Safety of Older Pedestrians: Strategy for future research and action initiatives
Monash University Accident Research Centre Report #157 - 1999
Full report in .pdf format [545KB]
Authors: J. Oxley and B. Fildes
While older pedestrian crashes are relatively few in number, their rates are significant per head of population. Moreover, with expected increases in the proportion and mobility of older people in the years ahead, the problem will only get worse without active intervention. This review aimed to identify issues of relevance to the safety of older pedestrians and prioritise research and countermeasures for future initiatives. A literature review was conducted along with discussions with local and overseas specialists to highlight management and research issues likely to be of relevance. A total of 16 action and 14 research items were then distributed to a panel of Australian and international gerontology experts where these items were rated in terms of their likely importance for improved older pedestrian safety. Priority action initiatives emphasised more pedestrian friendly environments in high older pedestrian areas while research into exposure, travel patterns and older pedestrian road crossing behaviour were recommended.
Older pedestrian safety was nominated as a priority issue for future road safety programs in both the National Road Safety Strategy by the Federal Office of Road Safety and Safety First published by VicRoads.
This older pedestrian strategy project was subsequently undertaken to provide direction for future intervention and research effort aimed at improving the safety of this vulnerable road user group.
The study involved a comprehensive review of current knowledge and practice to identify issues where intervention and/or research were required. Areas reviewed included incidence and types of older pedestrian crashes, potential risk factors for older pedestrians, and other issues relevant for older pedestrians including mobility, current engineering awareness, and educational programs. These are summarised below.
Older Pedestrian Crashes
There were approximately 550 pedestrians killed on average each year on Australian roads during the early 1990s. While this figure was declining annually up until 1995, recent trends show that these road deaths are on the increase. A similar trend also existed for non-fatal casualties over the same time period.
Pedestrians aged 60 years and older accounted for 40% of all pedestrian fatalities in 1995 even though they made up only 15% of the population. These figures are likely to increase in the years ahead as the population ages.
Seventy-three percent of all pedestrian crashes involving those aged 65 years and above in Victoria occur while crossing the road and were equally likely whether they were stepping off the kerb or when in either the near-side or far-side traffic lane.
Crashes involving older pedestrians commonly occurred in 6Okm/h zones, at intersections (especially uncontrolled ones), during daylight and often in good weather. There is some evidence that complex road environments are particularly dangerous for older pedestrians. The evidence of who caused crashes involving older pedestrians is unclear.
Older pedestrian crashes during the late 1980s were estimated to have cost the Transport Accident Commission of Victoria around $61 million annually. While the average claim cost was about two-thirds that of younger pedestrians, older pedestrians did experience larger hospital, medical and rehabilitation charges than their younger counterparts.
The Ageing Population
Most western societies are experiencing an ageing phenomenon as the proportion aged 65 years and older increases. It is estimated that the proportion of the Australian population aged 65 years or more will double between 1991 and 2031 as the so-called "baby boomers" of the mid- 1940s enter that age group.
Moreover, the increase in the proportion of the elderly is also associated with an increase in longevity and greater demand for individual mobility. Thus, the size of the older pedestrian safety problem is bound to increase in the years ahead without active intervention effort.
The Ageing Process
The ageing process is associated with reduced abilities in a number of anatomical and physiological processes. These include declines in visual acuity, sensitivity and visual field, substantial hearing losses, reductions in depth and motion perception and significant declines in physical and cognitive capacity.
Older people appear to be less able or willing to recognise these declines and to adjust their behaviour accordingly. In addition, older people are more susceptible to injury and death in the event of a crash than younger people.
Muscular atrophy during ageing has considerable behavioural consequences such as restricted walking speed, gait and the ability to twist and turn. While older people may be able to compensate for these restrictions by allowing greater time before crossing the road and increased gap acceptance, the degree to which they are able to compensate adequately is not well documented.
Health & Medical Issues
Health status also deteriorates with increased age where there is a greater tendency for these people to suffer on-going health or medical conditions than those of younger ages. Common ageing disorders include various eye disorders (cataracts, muscular degeneration, glaucoma and diabetes mellitus), dementia including Alzheimers and Parkinson's disease, arthritis, and various cardio- and cerebrovascular conditions such as angina, coronary and rheumatic heart disease hypertension, transient ischaemic attacks (mini-strokes) or cerebrovascular accidents (CVAs or full strokes). Many of these health conditions are likely to affect a person's ability to cross the road safely.
With declining health, there is also an increased likelihood that older people will also be taking one or more prescription medications on a regular basis, many of which are likely to affect their ability to use the road safely. Moreover, not all of these medications have clear and understandable messages of their likely influence on mobility, especially pedestrian performance.
Road & Traffic Complexity
As noted above, older people have considerable difficulty coping with multiple sources of information such as crossing busy and complicated road networks.
Despite the availability of traffic signals, marked walkways and stop signs, older pedestrian accidents often occur at intersections, especially those with minimum traffic control. In crossing the road, the pedestrian must not only look to the left and right in the near-side and far-side lane and often forwards and backwards for turning vehicles, they must also be continually assessing and modifying their walking behaviour as the situation changes. This can place undue demands on older pedestrians who may subsequently focus on simple inappropriate cues when crossing the road, thereby placing themself at greater risk.
Furthermore, it is not always obvious or known who has right-of-way in certain situations on the road such as a vehicle entering or turning at an intersection or a roundabout. It is extremely unusual for there to be road markings or signs that help to clarify this at intersections.
Undivided roads also appear to cause considerable difficulty for older pedestrians crossing the road mid-block for many of the reasons already stated. Indeed, recent research seems to suggest that the use of median strips or pedestrian refuge areas in the centre of roads can lead to improved (safer) road behaviour by older pedestrians.
Traffic speed is also a problem for those attempting to cross over busy roads. While humans are generally poor at assessing the speed of an approaching vehicle, it is especially a problem for older people. Moreover, they are less likely to be able to avoid the sudden onset of a fast car. This is also the case with reversing vehicles where older pedestrians seem to be less able to spot the vehicle in the first place or getting out of its way as it approaches.
The Road Environment
The road environment, itself, may also contribute to the level of risk elderly pedestrians face when using the road system. Roads and pedestrian facilities are built according to standards often based on young adult performance. Highway designs will need to accommodate the needs of older adults more in the years ahead.
The use of signalised pedestrian crossings for older people is clearly desirable in areas often frequented by older people. However, with restricted walking abilities, it is ambitious to expect older people to go much out of their way to use these if it imposes much of a distant penalty. Moreover, traffic light cycles need to reflect older people's crossing speeds.
The desirability of subways and footbridges for older pedestrians is less clear as they commonly have fear for their safety and difficulty climbing stairs.
Footpaths alongside roads, poorly designed kerbs and overhanging foliage cause considerable problems for older people. Poorly positioned and illegible signs are also problematic. Indeed, most sign standards fail to take account of the visibility, colour and contrast levels necessary for ageing eyesight.
Most pedestrian crashes involve contact with a vehicle, commonly a passenger car. While external vehicle designs have changed considerably in recent times, these changes generally have not been introduced to protect pedestrians in the event of a collision. It is often the vehicle, not the ground that causes most serious injuries to pedestrians.
Many external aspects of modern cars are injurious to pedestrians such as bumper designs, bonnets (and what is close and relatively unprotected under them), windscreen panels and fittings, and various sharp and hard attachments. Current V-shaped front designs, too, may induce greater injuries by promoting contacts with the upper bonnet, windscreen and surrounding structures.
Education, publicity and training to improve older pedestrian safety is scant. Given that behavioural factors play an increasing role in traffic safety, more emphasis needs to be placed on intervention programs aimed at changing unsafe behaviour.
Programs such as "Walk-With-Care" in Victoria and other Australian States need to be supported and adequately resourced in the years ahead. However, it is first imperative that their effectiveness be assessed to maximise their usefulness and allocation of resources.
There were a total of 16 action items and 14 research items identified during the older pedestrian strategy review that had potential to improve the safety of older pedestrians or further our understanding of these problems. One of the aims of the strategy was to prioritise these in terms of their likely importance for future work in this area.
These findings were circulated to an expert panel of agency, researchers and community groups, both in Australia as well as overseas to assist in setting priorities.
Each expert was asked to make his or her judgement of the relative importance of each item using a 1-5 scale response and these judgements were then summed to provide an overall assessment of action or research priority. The top eight items in each group are shown in Tables 1 and 2 below.
Table 1 - Older Pedestrian Strategy Action Item Priorities
|1||Greater effort to provide a safe traffic environment for older peds.|
|2||Reduced travel speed in high density pedestrian areas|
|3||Reduced traffic in high density pedestrian areas|
|4||Development of alternative mobility options for older peds.|
|5||Guidelines for adequate crossing times for older peds.|
|6||Better maintenance of footpaths, surrounds and street lighting.|
|7||Develop safer access for older people at bus and tram stops|
|8||Improved public transport access for older people|
Of particular note, the first three priority action items all related to the provision of a safer and more pedestrian friendly environment in high-density traffic areas. There have been a number of innovative designs of malls and pedestrian and car precincts that have addressed the specific needs of the more vulnerable and more attention of these efforts would seem warranted from these findings. Of particular interest is the need for greater attention to pedestrians rather than motorists in these environments.
Table 2 - Older Pedestrian Strategy Research Item Priorities
|1||More detailed investigation of crash involvement patterns|
|2||Better appreciation of older pad. performance in complex settings|
|3||Examine the role of inappropriate behaviour in older pad. crashes|
|4||Evaluate effectiveness of speed reduction measures for older peds.|
|5||Evaluate the effectiveness of median strips for older peds.|
|6||Assess their mobility needs and patterns|
|7||Examine the suitability of road & hwy design for older peds.|
|8||Develop countermeasures at tram and bus stops|
The research items judged to be most important by the panel of experts emphasised greater understanding of the exposure and travel patterns of older pedestrians to permit more accurate assessments of the crash involvement rates and mobility needs as well as a better appreciation of their performance and behaviour in complex road environments.
The strategic review identified a number of ageing, health, environment, road engineering and educational issues relevant for older pedestrian safety. These were prioritised in terms of their likely importance for improved safety for this vulnerable road user group. While the older pedestrian safety problem is currently not large in number, it is nevertheless significant in terms of their rate per head of population and represents a reasonably large cost to the community. As it is estimated that the number of older pedestrians will double in the next 30 years or so, it is imperative that additional resources be provided to improve their safety in the years ahead.
Sponsoring Organisations: Baseline Research Program - Department of Justice, Transport Accident Commission, Royal Automobile Club of Victoria (RACV) Ltd, VicRoads.