Review of safety and mobility issues among older pedestrians

https://doi.org/10.1016/j.aap.2016.02.031Get rights and content

Highlights

  • Walking is important in old age for staying autonomous and physically active.

  • Older pedestrians are an extremely vulnerable road-user group.

  • Several areas of pedestrian activity are subject to age-related changes.

  • Functional changes with aging affect the safety of older pedestrians.

  • Interventions for older pedestrians need to be developed and evaluated.

Abstract

Although old people make up an extremely vulnerable road-user group, older pedestrians’ difficulties have been studied less extensively than those of older drivers, and more knowledge of this issue is still required. The present paper reviews current knowledge of older-adult problems with the main components of pedestrian activity, i.e., walking and obstacle negotiation, wayfinding, and road crossing. Compared to younger ones, old pedestrians exhibit declining walking skills, with a walking speed decrease, less stable balance, less efficient wayfinding strategies, and a greater number of unsafe road crossing behaviors. These difficulties are linked to age-related changes in sensorial, cognitive, physical, and self-perception abilities. It is now known that visual impairment, physical frailty, and attention deficits have a major negative impact on older pedestrians' safety and mobility, whereas the roles of self-evaluation and self-regulation are still poorly understood. All these elements must be taken into consideration, not only in developing effective safety interventions targeting older pedestrians, but also in designing roads and cars. Recent initiatives are presented here and some recommendations are proposed.

Introduction

A common desire among older adults is to stay where they are as they age, while remaining mobile in their familiar environment (Lord and Luxembourg, 2006). The ability to stay connected to community services and to maintain social interactions is considered today to be crucial to well-being and successful aging (for a review, see Yen and Anderson, 2012). Beyond the need for mobility, walking is known to be the most common physical activity of older adults (McPhillips et al., 1989) and to have positive effects on health, cognition, and well-being (see e.g., Fox et al., 2007; for a review, see Kramer and Erickson, 2007). However, walking may be dangerous because it exposes the walker to accident risks and falling.

Within the last few decades, research has mostly focused on the safety of older drivers. The study of older pedestrians is more recent and more limited, even though a large portion of pedestrian accidents involve an older adult. For example, in Italy, Greece and France, more than half of all pedestrians killed on the road are over 65 years of age, whereas this age group represents a much smaller part (17–20%) of the population (ONISR, 2006, SafetyNet, 2009). The same pattern of over-implication of older adults in pedestrian casualties and injuries has also been observed in non-European countries such as New Zealand (Keall, 1995).

Being hit while crossing a street is not the only safety risk encountered by pedestrians: the risk of falls also increases dramatically with aging. About one third of adults age 65 or older have experienced a fall within the past year (for a review, see Lord et al., 2001). More than half of all falls in independent older community-dwelling people occur outside the home (Fothergill et al., 1995, Lord et al., 2001). Although the data are scarce, a study conducted on the US population reported that 77.5% of pedestrian’s nonfatal injuries were linked to a fall; accidents while crossing the street (15%) and overexertion (5.8%) were the other main causes (Naumann et al., 2011; see also Abou-Raya and ElMeguid, 2009).

The aim of the present paper was to comprehensively portray older pedestrians’ safety difficulties in carrying out three main tasks involved in travel on foot, i.e. walking and obstacle negotiation, navigation, and street crossing. To provide a more general understanding of these difficulties, we also report the underlying functional changes that occur with aging (sensorial, cognitive, and physical) and their consequences on pedestrian safety and mobility. Identifying risky situations and their main causes is a preliminary step toward developing efficient actions aiming at improving the safety and mobility of older pedestrians. Some of these programs are presented at the end of the paper.

Section snippets

Walking and obstacle negotiation

Directly linked to the risk of falling, walking and obstacle negotiation are two major components of pedestrian mobility that change during aging.

Wayfinding

Wayfinding is another important pedestrian activity. It can be divided into preparing for the journey (i.e., planning) and navigating while walking (i.e., moving and orientation).

Street crossing

Crossing a street is a complex task that requires several actions (Bailey et al., 1992). First, pedestrians have to select an adequate crossing place, approach the curb, and look for oncoming vehicles and/or traffic lights. If there is no traffic light, pedestrians then have to select an adequate moment to cross by judging the available gaps in the flow of traffic. From there, they have to adapt their start-up time and crossing time to the amount of time available for crossing, by calibrating

Functional changes affecting older pedestrians’ safety

Many components of pedestrian activity are affected by the normal aging process and may therefore have a negative impact on older pedestrians’ safety and mobility. These overall functional changes pertain to sensory, cognitive, and physical abilities, as well as self-perception.

Recommendations for improving safety and mobility

The studies reviewed above have shed light on the main causes of older adult pedestrian’s high rate of involvement in fatalities and injuries. Some of these factors are linked to the road user him/herself (i.e., declines in sensory, cognitive, and physical abilities, and incorrect estimation of one’s own capabilities). Risk factors linked to the road environment play an important role too (e.g., complexity of road infrastructures, vehicle speed). However, despite this accumulated knowledge,

Conclusion

Walking is the cheapest, easiest, and most sustainable way to get around. Every trip begins and ends by walking, which is the common link in the multimodal travel chain. While walking is the most common transportation mode used by older people, it is also a particularly risky activity for this population. Although population aging and urbanization, and in particular the development of “global age-friendly cities” (WHO, 2007), have been identified as two of the most important challenges of the

Acknowledgements

The work was funded by DG Move, through the SAMERU project (agreement number MOVE/SUB/2010/D3/300-1/SI2.565668-SAMERU), aimed at investigating the safety and mobility of elderly road users. The authors would like to thank Vivian Waltz for the English editing.

References (218)

  • E. Desapriya et al.

    Vision improvement and reduction in falls after expedited cataract surgery: systematic review and metaanalysis

    J. Cataract Refract. Surg.

    (2010)
  • A. Dommes et al.

    A simulator-based training method to improve older pedestrians’ safety

    Transp. Res. Part F: Traffic Psychol. Behav.

    (2012)
  • A. Dommes et al.

    Crossing a two-way street: comparison of young and old pedestrians

    J. Saf. Res.

    (2014)
  • A. Dommes et al.

    Age-related differences in street-crossing safety before and after older pedestrians’ training

    Accid. Anal. Prev.

    (2012)
  • A. Dommes et al.

    Towards an explanation of age-related difficulties in crossing a two-way street

    Accid. Anal. Prev.

    (2015)
  • G. Dunbar

    The relative risk of nearside accidents is high for the youngest and oldest pedestrians

    Accid. Anal. Prev.

    (2012)
  • D.D. Espy et al.

    Independent influence of gait speed and step length on stability and fall risk

    Gait Posture

    (2010)
  • S. Fickas et al.

    Route-following assistance for travelers with cognitive impairments: a comparison of four prompt modes

    Int. J. Hum.-Comput. Stud.

    (2008)
  • H. Fontaine et al.

    Fatal pedestrian accidents in France: a typological analysis

    Accid. Anal. Prev.

    (1997)
  • B. Galna et al.

    Obstacle crossing deficits in older adults: a systematic review

    Gait Posture

    (2009)
  • M. Gérin-Lajoie et al.

    The circumvention of obstacles during walking in different environmental contexts: a comparison between older and younger adults

    Gait Posture

    (2006)
  • C.A. Gorrie et al.

    Crash characteristics of older pedestrian fatalities: dementia pathology may be related to ‘at risk’ traffic situations

    Accid. Anal. Prev.

    (2008)
  • S.E. Halliday et al.

    The initiation of gait in young, elderly: and Parkinson’s disease subjects

    Gait Posture

    (1998)
  • C. Harley et al.

    Stepping over obstacles: Attention demands and aging

    Gait Posture

    (2009)
  • M.A. Harris et al.

    How age-related strategy switching deficits affect wayfinding in complex environments

    Neurobiol. Aging

    (2014)
  • R.C. Harruff et al.

    Analysis of circumstances and injuries in 217 pedestrian traffic fatalities

    Accid. Anal. Prev.

    (1998)
  • L. Hasher et al.

    Working memory, comprehension, and aging: a review and a new view

  • D. Head et al.

    Age effects on wayfinding and route learning skills

    Behav. Brain Res.

    (2010)
  • C. Holland et al.

    Gender differences in factors predicting unsafe crossing decisions in adult pedestrians across the lifespan: a simulation study

    Accid. Anal. Prev.

    (2010)
  • J.H. Hollman et al.

    Age-related differences in spatiotemporal markers of gait stability during dual task walking

    Gait Posture

    (2007)
  • R.B. Huitema et al.

    Effect of ageing on the ability to adapt to a visual distortion during walking

    Gait Posture

    (2005)
  • M. Hunt et al.

    Mind the gap: training road users to use speed and distance when making gap-acceptance decisions

    Accid. Anal. Prev.

    (2011)
  • J.S. Jermakian

    Crash avoidance potential of four passenger vehicle technologies

    Accid. Anal. Prev.

    (2011)
  • M.D. Keall

    Pedestrian exposure to risk of road accident in New Zealand

    Accid. Anal. Prev.

    (1995)
  • S. Abou-Raya et al.

    Road traffic accidents and the elderly

    Geriatr. Gerontol. Int.

    (2009)
  • N.B. Alexander

    Gait disorders in older adults

    J. Am.Geriatr. Soc.

    (1996)
  • S.L. Amosun et al.

    Are elderly pedestrians allowed enough time at pedestrian crossings in Cape Town, South Africa?

    Physiother. Theory Pract.

    (2007)
  • K.J. Anstey et al.

    Different cognitive profiles for single compared with recurrent fallers without dementia

    Neuropsychology

    (2009)
  • M. Angeraven et al.

    Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment

    Cochrane Database Syst. Rev. (Online)

    (2008)
  • J. Arango et al.

    Walking speed of older pedestrians who use canes or walkers for mobility

    Transp. Res. Rec.

    (2008)
  • C.M. Arnold et al.

    The relationship of intrinsic fall risk factors to a recent history of falling in older women with osteoporosis

    J. Orthop. Sports Phys. Ther.

    (2005)
  • L. Asher et al.

    Most older pedestrians are unable to cross the road in time: a cross-sectional study

    Age Ageing

    (2012)
  • S.S. Bailey et al.

    Issue of elderly pedestrians

    Transp. Res. Rec.

    (1992)
  • K. Ball et al.

    The useful field of view test: a new technique for evaluating age-related declines in visual function

    J. Am. Optometric Assoc.

    (1993)
  • R. Beurskens et al.

    Age-related deficits of dual-task walking: a review

    Neural Plast.

    (2012)
  • A.J. Blake et al.

    Falls by elderly people at home: prevalence and associated factors

    Age Ageing

    (1988)
  • A.A. Black et al.

    Inferior visual field reductions are associated with poorer functional status among older adults with glaucoma

    Ophthalmic Physiol. Opt.

    (2011)
  • W. Boot et al.

    Improving the safety of aging road users: a mini-review

    Gerontology

    (2014)
  • T.E. Boyce et al.

    A community-wide intervention to improve pedestrian safety. Guidelines for institutionalizing large-scale behavior change

    Environ. Behav.

    (2000)
  • P.C. Burns

    Navigation and the mobility of older drivers

    J. Gerontol.: Ser. B: Psychol. Sci. Soc. Sci.

    (1999)
  • Cited by (76)

    • Is there a relationship between time pressure and pedestrian non-compliance? A systematic review

      2023, Transportation Research Part F: Traffic Psychology and Behaviour
    • Associations between walkability and pedestrian related injuries is modified by sociodemographic characteristics

      2022, Injury
      Citation Excerpt :

      Given the fear of falling [43], elderly need to keep their balance when walking [44] and more likely to watch their steps as they cross, instead of focusing on approaching traffic [45]. In addition, elderly pedestrians may be at increased risk due to not using pedestrian crossings that may be some distance away [46]. The peak at the Somewhat Walkable and Very Walkable areas among elderly aged 64 years and over may be due to the inadequate support safety for elderly in these areas.

    • Heterogeneity in seniors' unmet walking needs: A latent class analysis

      2022, Journal of Transport Geography
      Citation Excerpt :

      A potential explanation for these findings might be related to the deteriorating health status on mobility. It is commonly acknowledged that seniors are more possible to experience walking difficulties because of age-related declining health functions including cognitive, physical, and sensory functions (Luiu and Tight, 2021; Tournier et al., 2016). In line with previous research (Böcker et al., 2019), adverse weather condition, i.e., weather is too hot/too cold (18.39%), is also identified as a notable walking obstacle.

    • Quantification of the movement characteristics for the elderly assisted by the young through exit

      2021, Safety Science
      Citation Excerpt :

      Due to the decline in physical functions, the elderly has lower movement ability and run a higher risk in the daily travel and emergency evacuation. Tournier et al. (2016) reviewed the current knowledge of older-adult problems with the main components of pedestrian activity. It showed that the elderly exhibit declining walking skills with a walking speed decrease, less stable balance, less efficient wayfinding strategies, and a greater number of unsafe road crossing behaviors.

    View all citing articles on Scopus
    View full text