Landscape Review

The challenges associated with maintaining safe mobility for an ageing population will necessarily require the engagement of a wider array of Whitehall departments and areas of public policy.

This report is the culmination of work to map the current policy landscape with a view to examining the challenges, opportunities, barriers and research gaps to delivering fair, accessible and safe mobility to those in later life. The purpose is to understand the public policy domains which can affect safety and mobility amongst an older population; and in turn, identify where improved safe mobility can positively affect these other policy domains

Key Facts

The main report has been summarised to present the key facts arising from each of the main policy areas investigated.

Mobility and living a healthier older-age are inextricably linked. Holley-Moore and Creighton (2015) state that mobility is:
  • beneficial to personal wellbeing, by improving quality of life through avoiding loneliness and isolation
  • beneficial to physical health, as those who travel more regularly are more active
  • beneficial to the wider community, providing opportunities for older people to volunteer, work, shop and spend.

  • The challenges associated with maintaining safe mobility for an ageing population will necessarily require the engagement of a wider array of government departments and areas of public policy.
    The Centre for Ageing Better proposed that the Healthy Ageing Challenge Fund focused on seven themes, with most of the seven related to mobility and transport in some way, to encourage innovations to assist longer, healthier lives. (Centre of Ageing Better, 2019)
    “Policies affecting economics, healthcare, the built environment, and transport will all be particularly critical to ensuring that we maintain an active, healthy, and socially engaged ageing population.” (Scottish Science Advisory Council, 2018)
    There are a wide range of policy strategies which have been adopted by OECD countries and cities to make the most of the opportunities that ageing societies present and mitigate the challenges as much as possible.
    These strategies include:
  • developing a long-term vision for ageing societies
  • defining outcomes and objectives
  • involving older citizens in the process of building the vision
  • by promoting synergies between local policies and national development objectives.

  • Another strategy is to develop indicators to inform citizens and understand the stage of demographic change which the city is at, measuring:
  • health and social care
  • community activities
  • labour
  • housing and living environment
  • transport and mobility
  • urban planning,

  • A third strategy is to promote health for all ages, using preventative measures (such as collecting and using long-term data about conditions and healthcare) and promote walking by citizens.
    Increasing older people’s engagement in the labour market and in social activities is another strategy which can be adopted by cities, as is ensuring that housing is affordable, in-home care services are available, and there is access to employment and public and private services by public transport.

    Road Safety

    [link to Safer Road Users pillar study] Casualty rates per mile driven are lowest for 70 years old but this increases from 75 years onwards, partly due to frailty leading to death or injury. “Older people are over-represented in collisions at junctions, in merging traffic, with turns across the road and in busy traffic.” (Ormerod, et al., 2015, p. 20) Many older drivers use self-regulation (choosing when, where and how they drive) to deal with their perceived reduction in ability, although they may not be accurate at assessing their own ability.

    Driving

    [link to Safer Road Users pillar study] There is a network of independent centres (see DrivingMobility.org.uk) which provide support to improve driver safety, through on-road and simulator training and advice. The centres also provide help with buying vehicles and technology that can be used to aid driving. People can self-refer to these centres or can be referred by medical staff or the Driver and Vehicle Licensing Agency.

    Driving Cessation

    [link to Safer Road Users pillar study] Giving up driving is a major life event for older people and is often linked to a social trigger, such as retirement from work, rather than due to a health incident or road collision. Rather than being a sudden event, the concept of driver cessation should be considered as part of a gradual and planned approach, where alternative travel options can be phased in.

    Car Design
    [link to Safer Vehicles pillar study] One challenge for all drivers, but one that may be especially true for older drivers, is that there is no standardisation of vehicle controls and driver assistance systems. This can cause confusion when purchasing a new or used vehicle or hiring or borrowing a car. Controls and systems can differ between make and models, making operation of basic controls such as headlights and parking brakes difficult when using a new car. There are also opportunities with car design for older people. “The Ford Focus was designed with the needs of older drivers specifically in mind. Designers were encouraged to wear the ‘Third Age Suit’, a suit which stimulated the effects of ageing. It stiffened joints, added bulk around the torso and added visual impairments such as cataracts.” (Holley-Moore & Creighton, 2015, p. 14)

    In-Car Technology

    [link to Safer Vehicles pillar study] Telematics, or BlackBox insurance, is being used by some car insurance providers to calculate premiums. Braking speed, cornering and acceleration can be measured through a device installed in a driver’s car or by using a smartphone app. Other technological advancements, such as rear-view cameras for reversing, blind-spot warning systems and auto-parking technology, can assist those with limited upper-body mobility and aid their independence. Driverless cars have the potential to benefit older people, as those with health-related issues will no longer need to cease driving; those in rural areas have greater independence; and giving greater freedom to those who have issues getting to train stations and bus stops.

    Public Transport

    There are barriers to older people using buses, even when the trip is free. “Crowds at bus stops or on the bus, prams taking up the seats or area at the front of the bus, steps up to the bus being too high (or the driver stopping too far from the kerb), and fear of falling over when the bus moves off” (Ormerod, et al., 2015, p. 29) are all barriers to bus use. Accessibility to the London Underground means that older people often stop using the tube and move to buses instead. Perceptions and concerns about long staircases, overcrowding, crime, and doors closing too quickly are all problems for older people. A key barrier to mobility for older people is poor travel information. Travel information can include pre-planning a route and deciding on which mode to take, looking at directions and costs, and using real-time data to understand traffic. The use of accurate travel information can help facilitate a reduction in habitual car trips by encouraging the use of different modes. The use of real time audio and visual information on buses, which tell passengers when they arrive at different stops helps prevent people miss their stop, gives them time to prepare to alight, and reassures them they are on the correct route. The use of public transport in rural areas is poor, because it is less convenient, infrequent, does not go where they would like it to, or it is not available. Older people in rural areas are therefore at a greater risk of losing mobility than those in urban areas and the consequences of a loss of mobility disproportionately affect those living in rural areas. Changing social norms about aiding other people on public transport could increase confidence for all of its users. Alongside signs encouraging passengers to give up their seats for others, there could be messages encouraging them to provide help in navigating public transport.

    Rural Transport
    Those living in rural communities need to travel to access vital services. With public transport often limited in these areas, alternative solutions should be considered. Schemes include older people donating their car to a younger person in need of transport, in exchange for transport vouchers for lifts in donated cars. An alternative would be a combination of volunteering and technology where online lift sharing platforms and mobile phone apps could be used to create a larger pool of volunteer drivers and make it easier to see what lifts were available.

    Rural Planning

    Rural communities have been hit particularly hard with shops and post offices having closed in recent years, making residents dependent on using a car, which creates challenges for older people.

    Urban Planning

    In urban areas, the closure of local services and amenities, social polarisation, crime and poor housing lead to social exclusion and a decreased quality of life amongst older people. Furthermore, decades of out-of-town housing developments have made driving more important. (Box, Gandolfi, & Mitchell, 2010) In Denmark, Germany and the Netherlands in the 1970s, there was a drive to make cycling safer, more accessible and more popular. Cycling rates were transformed in these countries through legislation, societal influencers and public spending, where Governments invested in infrastructure to create:
  • high-quality, safe cycle lanes
  • legislation to improve right of way for cyclists
  • mixed-use urban development planning regulations (making the average trip length was generally shorter than elsewhere)
  • For walking, decreasing mobility barriers in the environment (such as long distances, lack of resting places, poor street conditions and busy traffic) “will have an immediate effect on mobility by improving accessibility. However, removing barriers may also slow down progression of mobility decline by helping to maintain adequate activity levels.” (Rantanen, 2013, p. S53) Better design and maintenance could prevent many of the environmental risk factors, such as poor pavement quality, dilapidation and kerb height, which are associated with outdoor falls. The main components of a lifetime neighbourhood include “supporting older people as participants in developing neighbourhoods, access, services and amenities, the built and natural environment, social networks and well-being and housing.” (Torrington, 2014b, p. 13) Neighbourhood features that were prized by older people including a safe environment where residents can enjoy good relationships with neighbours, go for walks and have access to good services and facilities.

    General Planning

    [link to Safer Roads pillar study] Shared spaces can be a challenge for older pedestrians. Shared spaces are where there is no segregation (such as a kerb) between motorised vehicles and pedestrians and cyclists and all of the road users can use the carriageway together. Being able to safely cross the road is an important part of being an active pedestrian. If pedestrians feel unsafe, they are more likely to use a car instead. Feeling safe is also important when crossing the road and walking in general. Less traffic, shorter waiting time, presence of a green man on the opposite side of the carriageway, and the quality of information about when to cross were the four statistically significant predictors of feeling safe when crossing the road. The US Department of Transportation’s Federal Highway Administration issued a handbook for designing roads for the older population. (Federal Highway Administration, 2014) It provides evidence on how different road features can be problematic for older people and suggests design approaches to mitigate them, both on new roads and those locations with a history of collisions involving older people.

    Mental Wellbeing

    Mental wellbeing can be adversely affected by loneliness and isolation, making access to reliable, affordable and safe transport important for older people to maintain contact with family and friends. In turn, physical health can be adversely affected by loneliness and the subsequent decline in wellbeing (Holley-Moore & Creighton, 2015). Social isolation is where an individual, often due to deteriorating health or mobility, is isolated from normal social networks, whilst loneliness is a subjective negative feeling. Mortality, and physical and mental health are negatively influenced by both social isolation and loneliness. Social isolation and loneliness have been shown to influence the use of healthcare services and lonely older adults are more likely to enter care homes earlier (Robinson, 2014). The act of travel (rather than the end destination) can increase the opportunities for interactions with others and reduce feelings of isolation, making it beneficial for older people to have the opportunity to travel when they want to, rather than just because they need to. In addition to benefiting wellbeing, people who travel are more active and therefore enjoy the health benefits that come with more active lifestyles. An active, healthy older population could play a part in reducing the healthcare costs associated with an ageing population (Holley-Moore & Creighton, 2015).

    Healthcare Costs

    Whilst there are increases in funding for the NHS in the UK to help cope with rising demand for healthcare services, the current levels of additional funding will only equip the NHS to meet current, and not future, demand. As the population continues to age, this burden will continue to increase.

    Accessing Healthcare

    A significant minority (16%) of those over 65 find it difficult or very difficult to travel to hospital (equating to 1.45 million people) and 7% said the same about access to their GP (630,000 of over 65s). Older people with longstanding illnesses are the least likely to use public transport due to mobility or health problems (Holley-Moore & Creighton, 2015). Furthermore, “41% of people living in rural areas do not have access to their nearest hospital within an hour’s travel by public transport or walking, compared with 6% of users living in urban areas.” (Age UK, 2019, p. 7)

    Dementia

    Dementia prevents a particular challenge for travel. Dementia can affect a driver’s ability to plan and remember routes, anticipate and react to other road users, and understand and respond to road signs and obstacles. Dementia can also affect people using public transport on their own, where they may have difficulty with routes, dealing with money, or interacting with other passengers. If tickets are booked in advance, train operators will provide assistance to passengers with dementia and some bus companies are offering their staff dementia training.

    Active Travel

    Active transport is when physical activity, such as walking and cycling and incidental activities associated with using public transport, are used as a means of transport, rather than for recreational purposes. However, physical exercise becomes more difficult with age, with leg muscle strength weakening and the vestibular system (essential for balance) losing 40% of sensory cells by the age of 70. There are benefits to be gained from encouraging active travel amongst older people. “Physical activity among older people has been linked to better cognitive performance, reductions in morbidity and mortality and increased mental wellbeing. Encouraging active travel among older people could therefore not only extend people’s transport options but could also confer health benefits.” (Holley-Moore & Creighton, 2015, p. 21) A study by King’s College London found that cyclists aged 55 to 79 years old had levels of physiological function that were comparable to people much younger. One option for older people who want to continue or take up cycling in later life is to use electric bikes, which can be pedalled as a normal bike or powered through a small electric motor. One way in which active travel can be promoted amongst older people is through the ‘social prescription’ model. Older people can be ‘nudged’ into continuing or taking up active travel through a social prescription issued by a primary care provider (such as a GP).

    Physical Health

    As lower extremity strength and postural balance are needed to generate movement and maintain balance while walking, resistance training and balance training may help maintain or rehabilitate walking ability of those older people who are at risk of accelerated mobility decline. (Rantanen, 2013)

    Public Transport

    There are ways to support sick, frail or disabled older people with their transport needs. Transport assistance cards are issued by many transport operators and local authorities which record the passenger’s needs, allowing them to ask for assistance from the driver or other travel staff by showing the car privately. Staff can be alerted to passengers who have hearing loss, be partially sighted, are at risk of falls, have dementia or have a hidden disability.

    Social Care Costs

    The ageing population will put a two-fold pressure on public finances, with a smaller working-age population supporting a growth in spend on health, social care and pensions. Preventative care is about preventing unnecessary hospital admissions or morbidity, thereby reducing social and healthcare costs. Preventative care needs to be embedded into service provision so that strategies and processes are focused on supporting the promotion of wellbeing and health, rather than the management of disease.

    Employment

    “Policies that improve preventative healthcare, and help people to remain active and healthy in later life, could increase the proportion of life spent in good health and reduce costs… A healthier old-age population would also allow greater numbers to remain in the labour market for longer, thereby mitigating the impact of an ageing population on the dependency ratio.” (House of Commons Library, 2015, p. 51). Active travel policies encourage healthier lifestyles, thereby reducing the health care burden and providing opportunities to continue working and maintaining independence for longer. A study “estimated that a total of £7.67 billion could be achieved in NHS and healthcare savings if one third of inactive over 55s were supported to be active over the next ten years.” (UK Active, 2018, p. 17)

    Accessible Travel

    “Analysis from KPMG and Greener Journeys has shown that concessionary travel for older and disabled people in Britain provides value for money and helps contribute to the wider economy. For each £1 spent on concessionary travel, £2.87 is generated in benefits. Of these benefits, 50% go to the older person themselves, 20% to the other bus passengers and other road users who share the road, and the remaining 30% to the wider economic community. Easier and more accessible transport can also increase the opportunities for older people to volunteer. With the value of older volunteers expected to be worth £15.7 billion by 2033, this is a significant opportunity.” (Holley-Moore & Creighton, 2015, p. 8)
    Green spaces are one of the most important features of age-friendly cities, but these are sometimes poorly maintained or are considered unsafe. Parks do not always have adequate toilet facilities, seating or protection from the weather. There can also be hazards from other users of the park, such as cyclists, skateboarders, roller-bladers or dogs running about. (World Health Organisation, 2007)
    Cities should be designed for people, not private traffic, making them more inviting places to be. Planners should make physical accessibility for all citizens a vital component of inclusive cities and should introduce interventions to reduce traffic, improve air quality, prioritise walking, cycling and public transport to create cities where people enjoy spending their time.
    With green spaces being important but sometimes providing problems due to shared activities, some cities have suggested the provision of “small, quieter, contained green spaces in the fringe areas of the city rather than the large busy parks used by children and skateboarders.” (World Health Organisation, 2007, p. 13). Others have recommended special gardens for older people or demarcated areas in parks for older people.
    There are psychological restraints related to the different fears of older public transport users. Alongside the fear of falling or having an accident, there are also fears related to rude behaviour of staff and other passengers or when waiting at a deserted bus stop at night. Antisocial behaviour by young people on public transport is also a concern and in one survey of older car drivers, the second most important priority to make public transport more attractive to them was safety from crime and harassment. (Fiedler, 2007)
    Crime or fear of crime affects transport mode. Many older people have a mistrust of taxi drivers, being wary of drivers and the lack of control they have over their journey. There can also be a fear of falling over or being knocked down. “Personal security concerns meant the majority would not venture out in the dark.” (Marsden, Cattan, Jopson, & Woodward, 2013, p. 5)

    Read the full report here