Travel and transport in later life: A review for the United Kingdom (UK) government

A few years back myself and esteemed colleagues were asked to write an evidence review on the current state and future of transport in the UK for the Foresight, Government Office for Science, London, UK. The full report can be found at

Ormerod, M. Newton, R., Philips, J., Musselwhite, C., McGee, S and Russell, R. (2015).  How can transport provision and associated built environment infrastructure be enhanced and developed to support the mobility needs of individuals as they age? Future of an ageing population: evidence review Foresight, Government Office for Science, London, UK

But, here is a summary of what we wrote.

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Introduction

Despite being in better health and physically fitter than ever before, older people still report great difficulty in accessing shops, banks and hospitals and to stay connected to local communities), especially when no longer driving[i]. The need to be mobile and to travel is also related to psychological wellbeing in old age and a reduction in mobility can result in an increase in isolation, loneliness and depression[ii] and overall a poorer quality of life[iii]. Sadly around 342,000 over 75 year olds ‘feel trapped’ in their own homes through lack of suitable transport[iv]. We were asked to contribute to the UK Government’s Foresight task, bringing into focus the current issues surrounding older people and transport in the UK and looking ahead to the future. I want to explore four elements of travel and mobility in later life. First, to expunge the myth that older drivers are a particular danger on the road and need to be given a test. Secondly, the importance of free bus travel. Third, how to create age friendly pedestrian areas. Finally the role that cycling could play, all hopefully citing mobility and accessibility could be improved in later life.

Should we test older drivers?

Drivers KSIFigure 1: Casualty rates for drivers by age and types of casualty (KSI = killed or seriously injured) (Mitchell, 2012)

On a chart (see figure 1) of casualties by age resulting from road traffic collisions per mile driven, you will see an increase in number of casualties from around 75 and certainly 80 years of age . However, much of this increase is because the older person is more likely to be susceptible to injury or death due to increased frailty[v] and is especially an issue for those who drive a low number of miles[vi]. Interestingly, countries that have more stringent licencing for older people (such as in New South Wales, Denmark, Norway and Sweden) do not have any fewer road traffic casualties among that age group than in places with relaxed procedures (such as in the UK with self-report), suggesting introducing a test would not necessarily have positive effect[vii]. Many countries are relaxing their licencing for older people as a consequence. Finally we are seeing increasing automation of vehicles, perhaps with full automation possible in the future, this changes dramatically who might be able to drive a vehicle and open opportunities up for continuing driving in later life.

That said, not all older people are good drivers, however, and many of the things associated with old age can affect driving including changes in physical health, eyesight, hearing, cognition (e.g. memory, attention, distraction etc.) The types of collisions older people have when driving are different to those of younger people, for example older people are more likely to be involved in collisions at junctions, in merging traffic, with turning across the road and in busy traffic.   Also, since driving is a fairly automatic skill, we don’t always notice subtle changes in our driving ability and it is always a good idea to seek advice on driving ability from others, from family and friends that you trust and can give valid feedback. Then it may be useful for older people to visit one of the local driver assessment centres or book a driving instructor to give you some professional feedback and tips on staying on the road. Feedback from people who have been on these courses is often very positive, but a more formal evaluation, looking to see if it improves driver behaviour or reduces collisions is needed.  Planning to give-up driving and working out new ways of getting out and about without the car using lifts, public transport, taxis or walking, is best done way in advance of needing to give-up driving, so best to start from a young age!

The value of the free bus pass
The free bus pass for the over 65s has been excellent  in meeting practical needs , for example helping to meet essential health care appointments and shopping needs, reducing missed appointments and providing access to variety of goods. It can improve health by creating space for exercise, for example taking people to places for walking, and in creating walking to and from the bus stops themselves[viii]. It is also good for mental health, as Geoff Andrews [ix]and colleagues point out, the bus becomes a focus of social activity itself, with many going for journeys for their own sake, sometimes not even knowing where the route will take them, something that is traditionally missed when giving-up the car[x]. However, there must be provision of bus services in the first instance and in the current climate of cuts in local authority funding reducing services is a reality that can have detrimental effect on those that need them most. In addition, the buses must be accessible, have comfortable, sheltered places to sit and wait, with good information on services provided. Many bus companies are also providing training for bus drivers to understand older people’s needs, helping older people gain confidence in using the bus that the drivers will be patient and help with payment and ticket types and not drive off until being seated.

Age friendly pedestrian areas
We need to create environments for older people that they are able to walk in. Walking is a great way to stay fit and healthy, but casualties from walking are highest for those aged over 70. Cracked pavements, steep steps, unlit areas are all too commonly barriers to getting out and about and can be dangerous. Lack of toilets and lack of benches are often cited as reducing the accessibility for older people too. But it is also about desirability of an area, there must be something that pulls people to want to get out and about, decent shops with understanding and friendly staff, affordable coffee or tea shops, attractive architecture, a sense of place and history remembered and revealed. All too often these elements are forgotten, as needs of different users ignored. [xi]

TVs in city centre

Figure 2: Can we live without television as we visit a City Centre?

Modern town or city centres have prioritised commercial interests over social, the worst of these a lack of places to sit, forcing people into expensive café and coffee shops and the advent of big television sets in city squares, as if we can’t live without our televisions for the time we want to visit the shops (see figure 2).

crossing countdowns

Figure 3: Crossing with a countdown for pedestrians

Having places and spaces that are easy to understand and give clear messages as to their uses and to have easy to find, accessible entrances and for individual neighbourhoods to be defined by their own distinctive, varied characteristics, features and materials. Legibility is particularly important for people with cognitive impairment such as those with dementia if they are to remain active and independent. The Alzheimer’s Society (2013) defines a dementia-friendly community as “a city, town or village where people with dementia are understood, respected and supported and confident that they can contribute to community life”. For people with dementia, places need to have familiarity and meaning and they should be legible, distinctive, accessible, comfortable and safe.

A big issue is also crossing the road. The Department for Transport in the UK set the suggested crossing speed for a pedestrian at 1.2m/s. Countless studies suggest this is way too quick for older people and in my recent study 85% of all older people and 94% of women, over 65, did not walk at this speed[xii], making crossing the road inapproachable and dangerous. Smart crossings that follow people as they cross, only turning back to green for vehicles once completion of crossing has occurred should be rolled out. There also needs to be more standardisation over crossing types. Could there also be a role for crossing with a countdown which help pedestrians plan to cross the road? (see figure 3)

A note on improving cycling

Cycling is great for fitness and health for older people and has less impact on hips and joints as other cardio-vascular activity such as running, yet in the UK only 1% of all journeys by the over 65s are made by bicycle; compare this to15% in demark and 23% in Netherlands.  We need better supportive infrastructure and a change in attitude; roads are not just for cars and cycling isn’t just for the young[xiii].

Ways forwards

We identified ways in which life will change for older people over the next few years :

(1) Understanding the role of computers and technologies

Computers and technologies are playing an increasing role in our lives. Will technology take over the need to actually travel to places, for example keeping in touch with others over video links, doing shopping online and other aspects of virtual reality such as virtual walks. What is missing is understanding what is lost through virtual connections compared to actually being present and actually being mobile and more research is needed don this. We know that the need to physically interact with each other is important for most people, yet this is absent when aspects of virtual mobility are used as an alternative to physical mobility.

(2) Door-to-door transport and multi-modality of older people

Research in the past has tended to treat the modes people travel on in isolation. However, people often use more than one  mode of transport to complete a journey (walking to the bus stop, catching a bus, walking to the shops etc.) and more research needs to acknowledge and understand how people move between different modes and a door-to-door approach is advocated.

(3) Technologies, driverless vehicles and driver support

Driver assistance systems, that may take over difficult aspects of driving,  and driverless cars, where the car drives itself,  have the potential to aid personal mobility for older people and they may also prolong driving or reduce the need to give up driving altogether.

(4) Dementia

Dementia is the umbrella term given to over 100 different diseases involving the progressive loss of mental, and ultimately physical, functions. The key is to help a person with dementia to stay active and independent for longer, and transport can play a significant role in achieving this, but it is an under-researched area.

(5) Falls

Falling over, either as a pedestrian or on public transport, can result in injury and subsequent loss of independence. Even the fear of falling, rather than actual falling, can result in a person not going out of the home. Those falls that happen away from the home require further investigation.

(6)  Public spending cuts

Austerity cuts could disproportionately affect older people in terms of mobility, especially since there have already been cuts in infrastructure and services in the UK. In terms of walking, poor upkeep of pavements can have a huge effect on older people’s confidence to go out and may induce a fall if they do. In addition, there is a real fear about the future of buses and local authorities have reduced their support for unviable bus routes and times, resulting in lower provision in rural areas and in all areas outside of key times of the day, resulting in no buses after around 6 pm in some areas. The future of mobility for older people in light of such cuts needs to be made visible in order to highlight the resulting disproportionality. Perhaps community-based schemes will have a greater role and take over some of the bus services for those who need it most but it is harder to see how pedestrian areas can be kept up for less money. More research is needed to provide the evidence base for priority areas for older people’s mobility in times of austerity.

(7) Fun not just functional transport

Transport services provision for older people tends to often be around functionality, often based around a traditional deficit model. Transport services such as community transport focus on journeys to hospitals, doctors or for shopping. There is a growing realisation that older people want more than this, to be able to go out to the see the world, to the beach, to the forest, to go to the pub and more research is needed to identify the positive benefits of providing transport for these journeys so that they get provided more often..

Conclusion

Driving is often felt to be a pancea in later life, as it enables almost door-to-door travel with little physical or cognitive effort. Research shows that giving-up driving is usually associated with a huge increase in depression and poorer health. However, planning to give-up driving, gathering information on alternatives, trying them out before having to give-up driving altogether can help, as can emotional and practical support from family and friends. We need to improve the accessibility and desirability of our urban and pedestrian areas, shout about the benefits of free bus travel and possibly look to active travel such as cycling to help improve life beyond the car in later life.

Footnotes/references

[i] See Musselwhite, C. (2011) Successfully giving up driving for older people. Discussion Paper. International Longevity Centre – UK.

[ii] Ling, D. J. & Mannion, R. (1995), Enhanced Mobility and Quality of Life of Older People: Assessment of Economic and Social Benefits of Dial-a- Ride Services, in Proceedings of the Seventh International Conference on Transport and Mobility for Older and Disabled People, Vol. 1, DETR, United Kingdom.

Fonda, S. J., Wallace, R. B., & Herzog, A. R. (2001). Changes in driving patterns and worsening depressive symptoms among older adults. Journal of Gerontology: Social Sciences, 56B(6), S343-S351

[iii] Musselwhite, C. and Haddad, H. (2010). Mobility, accessibility and quality of later life. Quality in Ageing and Older Adults. 11(1), 25-37.

[iv] WRVS (2013) Going nowhere fast: Impact of inaccessible public transport on wellbeing and  social connectedness of older people in Great Britain http://www.royalvoluntaryservice.org.uk/Uploads/Documents/Reports%20and%20Reviews/Trans%20report_GB_web_v1.pdf

[v] See Box, E., Mitchell., K. And Gandolfi, K (2010). Maintaining, Safe Mobility for the Ageing. London:

RAC Foundation Report for a review.

[vi] Langford J., Methorst, R. and Hakamies-Blomqvist, L. (2006) Older drivers do not have a high

crash risk—A replication of low mileage bias, Accident Analysis & Prevention, 38 (3) , 574-578.

[vii] See Box, E., Mitchell., K. And Gandolfi, K (2010). Maintaining, Safe Mobility for the Ageing. London: RAC Foundation Report for review via http://www.racfoundation.org/media-centre/Older-drivers

[viii] Green, J; Jones, A; Roberts, H (2014) More than A to B: the role of free bus travel for the mobility and wellbeing of older citizens in London. Ageing and society, 34 (3). pp. 472-494. See http://researchonline.lshtm.ac.uk/1520149/1/-ASO-ASO34_03-S0144686X12001110a.pdf

[ix] Andrews, G., Parkhurst, G., Shaw, J. and Susilo, Y. (2011) The grey escape: How and why are older people really using their free bus pass? In: 43rd Universities Transport Study Group Conference, Milton Keynes, UK, 5th-7th January 2011. See http://eprints.uwe.ac.uk/16908/1/utsg2011_andrews_et_al.pdf

[x] Musselwhite, C. and Haddad, H. (2010). Mobility, accessibility and quality of later life. Quality in Ageing and Older Adults. 11(1), 25-37.

[xi] See the excellent IDGO project for more details http://www.idgo.ac.uk/ and the recent community matters paper from ILC UK at http://www.ilcuk.org.uk/index.php/publications/publication_details/community_matters_making_our_communities_ready_for_ageing_a_call_to_action

[xii] Musselwhite, C.B.A. (2014). Environment-person interactions enabling walking in later life Proceedings of the 46th Annual UTSG Conference, Transport Operations Research Group, Newcastle University, 6th January

[xiii] There is a three year project just kicked off aiming to develop a deep understanding of cycling amongst the older population in the UK – See www.cycleboom.org for more details.

 

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