Why Are Older Adults More at Risk as Pedestrians? A Systematic Review

Abstract

Objective To explore factors that could explain why older adults are more at risk at the roadside. Background The physical and psychological health benefits of walking have been well-established, leading to the widespread promotion of walking amongst older adults. However, walking can result in an increased risk of injury as a pedestrian at the roadside, which is a greater risk for older adults who are overrepresented in pedestrian casualty figures. Method Relevant databases were searched up to January 2020. All peer-reviewed journals that presented data on healthy older adults and some aspect of road crossing or roadside behavior were included. A total of 142 papers were assessed and 60 met the inclusion criteria. Results Identified papers could be grouped into three areas: crossing at a designated crossing place; crossing with no designated crossing place; perceptions or behaviors. Conclusion Multiple individual (attitudes, perceived behavioral control, walking time, time-to-arrival judgments, waiting endurance, cognitive ability), task (vehicle size, vehicle speed, traffic volume), and environmental (road layout, time of day, weather) constraints influence road crossing in older adulthood. Application Accessibility of designated crossing areas needs to be addressed by ensuring sufficient time to cross and nonrestrictive waiting times. Signalized crossings need to be simplified and visibility increased. Where there is no designated crossing place, a reduction in speed limit alongside the provision of pedestrian islands to provide “pause” places are needed. Educational-based programs may also help ensure safety of older adults where there is no designated crossing place.

A methodology for the public health surveillance and epidemiologic analysis of outdoor falls that require an emergency medical services response

“…Placing this in context, in 2019 this figure is 70% higher than estimates of the number of pedestrians (76,000) injured by automobiles in 2019 (National Highway Traffic Safety Administration 2021 ). While there is a large body of research on pedestrian injuries from automobiles (Halari et al 2020 ; Namatovu et al 2022 ; Rezapur-Shahkolai et al 2022 ; Wilmut et al 2022 ), there is almost no literature on pedestrian injuries from falls that occur on streets and sidewalks (Timsina et al 2017 ). This discrepancy in research attention translates into a marked focus on policy and design interventions to prevent pedestrian injuries from automobiles, including the national Vison Zero program, and minimal focus on interventions to prevent pedestrian injuries from outdoor falls, even though these injuries occur in the same or adjacent physical environments (Evenson et al 2018 ).…”

Epidemiology and patterns of nasal bone fracture in elderly patients in comparison to other age groups: an 8-year single-center retrospective analysis

“…The proportion of injuries due to road TA was significantly higher in the elderly than in other groups, which can also be ascribed to aging-related physical changes. The elderly have poorer knowledge of transportation, lower compliance with laws, and less risk readiness and risk sensitivity in dangerous traffic conditions [ 21 ].…”

Should Slowing Be Considered a Distinct Geriatric Syndrome?

“…28 Furthermore, psychomotor slowness can be a risk factor for many problems in everyday living, such as by increasing one's risk of accident as a pedestrian. 29 In our clinical experience, functionally relevant slowness tends to be associated with 1 or more comorbid diseases. As is the case for well-known geriatric syndromes such as cognitive impairment, recurrent falls, and urinary incontinence, 30 physiological slowness likely needs the added effect of 1 or more comorbid diseases to become severe enough to negatively affect daily activities.…”