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OLDER PEOPLE
AND ROAD SAFETY: DISPELLING THE MYTHS
By C G B (Kit) Mitchell Retired, formerly
Transport Research Laboratory
ABSTRACT
For all travellers except bus passengers, people aged 60 and over
are under-represented among road accident casualties of all severities
(mainly slight). For all travellers except pedal cyclists, people
aged 60+ are over-represented among road accident fatalities. The
same statements apply to people aged 80+. The reason for this difference
is the increasing fragility of people as they age. People aged over
80 are about six times as likely to be killed in a given accident
as someone aged 20 - 50.
For elderly people, road accident fatalities are primarily pedestrians.
For everyone aged 60 and over, 49 percent of all fatalities are
pedestrians, and outnumber car occupants, who are 43 percent of
all fatalities. For people aged 80 and over, pedestrians are 61
percent of all fatalities.
Older drivers have different types of accident to younger drivers,
often involving collisions at intersections and failure to yield
right-of-way. A slightly higher proportion of accidents to older
pedestrians are on a pedestrian crossing. Older bus passengers are
most likely to be injured in accidents that do not involve collisions
or violent manoeuvres. Their injury is most likely to be caused
by a fall within the bus.
1. INTRODUCTION This paper attempts to look objectively at accidents to elderly
travellers and the resultant casualties. It will show that while
older travellers have fewer slight accidents than younger travellers,
a disproportionate number of older travellers are killed in road
accidents. This applies to pedestrians, car occupants and bus passengers.
Over a quarter of all traffic fatalities are people aged 60 and
over.
It is important to understand the reality of road safety issues
for elderly people, if policies to reduce casualties are to be effective.
The number of elderly people is increasing, and of older drivers
even more so. Road safety policies need to reflect the issues that
are important for older travellers, and not the misperceptions that
are unfortunately all too prevalent. Independent mobility is very
important to older people, and to them may be worth the higher risk
of injury as a result of greater fragility. There is no evidence
that older people pose a greater threat to other road users. Finally,
road traffic accidents are the cause of death of less than 0.2 percent
of people aged 60 and over.
2. CASUALTIES TO OLDER TRAVELLERS Table 2 shows the number of fatal casualties for different categories
of road user in different age bands. From the age of 50, the number
of pedestrian fatalities increases with increasing age. For ages
60 - 69, there are more pedestrian than car driver fatalities, and
for ages 70 - 79, more pedestrian fatalities than all car occupants.
For ages over 80 years, 61 percent of all traffic fatalities are
pedestrians.
The under-representation of elderly people in casualties of all
severities, for all means of transport except buses, suggests strongly
that elderly people have fewer accidents than do other age groups.
This may be a result of reduced exposure (elderly people travel
less) and possibly of safer behaviour. The increase in risk of serious
and fatal injury with age is almost certainly a result of the greater
fragility of elderly people. Figure 1 shows the variation with age
in the percentage of road traffic injuries that are fatal (DETR,
1999a). The percentage differs between types of road user, but the
increase with age is similar for all. For people aged 20 - 50, about
2 percent of those injured as pedestrians are killed. This increases
steadily with age, so that for people aged 80 and over, more than
9 percent of all pedestrian injury accidents are fatal. For the
other types of transport the percentages are lower, but the increase
with age is similar.
Figure 2 shows the increasing fragility with age, by normalising
the percentage of accidents that are fatal - the fatality ratio
- to be 1.0 for the age group 20 - 50. This "fragility index" is
the same for car drivers, car passengers and pedestrians, rising
from a defined 1.0 for ages 20 - 50 to 1.75 at 60, 2.6 at 70 and
5.9 for people aged 80 and over. These results are fairly similar
to those given by Evans (1991) from US data for car occupants.
The detailed reasons for peoples' increasing fragility with age
deserve investigation, to identify aspects of the protection for
road users and vehicle occupants that should be improved to better
match the characteristics of elderly people. Mortality Statistics
for England and Wales tabulate the medical causes of death for various
classes of road user (ONS, 1999b). As an example, Figure 3 shows
how these vary with age for pedestrians. The percentage of deaths
caused by head injuries falls as age increases, and the percentage
caused by internal injuries increases. Head injuries are a more
frequent cause of death for pedestrians than car drivers. Data on
the cause of death should be treated with some caution, as there
are substantial differences between the figures for 1990 and 1997.
The general variation with age remains the same, but in 1990 for
both drivers and pedestrians, more fatalities were caused by head
injuries and fewer by internal injuries than in 1997.
4. CASUALTY RATES Figure 5 shows that because of elderly peoples' fragility, the
fatality rate for all road users more than doubles from 40 year
olds to people aged 80 and over. The increase in fatality rate for
pedestrians is even greater, by a factor of almost ten for people
aged 80 and over.
There has been concern over the safety of older car drivers, because
the physiological changes associated with ageing make driving more
difficult. But most older drivers are well aware of these changes
and problems, and modify their driving to accommodate them (Simms,
1993; Hakamies-Blomqvist, 1996). Figure 6 shows the effect of age
on the casualty rate per licenced driver. The number of licenced
drivers of different ages has been obtained from the National Travel
Survey 1996-98 (DETR, 1999b). Unlike Figure 4, Figure 6 (based on
drivers rather than the whole population) shows an increase in the
rate of casualties of all severities for car drivers aged 70 and
over. This increase is modest, and the rate for those aged 80 and
over is less than that for those aged 40 - 49. The increase with
age in the fatality rate for older drivers in Figure 6 is a result
of increasing fragility with age.
4.2 Rate per journey The number of person journeys per year is used as a measure of
exposure for that means of transport. Casualty numbers for 1998
and are combined with travel data averaged over 1996 to 1998 and
population numbers estimated for 1998. The variations in the casualty
rate per journey between types of transport and age groups are so
striking that it is unlikely that this approximation will have more
than a minor effect on the results.
Figure 7 shows the casualty rate for all severities per journey
by age group. For all road users and for pedestrians and car users,
the rates drop with increasing age to a minimum for people in their
sixties, then rise with age for people aged 70 and over. Over most
of the age range the rate is highest for pedal cyclists (not shown)
followed by car passengers and car drivers, with pedestrians and
bus passengers lowest of all.
Figure 8 shows the fatality rate per journey. The rates drop to
minima for people in their thirties and forties and then rise with
increasing age. Over the age range 30 to 55, the rates per journey
are similar for car drivers, passengers and pedestrians. The rate
for pedestrians increases by a factor of 12 between people in their
thirties and those over 80, and that for car drivers by a factor
of 11 from the forties to the over 80s. At every age over 30, the
rate for pedestrians is higher than for car users, drivers or passengers.
The rate for bus passengers is very low, and for pedal cyclists
(not shown) very high.
Policies that cause older car drivers to become pedestrians or
pedal cyclists would, with existing fatality rates per journey,
increase the total number of road accident fatalities. This is because
travel as a pedestrian or cyclist is more dangerous per journey
than travel as a car driver. Finland, which has a policy of testing
older drivers, has a larger total of fatalities for older road users
than does Sweden, with no such policy. A high proportion of the
Finnish elderly traffic fatalities are pedestrians and pedal cyclists
(Hakamies-Blomqvist et al, 1999).
To date there are no figures for accidents involving elderly people
travelling in powered wheelchairs or on scooters. The use of this
class of vehicle is increasing, and unless steps are taken to provide
safe paths for them (quite possibly on pedestrian pavements), it
is inevitable that they will begin to be involved in accidents either
with road vehicles or with pedestrians. Intuitively, it would appear
that cycle paths should provide ideal safe paths for powered wheelchairs
and scooters.
4.3 Rate per mile 5. WHERE ELDERLY PEOPLE HAVE ACCIDENTS 5.2 Car drivers Older drivers are less likely than younger drivers to have single-vehicle
accidents and accidents in which excessive speed is a causative
factor, and they are less likely to have drunk alcohol before driving.
They are over-represented in accidents at intersections and in complex
traffic situations; their fault is likely to have been to fail to
yield right-of-way or to respond to a traffic sign or signal. Most
accidents to older drivers happen in daylight (Hakamies-Blomqvist,
1996).
5.3 Bus passengers Casualties in collisions are distributed between older and younger
passengers approximately in proportion to their numbers among the
bus passengers. Older passengers are greatly over-represented among
non-collision casualties, in that 43 percent of the casualties come
from about 27 percent of the passengers.
6. POLICY ISSUES Mobility is essential for independent living and contributes to
older people remaining healthy and avoiding isolation and depression.
The balance between the benefits of mobility and the risk of travelling,
increased by the fragility of older age, should be a matter for
individual older people.
In Britain, more elderly people are killed as pedestrians than
as car occupants. Almost half of all pedestrian fatalities are from
the 20 percent of the population aged 60 years and over. There is
a need to improve the safety of all pedestrians, and particularly
of elderly pedestrians.
There is no evidence that older drivers are any greater threat
to other road users than are middle-aged drivers, but they are at
greater risk themselves because of their fragility. Some older drivers
with various diseases, such as early dementia, are at increased
risk of accident. If they can be detected, they may be helped by
retraining and by counselling on alternative ways to remain mobile
and live independent lives. Techniques for assessing drivers are
still far from reliable.
Older drivers, except for some of those in the early stages of
dementia, avoid driving situations that are stressful and dangerous.
All drivers reduce the number of journeys and distance driven as
they age. There is a need for improved mobility alternatives to
the car to help older drivers avoid driving in difficult conditions
(darkness, congestion, unfamiliar areas, bad weather, motorways),
and to substitute for the car when the driver decides to stop driving.
Policies on older drivers should distinguish between the risks
to themselves that result from increasing fragility in old age,
and any increased threat that they may pose to other road users.
The former is arguably a matter for informed decision by the older
driver, the latter undoubtedly a matter for public concern and policy.
Any policy must be based on the real situation and not on public
perceptions, some of which are probably mistaken.
Age based screening programmes for elderly drivers cannot be justified
on experience to date. They may well frighten some people, particularly
elderly women, into stopping driving unnecessarily early. If these
people then satisfy their mobility requirements by walking, this
will increase the total road accident fatalities, because walking
is more dangerous per journey than is driving.
It is about 50 percent more dangerous for older people to make
a journey on foot than to make a journey by car (the journeys being
of the lengths appropriate to the different modes and the age of
the traveller). Any policies that cause older people to travel on
foot instead of by car will increase the total number of road accident
fatalities. There are indications that this has happened in Finland,
in contrast to Sweden.
7. CONCLUSIONS For all travellers except bus passengers, people aged 60 and over
are under-represented among road accident casualties of all severities
(mainly slight). For all travellers except pedal cyclists, people
aged 60+ are over-represented among road accident fatalities. The
same statements apply to people aged 80 and over. The reason for
this difference is the increasing fragility of people as they age.
People aged over 80 are about six times as likely to be killed in
a given accident as someone aged 20 - 50. The traumas that kill
older traffic casualties are different from those that kill younger
casualties, so attention needs to be given to whether the design
of occupant and road user protection systems is properly serving
elderly people.
For elderly people, road accident fatalities are primarily pedestrians.
For everyone aged 60 and over, 49 percent of all fatalities are
pedestrians, and outnumber car occupants, who are 43 percent of
all fatalities. For people aged 80 and over, 61 percent of all fatalities
are pedestrians. To reduce the total number of fatal casualties,
at least as much attention must be given to pedestrians as to car
drivers.
Older drivers have different types of accident to younger drivers,
often involving collisions at intersections and failure to yield
right-of-way. A slightly higher proportion of accidents to older
than younger pedestrians are on a pedestrian crossing. Older bus
passengers are most likely to be injured in accidents that do not
involve collisions or violent manoeuvres. Their injury is most likely
to be caused by a fall within the bus.
7. ACKNOWLEDGEMENTS This paper has been developed from one originally written for
a conference "Delivering Britain's Aggressive Casualty Reduction
Target" arranged by the AA Foundation for Road Safety Research and
held on 30 November 2000. Some of the material was originally published
in Transport Trends 2000, Department of the Environment, Transport
and the Regions on behalf of the Controller of The Stationary Office.
8. REFERENCES DETR (1999b) National Travel Survey: 1996-98 update. Transport
Statistics Bulletin SB (99) 21, Department of the Environment, Transport
and the Regions, London.
Evans, Leonard (1991) Older driver risks - to themselves and to
other road users. TRB Paper No 910490, Transportation Research Board,
Washington DC.
Hakamies-Blomqvist, Liisa (1996) Research on older drivers: a
review IATSS Research Vol 20, No 1, pp 91 - 101.
Hakamies-Blomqvist, L, P Henriksson and S Henriksson (1999) Diagnostisk
testning av älder bilförare (Diagnostic testing of older drivers)
AKE report 1/1999, Helsinki.
Leyland Vehicles Ltd (1980) Passenger problems in moving buses.
TRRL Supplementary Report SR 520, Transport and Road Research Laboratory,
Department of Transport Department of the Environment, Crowthorne.
ONS (1999a) Population Trends No 98, Winter 1999, Office for National
Statistics, HMSO, London.
ONS (1999b) Mortality statistics - causes, Series DH4, no 22,
Office for National Statistics, HMSO, London.
Simms, Barbara (1993) The characteristics and driving patterns
of drivers over seventy TRL Project Report PR 26, Trans
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So elderly people are less likely than
the rest of the population to be involved in a road accident that
causes them to suffer a slight injury. But they are more likely
than the rest of the population to be killed by a road accident,
particularly as a pedestrian or bus passenger.
Source: Road Accidents Great Britain,
1998, Table 29a (DETR, 1999a) Table 3 shows the number of casualties
of all severities, mainly slight injuries, for different categories
of road user in different age bands, and is the best indication
available of the relative number of accidents, other than minor
"damage-only" incidents. The pattern is quite different to that
for fatalities. Up to the age of 80, car drivers outnumber pedestrian
casualties. It is worth noting the way that car driver casualties
reduce steadily with increasing age. Drivers aged 60 and over represent
only 8.8 percent of all car driver casualties; those over 70 years,
who make up 11.5 percent of the population, only 4 percent. 
The results given in this section show that the dominant road accident
issues for elderly people are
