Prioritising transport barriers and enablers to mobility in later life: A case study from Greater Manchester in the United Kingdom

Introduction:There are many barriers to mobility for older people which are detrimental to older people’s health and wellbeing. This research got older people to prioritise their transport barriers in terms of their importance as a barrier to getting out and about, and the likelihood that that barrier occurs locally to them. Following this, older people then co-developed and prioritised solutions to the barriers, prioritising them in terms of potential effectiveness and perceived ease of implementation. Methodology: Using a case study of Greater Manchester in the United Kingdom, a series of focus groups in different locations got older people and stakeholders to prioritise issues and solutions for older people’s mobility around neighbourhood, public and community transport and policy and practice themes. Results: Participants tended to prioritise issues that affected their safety. Poor quality pavements, sharing pavements with cyclists and mobility scooters, poor crossing facilities and bus drivers driving off before they had a chance to sit down were all major issues and all related to the potential for falls. Poor information and signage was another issue with public and community transport. To help put things right, it was strongly suggested transport staff need age friendly awareness training. Participants also wanted more involvement with decision making over transport and the built environment with a need to move beyond the current forms of consultation. Conclusion: Overall, there was a constant tension between older people portraying themselves and being seen as frail and needy and as resourceful, proactive and engaged. This makes the transport offering difficult to achieve, schemes aimed at plugging deficits are seen as inappropriately patronising, yet schemes not aimed at older people can make them feel misunderstood or ignored

JTH editorial v17 – The importance of psychosocial factors in transport and health

The need to shift out of the car to more active travel is vital for our health. Research into transport and health highlights the need to take into account the wider psychological and social (sometimes referred to as psychosocial) determinants of transport behaviour if we’re to fully understand how to encourage a shift to more safe and more active travel

Editorial JTH 16 –The Coronavirus Disease COVID-19 and implications for transport and health

This paper looks at how our highly connected, hypermobile society contributes to the spread of disease and the consequences of lockdown on curtailing such hypermobility might have on life, for work and also for fulfilling everyday duties, getting shopping in and seeing friends and family. Who knows at the moment how long such a lock down will be for in many countries, and further what effect it will have on changing our mobility patterns forever. Will we get used to virtual meetings being the norm for office workers, will we want to connect to local communities more than those far away, will we notice and enjoy cleaner air from less pollution in reduction in transport movement and want to sustain this afterwards? But, given the benefits of mobility are not distributed equally, the disbenefits of mobility lock-down are likely to be faced differently by different populations.Reducing hypermobility of our transport networking and focussing on local connectivity seems a reasonable solution from this. If we are to face increasing threat from viruses we need to have strong social and local economic capital in strong local communities and neighbourhoods to support one another without recourse to hypermobility. Perhaps a move to a more sustainable hypomobile practice is desired, a slow mobility focus, with more localised active mobility

Public transport use in later life

Public transport is highly important for older people’s mobility. Buses and trains can be a protective factor in isolation and loneliness and improve physical health for older people. They are also important “third spaces” to be social, to watch the world go by and to experience mobility. In countries that have free or low fares for older people, they tend to see an increase in use among older people. However, older people face many challenges to public transport use, including accessibility, feeling unsafe, poor information and signage and poor-quality services. Railways are generally used less than buses but provide great potential if accessibility issues can be overcome. Older people’s anxiety over public transport use also includes psychosocial aspects, especially concerns about norms of behaviour. COVID-19 has seen a reduction in public transport use, and now a response is needed from public policy and public transport providers to restore confidence with the public to increase use and retain it as a viable method of mobility among older people

Public participation for 21st century democracy

Public participation in the 21st century is often complex, frustrating, and confusing. A guide to help navigate through the labyrinth of bureaucracy and conventional participation is necessary as we strive to find ways in which our civic engagement will create a more democratic, just, and participatory country. With Public Participation for 21st Century Democracy, Tina Nabatchi and Matt Leighninger provide a history of public participation, contemplate the current state of our democracy, and offer both theory and praxis regarding how we might effectively engage in public participation to create the changes we desire. This book presents more than hypothetical constructs, and instead produces concrete examples to illustrate how various methods of public participation have succeeded. The authors emphasize the importance of partnerships, especially those between members of the public and the institutions that represent them. Public Participation for 21st Century Democracy offers both the hope and means for people to solve public problems, effect social change, and ensure democracy’s survival

How can transport provision and associated built environment infrastructure be enhanced and developed to support the mobility needs of individuals as they age?

Mobility touches every aspect of most of our lives. Restrictions on our mobility are perceived asa loss of freedom, and we seek wherever possible to regain that mobility, or replace it with otherforms of mobility. While we immediately think of physical mobility, virtual mobility is increasinglybecoming another world that we inhabit and move around in.Older people, however, are the most likely to experience mobility deprivation. The need to bemobile and to travel is related to psychological well-being in older age, and a reduction inmobility can lead to an increase in isolation, loneliness and depression and overall a poorerquality of life. Mobility is important to older people. There are also benefits to society as a wholein increasing travel for older people, including the economic benefits of older people spendingmore in shops, of them looking after grandchildren, undertaking voluntary work, and carrying outother caring responsibilities.In order to develop a framework of the mobility of people as they age, we formulated a set ofguiding principles that underpin this Evidence Review. These principles are drawn from currentthinking in applied gerontology in the many differing fields that cover mobility issues andrepresent a shift from individual discipline-based silo thinking to person-centred thinking thatattempts to cross traditional disciplinary boundaries. The key principles are:• Adopting an ecological model of ageing.• Placing the user at the heart of mobility in order to take a person-centred approach.• Mobility behaviour and perceptions should take a life-course approach that builds uponwhole life experiences and choices.• Understanding older people’s mobility requires a relationship-centred approach.• Images of ageing can be positively changed through an inclusive design approach totransport provision and built environment infrastructure.• Mobility is multi-faceted and as such should be considered as a whole systemsapproach, moving away from traditional transport planning.• The physical environmental context in which mobility is conducted is important toacknowledge and understand.• There is a need to balance diverse requirements.• Addressing the wider societal challenges such as loneliness and isolation, civicparticipation, connectivity and health and well-being in relation to mobility is important.Underpinning the principles is user engagement – the need to involve older people in decisionsthat affect their mobility needs, desires and wants, and to work co-productively with them tounderstand the barriers and enablers to mobility from their perspective.Through this review of evidence, including both academic and grey literature, and using theabove principles to focus our study, we set out the current state of knowledge in this complex5 and diverse subject area. The scope of transport is vast, and we acknowledge that any suchsearch of evidence is limited by both time and the documentary evidence freely available to theauthors. We conclude that there are evidence gaps that require further research, that othergaps may well emerge, and that there is still much to be understood. As such, this is very muchthe start of a journey, rather than the end.We consider that the following areas require further investigation to provide evidence on howthe transport provision and associated built environment infrastructure can be enhanced anddeveloped to support the mobility needs of individuals as they age:• Transport decisions and the effect of these into older age need to be investigated acrossthe life course.• We need a better understanding of the role of virtual mobility.• Individual differences are important, and so we need to have a better understanding ofwhich mobility interventions will affect which people, and why.• Understanding train travel from the point of view of older people to help identify barriers touse.• Social capital and networks and mobility in later life and how these might enable mobility.• Future research and interventions must acknowledge that a variety of modes are used tocomplete travel and a door-to-door approach is advocated.• To gain a greater, more holistic understanding of transport in later life, future researchshould look beyond literal or corporeal mobility to include constructions of travel related tovirtual, potential, imagined, aspirational and emotive mobilities, utilising not just transportstudies, health and geography but also sociology, gerontology, and arts and humanities.• Technologies, driverless vehicles and driver support. Clearly there is a need to betterunderstand the impact of these technologies on different cohorts of older people, not justin terms of driving, but also on health, well-being and quality of life.• Transport can play a significant role in helping a person with dementia to stay active andindependent for longer, but this is an under-researched area.• We need to understand cycling among the older population, and how this affectsindependence, health and well-being.• Driver safety – rich qualitative data may be able to inform existing transport policy in amore meaningful way than quantitative data alone.• Falls, as a pedestrian and on public transport, require further research, particularly inunderstanding the impact of a fall on subsequent mobility and independence.• Segregated space between older pedestrians and other transport users is important forolder people’s mobility, but we need to better understand how sharing space affects olderpeople – which people, why, and in what ways?6• There is a need to ensure there is an awareness of the mobility, transport and builtenvironment issues of older people made by health and social care professionalsregarding the mobility of people who have returned home from hospitalisation.• Economic evaluation – there is a need for research to be able to put a cost/benefit both onstaying at home, and also on interventions that get the person out and about.• The over-emphasis on problematising older people’s mobility. More research is needed toidentify the benefits of involving older people within the context of mobility as a whole,rather than simply involving older people in identifying barriers and issues.• More research is needed to provide the evidence base for priority areas for older people’smobility in times of austerity.• We recommend that an independent robust evaluation is undertaken, examining whethercourses really improve driver skill and awareness and whether they reduce accidents

Environment–person interactions enabling walking in later life

Observations and intercept surveys of older people were carried out (n = 365) in three locations (urban shopping centres, suburban residential area and an area of shared space) examining active use of outdoor space, measured by confidence to use and explore space. In all three areas, dominance of the space was associated with being male and having higher levels of reported health, confidence and higher socioeconomic status. Only 11% of participants walked at least as fast as the UK department for transport guidance on crossing speeds