Older Adults at Increased Risk as Pedestrians in Victoria, Australia: An Examination of Crash Characteristics and Injury Outcomes

Temporal instability of the determinants of fatal/severe elderly pedestrian injury outcomes in intersections and non-intersections before, during, and after the COVID-19 pandemic

This study examines the variability in the impacts of factors influencing injury severity outcomes of elderly pedestrians (age >64) involved in vehicular crashes at intersections and non-intersections before, during, and after the COVID-19 pandemic. To account for unobserved heterogeneity in the crash data, a random parameters logit model with heterogeneity in the means approach is utilized to analyze vehicle-elderly pedestrian crash data from Seoul, South Korea, occurring between 2018 and 2022. Preliminary transferability tests revealed instability in factor impacts on injury severity outcomes, highlighting the need to estimate individual models across various road segments and time periods. Thus, the dataset was segregated by crash location (intersection/non-intersection) and period (before, during, and after COVID-19), with individual models estimated for each group. Results obtained from the analyses revealed that back injuries positively influenced fatalities at non-intersections after the pandemic and was negatively associated with fatalities at intersections before the pandemic. Additionally, several indicators demonstrated significant instability in their impact magnitudes across different road segments and crash years. During the pandemic, head injuries increased the probability of fatalities higher at non-intersections. After the pandemic, crosswalk locations decreased the possibility of fatalities more at intersections. Compared to intersection segments, the female indicator reduced the likelihood of fatal injuries at non-intersections more before, during, and after the pandemic. Before the pandemic, much older pedestrians experienced a greater decline in fatalities at intersections than non-intersections. This instability could be attributed to altered mobility patterns stemming from the COVID-19 pandemic. Overall, the study findings highlight the variability of determinants of fatal/severe injury outcomes among elderly pedestrians across various road segments and years, with the underlying cause of this fluctuation remaining unclear. Furthermore, the findings revealed that accounting for heterogeneity in the means of random parameters enhances model fit and provides valuable insights for safety professionals. The factor impact variability in the estimated models carries significant implications for elderly pedestrian safety, especially in scenarios where precise projections of the effects of alternative safety measures are essential. Road safety experts can leverage these findings to refine or update current policies to enhance elderly pedestrian safety at intersections and non-intersections.

Do Simulated Augmented Reality Overlays Influence Street-Crossing Decisions for Non-Mobility-Impaired Older and Younger Adult Pedestrians?

OBJECTIVE

This study used a virtual environment to examine how older and younger pedestrians responded to simulated augmented reality (AR) overlays that indicated the crossability of gaps in a continuous stream of traffic.

BACKGROUND

Older adults represent a vulnerable group of pedestrians. AR has the potential to make the task of street-crossing safer and easier for older adults.

METHOD

We used an immersive virtual environment to conduct a study with age group and condition as between-subjects factors. In the control condition, older and younger participants crossed a continuous stream of traffic without simulated AR overlays. In the AR condition, older and younger participants crossed with simulated AR overlays signaling whether gaps between vehicles were safe or unsafe to cross. Participants were subsequently interviewed about their experience.

RESULTS

We found that participants were more selective in their crossing decisions and took safer gaps in the AR condition as compared to the control condition. Older adult participants also reported reduced mental and physical demand in the AR condition compared to the control condition.

CONCLUSION

AR overlays that display the crossability of gaps between vehicles have the potential to make street-crossing safer and easier for older adults. Additional research is needed in more complex real-world scenarios to further examine how AR overlays impact pedestrian behavior.

APPLICATION

With rapid advances in autonomous vehicle and vehicle-to-pedestrian communication technologies, it is critical to study how pedestrians can be better supported. Our research provides key insights for ways to improve pedestrian safety applications using emerging technologies like AR.

Built environment influence on the incidence of elderly pedestrian collisions in a medium-large city in southern Brazil: a spatial analysis

Trauma disproportionately affects vulnerable road users, especially the elderly. We analyzed the spatial distribution of elderly pedestrians struck by vehicles in the urban area of Maringa city, from 2014 to 2018. Hotspots were obtained by kernel density estimation and wavelet analysis. The relationship between spatial relative risks (RR) of elderly run-overs and the built environment was assessed through Qualitative Comparative Analysis (QCA). Incidents were more frequent in the central and southeast regions of the city, where the RR was up to 2.58 times higher. The QCA test found a significant association between elderly pedestrian victims and the presence of traffic lights, medical centers/hospitals, roundabouts and schools. There is an association between higher risk of elderly pedestrians collisions and specific elements of built environments in Maringa, providing fundamental data to help guide public policies to improve urban mobility aimed at protecting vulnerable road users and planning an age-friendly city.

Associations between walkability and pedestrian related injuries is modified by sociodemographic characteristics

BACKGROUND

Walkability scores have been developed to measure how well the characteristics of the physical environment support walking. However, because pedestrian safety is not taken into account, areas that have higher Walk Scores could be associated with more walking and also more pedestrian-related injury. We aimed to explore the association between Walk Score and pedestrian-related injury in Sydney.

METHOD

Pedestrian-related injuries from 2010 to 2018 in Sydney were identified in the New South Wales Combined Admitted Patient Epidemiology Data. Walk Score was used to measure area-level walkability in Sydney statistical division. Regression models were used to examine the association between Walk Score, pedestrian-related injury, length of hospital stay (LOS) and injury severity.

RESULT

Among people aged ≤64 years, there was no significant association between walkability score and pedestrian-related injury. Among people aged ≥ 65 years, walkability score was significantly positively associated with pedestrian-related injury, which peaked at Somewhat Walkable. For most disadvantaged areas, the risk of pedestrian-related injury was highest for areas that were classified as Somewhat Walkable. For moderately disadvantaged areas, the risk of pedestrian-related injury was highest at Very Walkable to Walker's Paradise areas. For the least disadvantaged areas, there was no significant association between walkability score and pedestrian-related injury. For LOS among people aged ≥ 65 years or in the most disadvantaged areas, it peaked at Somewhat Walkable areas. For injury severity, the risk of serious pedestrian-related injury was highest at Very Walkable to Walker's Paradise areas among people aged 16-64 years.

CONCLUSION

For the majority of the population, built environment characteristics that are considered to make walking attractive also make it safer, offsetting any exposure-related increase injury risk. However, this is not the case for people aged ≥ 19 years, and those living in socioeconomically disadvantaged areas. Incorporating measures of pedestrian safety in walkability scores may create an impetus to ensure that the built environment is designed to support the safety of pedestrians from these groups.

Using ordered and unordered logistic regressions to investigate risk factors associated with pedestrian crash injury severity in Victoria, Australia

INTRODUCTION

The safety of pedestrians is a major concern in Victoria, Australia. Despite the considerable number of pedestrian fatalities and injuries in traffic crashes, a limited number of studies focused on pedestrian crash severity in Victoria.

METHODS

This study investigates and identifies the influential factors determining the severity of pedestrian injuries in traffic crashes in Victoria by using crash data from 2010 to 2019. An unordered multinomial logit model and an ordered logit model are developed for this purpose.

RESULTS

The results indicate that pedestrian crashes on weekends, in the period of 10 a.m. to 10 p.m., on dark streets, at intersections, in areas with a speed limit above 50 km/h, and on medians or footpaths are associated with a higher probability of severe and fatal injuries. Male pedestrians, children, and older adults (>59) were more likely to sustain a higher level of injury in crashes. Concerning the driver characteristics, no significant relationship was found between pedestrian injury severity and driver gender and license status, but older drivers were more likely to cause severe and fatal injuries. Pedestrian collisions with motorcycles, heavy vehicles, light commercial vehicles, bus/minibus/coach, and trams increase the probability of more severe injuries compared to cars. Moreover, older vehicles are associated with a higher probability of severe pedestrian injuries. Comparison of the model results illustrated that the MNL model was slightly better fitted on the data than the ordered logit model, but the conclusions inferred from these two models were generally similar.

PRACTICAL APPLICATION

To reduce the injuries of pedestrian crashes, we recommend improving lighting conditions and sidewalk design, implementing speed reduction strategies at high pedestrian activity areas, introducing more pedestrian crossings at midblock, installing warning signs to drivers, and discouraging the use of vehicles that are more than 20 years old.

Exploratory Analysis of Pedestrian Road Trauma in Finland

In Finland, all fatal on-road and off-road motor vehicle crashes are subject to an in-depth investigation coordinated by the Finnish Crash Data Institute (OTI). This study presents an exploratory and two-step cluster analysis of fatal pedestrian crashes between 2010 and 2019 that were subject to in-depth investigations. In total, 281 investigations occurred across Finland between 2010 and 2019. The highest number of cases were recorded in the Uusimaa region, including Helsinki, representing 26.4% of cases. Females (48.0%) were involved in fewer cases than males; however, older females represented the most commonly injured demographic. A unique element to the patterns of injury in this study is the seasonal effects, with the highest proportion of crashes investigated in winter and autumn. Cluster analysis identified four unique clusters. Clusters were characterised by crashes involving older pedestrians crossing in low-speed environments, crashes in higher speed environments away from pedestrian crossings, crashes on private roads or in parking facilities, and crashes involving intoxicated pedestrians. The most common recommendations from the investigation teams to improve safety were signalisation and infrastructure upgrades of pedestrian crossings, improvements to street lighting, advanced driver assistance (ADAS) technologies, and increased emphasis on driver behaviour and training. The findings highlight road safety issues that need to be addressed to reduce pedestrian trauma in Finland, including provision of safer crossing facilities for elderly pedestrians, improvements to parking and shared facilities, and addressing issues of intoxicated pedestrians. Efforts to remedy these key issues will further Finland’s progression towards meeting Vision Zero targets while creating a safer and sustainable urban environment in line with the United Nations sustainable development goals.

Quality of life in the urban environment and primary health services for the elderly during the Covid-19 pandemic: An application to the city of Milan (Italy)

The outbreak of the Coronavirus during the first months of 2020 completely reshaped urban lives because of the need to limit the spread of the disease and ensure essential services to the most vulnerable city users, such as elderly people. The urban population in European is ageing at unprecedented rate; at the same time, ageing is associated with increased vulnerability and dependence on medical care services. Age-friendly approaches are consequently necessary in urban planning strategies to ensure equal accessibility to essential services, not least in view of coronavirus pandemic. This article aims at defining a methodology for measuring urban accessibility to healthcare services as indicative of quality of life for the elderly within the city of Milan - affected by Covid - both in ordinary working scenarios and during the pandemic. The outputs show that entire neighbourhoods' elderly populations suffer from very poor accessibility to primary health services, especially in the city suburbs, and their condition deteriorates even more because of limited services and activities. The methodology would be effective to suggest policy recommendations to distribution of public services in urban areas and to reduce the potential effects of the Covid-19 pandemic on old people's health and quality of life.

Older adult pedestrian trauma: A systematic review, meta-analysis, and GRADE assessment of injury health outcomes from an aggregate study sample of 1 million pedestrians

This systematic review sought to assess older adult pedestrian injury severity, injury by anatomical location and incidence proportions, including comparisons to younger age groups when available and provide an analysis of the quality of the existing evidence. A structured search was conducted in PubMed, Embase, Scopus, CINAHL, PsycInfo, AMED, Web of Science, LILACS and TRID. STROBE was used to assess the reporting quality of the included studies. Random-effect model meta-analysis served to obtain pooled relative risk, incidence proportions and standardized mean differences for different outcomes due to pedestrian crashes comparing older and younger pedestrians, while meta-analyses could not be conducted for pedestrian falls. We screened 7460 records of which 60 studies (1,012,041 pedestrians) were included in the review. Injured pedestrians 60+ compared to those <60 were found to have a higher relative risk of severe injury (pooled relative risk RR 1.6, 95 % CI: 1.4-2.0 p < 0.001), critical care admission (pooled RR 1.5, 95 %CI: 1.3-1.8 p < 0.001), and fatality (pooled RR of 3.7, 95 % CI: 3.0-4.5 p < 0.001). Pedestrians 60+ also had higher incidence rates of pedestrian falls causing higher injury severity. GRADE was used to evaluate evidence quality, with the results suggesting that the overall quality of the evidence supporting these findings was low. Further research is needed to understand health risks associated with older pedestrian trauma and to develop effective risk management strategies.

Identify the key characteristics of pedestrian collisions through in-depth interviews: a pilot study

This study aimed to assess the feasibility of recruiting injured pedestrians from the emergency department of a major trauma centre, using an in-depth interview shortly post collision. Convenience sampling was used to prospectively recruit injured pedestrians from the Alfred Hospital Emergency and Trauma Centre. Of the 102 injured pedestrians, 39 met eligibility criteria and of these, 30 (77%) consented and completed the questionnaire. Over half of the collisions occurred at an intersection (57%), and of these the most common pre-impact vehicle manoeuvre was a vehicle turning into the street the pedestrian was crossing. In-depth interview during the early post-crash period was a feasible and effective method of collecting detailed data in an accessible sample. However, only 38% of patients met eligibility criteria. To enhance representativeness, supplementing interview data with police-reported crash data, recruiting from hospital wards and crash location assessment is recommended.

The road to recovery for vulnerable road users hospitalised for orthopaedic injury following an on-road crash

BACKGROUND

Pedestrians, cyclists and motorcyclists are vulnerable to serious injury due to limited external protective devices. Understanding the level of recovery, and differences between these road user groups, is an important step towards improved understanding of the burden of road trauma, and prioritisation of prevention efforts. This study aimed to characterise and describe patient-reported outcomes of vulnerable road users at 6 and 12 months following orthopaedic trauma.

METHODS

A registry-based cohort study was conducted using data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and included pedestrians, cyclists and motorcyclists who were hospitalised for an orthopaedic injury following an on-road collision that occurred between January 2009 and December 2016. Outcomes were measured using the 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3 L), Glasgow Outcome Scale - Extended (GOS-E) and return to work questions. Outcomes were collected at 6 and 12 months post-injury. Multivariable generalized estimating equations (GEE), adjusted for confounders, were used to compare outcomes between the road user groups over time.

RESULTS

6186 orthopaedic trauma patients met the inclusion criteria during the 8-year period. Most patients were motorcyclists (42.8%) followed by cyclists (32.6%) and pedestrians (24.6%). Problems were most prevalent on the usual activities item of the EQ-5D-3 L at 6-months post-injury, and the pain/discomfort item of the EQ-5D-3 L at 12 months. The adjusted odds of reporting problems on all EQ-5D-3 L items were lower for cyclists when compared to pedestrians. Moreover, an average cyclist had a greater odds of a good recovery on the GOS-E, (AOR 2.75, 95% CI 2.33, 3.25) and a greater odds of returning to work (AOR = 3.13, 95% CI 2.46, 3.99) compared to an average pedestrian.

CONCLUSION

Pedestrians and motorcyclists involved in on-road collisions experienced poorer patient-reported outcomes at 6 and 12 months post-injury when compared to cyclists. A focus on both primary injury prevention strategies, and investment in ongoing support and treatment to maximise recovery, is necessary to reduce the burden of road trauma for vulnerable road users.

A simulator study of driving behavior and mental workload in mixed-use arterial road environments

Objectives: Mixed-use urban environments, such as arterial roads with adjacent commercial land uses, represent crash locations with the highest risk. These locations are often characterized by high volumes of motor vehicle traffic, on-street parking, and interactions with multiple road user groups such as pedestrians, cyclists, and public transportation. The objective of this study was to investigate previously identified crash risk factors for mixed-use urban environments and assess how parking occupancy, center medians, and cyclist volume influence performance and workload in a driving simulator study. Methods: Thirty participants were recruited for the study. Participants completed 6 drives that presented different combinations of cyclist volume, median condition, and parking occupancy. Incorporated into the simulator drives was a secondary peripheral detection task (PDT) designed to measure mental workload. Participants provided subjective assessments of workload using the Rating Scale Mental Effort (RSME). Results: Mean lateral lane position was found to significantly vary across the 3 independent variables of parking occupancy, cyclist volume, and median conditions. No significant changes were identified for mean speed across the conditions. Subjective and objective measures of workload identified changes due to the presence of cyclists with slower reaction times for the PDT task when cyclists were present. Conclusion: The findings provide insight into the interaction of road design elements in mixed-use urban road environments and demonstrate that increasingly complex environments increase driver demand. This has important road design implications for mixed-use arterial roads, which are often characterized by complex interactions between multiple road user groups.

Falling while walking: A hidden contributor to pedestrian injury

Walking is a sustainable mode of transportation which is beneficial to both individuals and to the broader community, however, there are risks and it is essential that road design and operation provides safe conditions for walking. In Victoria, pedestrians represent one of the most vulnerable road user groups, accounting for approximately 12% of all road fatalities and serious injuries. These figures largely represent injuries where the pedestrian has been struck by a vehicle with the extent of pedestrian-only injuries largely un-reported. Falling while walking may be a significant contributor to pedestrian only injuries. Indeed, the World Health Organisation has identified falls generally as the second leading cause of unintentional injury death in older populations. Despite the prevalence of fall-related injuries, there has been relatively little research undertaken to address the issues surrounding falls that occur while walking for transport and in public spaces. This study, therefore, aimed to address this gap in our knowledge. Analyses of various data sources were undertaken to enhance our understanding of fall-related injuries while walking in Victoria. Two sources of data were accessed: Only 85 fall-related incidents were reported in the crash-based data, however, pedestrian falls while walking in the road environment accounted for an average of 1680 hospital admissions and 3545 emergency department presentations each year, and this number is rising. The findings in this study show clearly that Police data is of little use when attempting to understand issues of safe travel for pedestrians other than vehicle-pedestrian incidents. However, analysis of hospital data provides a more realistic indication of the extent of pedestrian fall-related injuries and highlights the significant number of pedestrian fall-related injuries that occur each year. Moreover, the findings identified that older pedestrians are significantly over-represented amongst fall-related injuries that require hospital admission, while also having the highest rate of emergency department presentations when adjusting for age and exposure based on estimates of aggregate walking distances. The study also highlighted that the most common injury sustained from a fall were fractures. The implications of these findings and identification of 'best-practice' within a Safe System context are discussed in terms of enhancements to the physical environment (particularly footpath, kerb and ramp construction and maintenance), implementation of fall hazard assessment and management strategies, and educational programs to highlight the risks for falls and recommend preventative strategies, and overall enhancements of general fall interventions to include falls while walking outside (including exercise interventions). In addition, a number of research and data needs, particularly collection of in-depth data to identify contributory factors and injury outcomes related to falls while walking incidents.

Considering built environment and spatial correlation in modeling pedestrian injury severity

OBJECTIVE

This study looks at mitigating and aggravating factors that are associated with the injury severity of pedestrians when they have crashes with another road user and overcomes existing limitations in the literature by focusing attention on the built environment and considering spatial correlation across crashes.

METHOD

Reports for 6,539 pedestrian crashes occurred in Denmark between 2006 and 2015 were merged with geographic information system resources containing detailed information about the built environment and exposure at the crash locations. A linearized spatial logit model estimated the probability of pedestrians sustaining a severe or fatal injury conditional on the occurrence of a crash with another road user.

RESULTS

This study confirms previous findings about older pedestrians and intoxicated pedestrians being the most vulnerable road users and crashes with heavy vehicles and in roads with higher speed limits being related to the most severe outcomes. This study provides novel perspectives by showing positive spatial correlations of crashes with the same severity outcomes and emphasizing the role of the built environment in the proximity of the crash.

CONCLUSIONS

This study emphasizes the need for thinking about traffic calming measures, illumination solutions, road maintenance programs, and speed limit reductions. Moreover, this study emphasizes the role of the built environment, because shopping areas, residential areas, and walking traffic density are positively related to a reduction in pedestrian injury severity. Often, these areas have in common a larger pedestrian mass that is more likely to make other road users more aware and attentive, whereas the same does not seem to apply to areas with lower pedestrian density.

Geriatric Trauma

Within the next 15 years, 1 in 5 Americans will be over age 65. $34 billion will be spent yearly on trauma care of this age group. This section covers situations in trauma unique to the geriatric population, who are often under-triaged and have significant injuries underestimated. Topics covered include age-related pathophysiological changes, underlying existing medical conditions and certain daily medications that increase the risk of serious injury in elderly trauma patients. Diagnostic evaluation of this group requires liberal testing, imaging, and a multidisciplinary team approach. Topics germane to geriatric trauma including hypothermia, elder abuse, and depression and suicide are also covered.

Perceptions of Speed and Risk: Experimental Studies of Road Crossing by Older People

Crossing a road safely is a complex task requiring good sensorimotor function and integration of information about traffic speed, distances and one’s own speed. Poor judgement through age-related sensorimotor or cognitive impairment or a predisposition to take risks could lead to errors with serious consequences. On a simulated road, 85 participants (age ≥70 years) were asked to cross in front of an approaching car with a clearance as small as considered safe in two conditions; (1) with nothing else to attend to (free crossing) and (2) with an additional ball-gathering task while waiting to cross (task crossing). Participants were categorised according to their crossing outcome (failed to cross, ‘hit’, exact, safe, cautious). Participants also performed two sub-studies; (1) the perception of the time-to-arrival of moving objects and (2) the perception of own gait speed. Physical and cognitive function and everyday risk-taking behaviour were also assessed. In free crossing, clearances varied but no participants were “hit” by the car. In task crossing, participants allowed smaller clearances and 10% of participants would have been hit while 13% missed the opportunity to cross altogether. Across a wide range of physical and cognitive measures, including perceived and actual gait speed, a consistent pattern was observed in the task crossing condition. The exact group performed best, the ‘hit’, safe and cautious groups performed less well while those who missed the opportunity (fail) performed worst. The exact group reported taking the greatest risks in everyday life whereas the remaining groups reported being cautious. In conclusion, we found older people with poorer perceptual, physical and cognitive function made inappropriate and risky decisions in a divided attention road-crossing task despite self-reports of cautious behaviour in everyday life.