport usage among older adults, defined as persons over 65 years of age, in Melbourne, Australia. Data from the Victorian Integrated Survey of Travel Activity (VISTA) was analysed to undertake the assessment.
The analysis revealed that private motorised transport is the predominant mode of transport for older adults, representing approximately 70% of travel. Approximately 22% of travel was made using active transportation, with the majority of these being walking trips. Average trip distance, trip duration and walking speed were found to decrease past the age of 75 years.
The analysis shows that the travel patterns of older adults differ from those of younger adults which may reflect the fact that transitions in lifestyle influence their travel needs, destinations and time of travel, or an overall decrease in mobility. The implications of the findings are discussed in terms of ways to improve participation in active transportation and enhance the safe mobility of older active transport users, including a need to enhance the urban environment.
Future mobility in an ageing society – Where are we heading?
Ian Shergold, Glenn Lyons, Christa Hubers.
- Assistive technologies influence where and how older people will live.
- Scenario planning reveals plausible but divergent futures for older people.
- Assistive technologies coupled with state support for care indirectly affect travel.
- Shaping change rather than anticipating change may be a better policy response.
The demographic profile of UK society is changing as people live longer. Maintaining the wellbeing and quality of life of an ageing society is set to be extremely challenging.
To what extent can the state afford to meet a potentially burgeoning demand for social care?
- What expectations will be placed upon informal carers to enable the system to cope?
- In what ways and to what extent might assistive technologies have a part to play in supporting people both in terms of active ageing and in relation to coping with failing health?
- Beyond these questions is one which is more explicitly pertinent to transport policy: how and where will older people live and how will this affect patterns of mobility and levels of travel demand?
This paper reports on a scenario planning exercise which has examined four different futures for living in later life, defined by considering two critical uncertainties: the extent to which older people in society engage with new healthcare technologies; and the extent to which the state provides care for people living in later life. The scenarios, explored with transport, ageing and assistive technology experts, serve to highlight how social practices may be shaped in very different ways both for older people and for those with whom they interact.
The paper goes on to examine the implications for future mobility – such as the role of the home as a trip attractor as well as a trip generator – as well as to explore the extent to which transport policymakers are equipped to address the uncertainties for the transport system of an ageing society.