Abstract
Background:
Attending healthcare appointments and participating in social activities are important for older adults, but these activities are often limited by transportation barriers. Public transportation may bridge these gaps, but little is known about older public transportation users. This study compares the characteristics of older adults who use public transportation to those who do not.
Design:
Cross-sectional analysis of data from Round 5 of the National Health and Aging Trends Study (NHATS). We identified 5696 urban, community dwelling older adults, and calculated national estimates of those who reported public transportation use in the last month and those who used transit to see their regular doctor. We evaluated the age and sex-adjusted associations between economic and clinical characteristics and recent use of public transportation using survey-weighted logistic regression.
Results:
Nearly 1 in 10 (n=555/5696, weighted n=3,122,583) urban-dwelling older adults in the United States reported use of public transportation in the last month, and over 20% of users (weighted n=658,850) relied on transit to see their regular doctor. Compared to non-users, those who reported using transit were significantly more likely to be younger and identify as non-Hispanic Black or Hispanic. Financially strained older adults were more likely to have recently relied on public transportation (adjusted odds ratio [aOR] 1.62, 95% confidence interval [CI] 1.07-2.44), but frailty (aOR=0.61, 95% CI 0.41-0.91) and living in an area with cracked or broken sidewalks (aOR=0.35, 95% CI 0.27-0.46) were both associated with lower odds of public transportation use.
Conclusion:
More than 3 million older adults in the United States reported recently using public transportation, with over 600,000 relying on these services to visit their doctor. With increasing investment in public infrastructure on the horizon, centering the unique medical, economic, and social needs of older transit users is critical to ensure urban communities remain age-friendly.
INTRODUCTION
Older adults frequently identify transportation-related barriers to attending healthcare visits as a common concern.1 Transportation barriers disproportionately impact the 11 million older adults in the United States who are non-drivers, a population that is more likely to be part of racial and ethnic minority groups or socioeconomically disadvantaged.2,3 Social participation is also negatively impacted by poor access to transportation; a recent estimate suggests 2.3 million older adults in the United States have transportation-related barriers to participating social activities, visiting with family or friends, and attending religious services.2 Recent work suggests that use of public transportation, such as public buses and trains, may help maintain or even increase social participation among older adults4, with additional positive effects also observed on physical activity of older adults5 and well-being of their caregivers.6
Public buses, trains, and trams are rapidly growing methods of transportation in older adult populations. Between 2001 and 2017, the percentage of older adults using public transportation services increased from 14% to 23%7, which is important considering older adults who rely on public transportation are more likely to report difficulty attending healthcare visits. A 2017 poll by the National Aging and Disability Transportation Center found that 40% of older adults felt access to public transportation impeded use8—an unsurprising finding given federal estimates that 1 in 5 transit stations are not fully compliant with the Americans with Disabilities Act (e.g., lack elevator access), and many have poor signage, lighting, and audio systems that would be difficult for older adults with visual or hearing impairments to navigate.7,9 Older adults who report trouble getting to places like the doctor’s office are more likely to rely on family members and friends to drive them to their appointments, or use public transportation services to attend these visits.10 Older adults without caregivers may also rely more heavily on public transit to get to important social engagements—suggesting poor access to transit may limit social connectedness.11 Lastly, there are unique challenges associated with public transportation use that are more likely to affect older adults than younger transit users; this higher burden of public transportation use among older adults has been framed as increased “mobility work.12” For example, it is plausible that age-related visual changes among older adults may affect confidence taking rides at night, changes in temperature regulation common during the aging process may make it challenging to walk to or wait at transit stops during extremely hot or cold weather, and declines in balance performance and confidence commonly observed with aging may lead some older adults to avoid taking buses during busy times where they might not be able to obtain a seat. Additionally, transit users may have to walk 500 meters or more in urban areas to access the closet public transportation stop.13 Getting to these stops may be more difficult and dangerous for those with common geriatric risk factors such as mobility limitations, or for those who must traverse broken or cracked sidewalks.14,15
Public transportation access and safety is also a growing area of concern for healthcare and social policymakers. Specific funding to improve public transportation access, especially for riders with disabilities, was included in the Infrastructure Investment and Jobs Act passed in late 202116 suggesting an increasing urgency to characterize ridership and modify transit infrastructure to ensure equitable access for older adults. Yet, little is known about older adults who use public transportation; notably, it is unclear how many rely on public transportation for healthcare, and what geriatric factors may influence ridership. This may be one reason why transportation interventions targeted to medically complex patients and older adults have reported decidedly mixed and modest impact on access to care and health outcomes.1,17
To address these research gaps, we used data from National Health and Aging Trends Study (NHATS) to generate nationally representative estimates of public transportation use, and characterize the clinical, economic, environmental, and technological profile of older adult transit users. Understanding the population of older public transportation users is an essential first step towards improving access to healthcare and facilitating social participation among older adults who rely on, or could benefit from, public transportation.
METHODS
Data and Sample:
The data for this analysis was drawn from Round 5 of the National Aging and Trends Study (NHATS), which is a nationally representative population-based survey of older Medicare beneficiaries aged 65 and above. NHATS oversamples individuals over 90 years old and individuals who self-identify their race and ethnicity as non-Hispanic Black18. These in person interviews, designed to evaluate late-life disability, collect detailed information including demographics, health conditions, mobility, physical capacity, cognitive capacity, economic status, home and neighborhood environment, and overall well-being. The initial cohort was drawn in 2011 and replenished in 2015. Using rural-urban continuum code classifications, participants are also categorized as living in metropolitan or non-metropolitan (e.g., rural) area. Our analytic sample included older adults who were community dwelling (n=7070) and further restricted to those living in metropolitan areas (n=5696) given that most public transportation infrastructure exists in urban neighborhoods. The NHATS study protocol was approved by the Johns Hopkins Institutional Review Board, and all participants provided written informed consent. Because our analysis uses only publicly available files from NHATS, it is considered exempt research by the University of Maryland Baltimore Institutional Review Board.
Outcomes:
Public Transportation Use:
The primary outcome of interest was use of public transportation. During each NHATS round, participants are asked whether they used public transportation (bus, subway, or train) in the last month. Any participant who answered affirmatively was categorized as a public transportation user. In a separate section of the NHATS survey, participants are also asked what mode(s) of transportation they relied on to get to their regular doctor in the last year; those who reported using public transportation were categorized as using public transportation to access healthcare.
Contributing Factors:
Our selection of contributing factors, in addition to basic demographic information (e.g., age, race), was guided by the Anderson behavior model of healthcare utilization19. We categorized these according to a conceptual framework developed by our team (Figure 1), focusing on key predisposing and enabling factors that may impact public transportation use for older adults including geriatric factors (e.g., advanced age, sensory, and cognitive impairments), mobility limitations and use of assistive devices, economic characteristics, and use of technology (e.g., cell phones).
Figure 1:
Conceptual framework of the interrelated factors influencing public transportation use among older adults in the United States.
Demographic Information:
Information on age, sex, self-identified race/ethnicity, educational attainment, marital status (married/living together or separate) and whether the sample person primarily spoke a language other than English was extracted from the NHATS assessment data. We also captured whether the sample person reported being covered by Medicaid. Last, we identified whether the sample person had been seen by their doctor in the last year, and whether they attended medical visits alone or with a partner.
Geriatric Factors:
Data on participants self-reported medical conditions were included as measures of chronic disease burden. Visual impairments were defined as an answer of yes to any of the three NHATS questions (1) do you have difficulty reading newspaper print (2) do you have difficulty recognizing a person across the street (3) do you have difficulty seeing a television across the room. Hearing impairment was defined by participants answering “yes” to the following question: (1) in the last month have you used a hearing device or hearing aid, or an answer of “no” to the question (2) are you able to hear well enough to have a conversation with the TV or radio playing (3) are you able to hear well enough to have a conversation in a quiet room. We categorized frailty (Fried criteria) and dementia status among older adults using previously described NHATS methods.20,21 Older adults were identified as living with a disability if they required assistance from another person to complete any of the following basic activities of daily living: getting cleaned up, using the toilet, dressing, eating, getting around inside, going outside, and getting out of bed.
Mobility:
To evaluate mobility impairment among older public transit users, we included measures of community ambulation ability and use of assistive devices in our analysis. If participants answered yes to being able to walk either three or six blocks, they were categorized as community ambulators. Data on whether participants used a walker, wheelchair/scooter, or a cane to get around was also collected—participants who had used multiple devices were coded as having used the most restrictive reported. We categorized patients as follows 1) using no device or requiring only a cane, 2) requiring a walker, or 3) requiring a wheelchair or a scooter.
Socioeconomic Factors:
A measure of financial strain was included to identify socioeconomic hardship. Participants were classified as having financial strain if they reported lacking money to pay the rent/mortgage, utility bills or medical /prescription bills or skipping meals because there was not enough money to buy food.22
Technology Use:
To evaluate the use of technology among older public transit users, we explored cell phone and computer usage. If the participant answered “no” to questions asking if they had a working cell phone, or a working computer, they were categorized as not having these devices.
Neighborhood Environment Characteristics:
To include information on the participant’s neighborhood environment, we categorized participants as living in areas with broken/cracked sidewalks, which was captured from standardized interviewer observations of whether survey participants had continuous sidewalks surrounding their homes (Yes/No).
Statistical Analysis
We applied survey-weighted methods, accounting for the complex design of the NHATS survey and differential probability of nonresponse23, to produce count and national prevalence estimates and 95% confidence intervals (CI) of community-dwelling Medicare beneficiaries over the age of 65 who were current public transportation users. We used the same approach to produce national estimates of the number and percentage of community dwelling older adults who used public transportation to get to their regular doctor. We report descriptive statistics for the entre cohort and stratified by users and non-users of public transportation. We then evaluated age and sex-adjusted associations between our hypothesized contributors and recent use of public transportation using logistic regression and procedures to incorporate the complex survey design and weighting of the NHATS survey. Participants who refused to answer or didn’t know were considered to be missing. Missing data was less than 5% for all variables, thus all of the descriptive analyses are complete case data. All analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC).
RESULTS
In the United States, the prevalence of public transportation use among urban-dwelling older adults was 9.8% (95% confidence interval [CI] 7.9 to 11.6), which is an estimated 3,122,583 older adults. Conditional on being a public transportation user, 22.4% relied on these services to get to their regular doctor—overall, this was 2.2% (95% CI 1.5 to 2.8) of all community dwelling older adults in the United States, or an estimated 658,850 people.
Public transportation users were generally younger and more likely to self-identify their race and ethnicity as non-Hispanic Black (37.1% vs. 21.5%, p<.001) or Hispanic (12.6% vs 6.2%; p<.001), and significantly more likely to report their primary language as one other than English (32.1% vs 18.3%, p<.001). Self-reported Medicaid eligibility was also more common among transit users as compared to non-users (29.7% vs 13.3%, p<.001). Transit users were significantly more likely to report going to the doctor alone (74% vs 59%, p<.01) but similar proportions of transit and non-transit users had not seen a physician in the last year (Table 1). There were also several clinical characteristics that differed among transit users and non-users. Significantly lower transit use was observed among adults over the age of 85, among those that were frail or characterized as having probable dementia, and among those who used assistive devices (Table 2).
Table 1.
Demographic Characteristics of Urban-Dwelling Older Adult by Transit Use Using the National Health and Aging Trends Study (NHATS), United States, 2015
| Characteristic | NHATS Total (n=5696) | Transit User (n=555) | Non-Transit User (n=5141) | p-value |
|---|---|---|---|---|
| Sample n | 5696 | 555 | 5141 | |
|
| ||||
| Weighted n | 31800941 | 3122583 | 28678358 | |
|
| ||||
| Weighted % | -- | 9.8 % | 90.2 % | |
|
| ||||
| Age Category, n(%) | p<.001 | |||
|
| ||||
| 65-69 | 828(14.5) | 110(19.8) | 718(14.0) | |
|
| ||||
| 70-74 | 1375(24.1) | 148(26.7) | 1227(23.9) | |
|
| ||||
| 75-79 | 1230(21.6) | 117(21.1) | 1113(22.0) | |
|
| ||||
| 80-84 | 1049(18.4) | 104(18.7) | 945(18.4) | |
|
| ||||
| 85-89 | 738(13.0) | 48(8.7) | 690(13.4) | |
|
| ||||
| >90 | 476(8.4) | 28(5.1) | 448(8.7) | |
|
| ||||
| Male sex, n(%) | 2537(42.8) | 264(47.6) | 2173(42.3) | p=.06 |
|
| ||||
| Race, n(%) | p<.001 | |||
|
| ||||
| Non-Hispanic white | 3671(64.5) | 237(42.7) | 3434(66.8) | |
|
| ||||
| Non-Hispanic black | 1311(23.0) | 206(37.1) | 1105(21.5) | |
|
| ||||
| Hispanic | 386(6.8) | 70(12.6) | 316(6.2) | |
|
| ||||
| Other | 175(3.1) | 27(4.9) | 148(2.9) | |
|
| ||||
| Education, n(%) | p<.001 | |||
|
| ||||
| <High school | 1214(21.9) | 140(25.9) | 1074(21.4) | |
|
| ||||
| Highschool or Equivalent | 1399 (25.2) | 91 (16.8) | 1308(26.1) | |
|
| ||||
| >High school | 2940(52.9) | 310(57.3) | 2630(52.5) | |
|
| ||||
| Living in Section 8 Housing, n(%) | 279(4.9) | 78(14.2) | 201(3.9) | <.001 |
|
| ||||
| Marital Status, n(%) | <.01 | |||
|
| ||||
| Married or living with partner | 2815(49.4) | 226(40.7) | 2589(50.4) | |
|
| ||||
| Not married or living with a partner | 2881(50.6) | 329(59.3) | 2552(49.6) | |
|
| ||||
| Covered by state Medicaid, n(%) | 804(14.9) | 156(29.7) | 648(13.3) | <.001 |
|
| ||||
| Speak Language other than English, n(%) | 1093(19.6) | 175(32.1) | 918(18.3) | <.001 |
|
| ||||
| Chronic Conditions, n(%) | ||||
| Myocardial infarction | 450(7.9) | 38(6.9) | 412(8.0) | 0.09 |
| Heart disease | 1133(19.9) | 98(17.7) | 1035(20.1) | 0.19 |
| Hypertension | 4039(70.9) | 379(68.3) | 3660(71.2) | 0.06 |
| Arthritis | 3462(60.8) | 306(55.1) | 3156(61.4) | 0.01 |
| Osteoporosis | 1372(24.1) | 114(20.5) | 1258(24.5) | 0.75 |
| Diabetes | 1625(28.5) | 164(29.6) | 1461(28.4) | 0.23 |
| Lung disease | 1029(18.1) | 80(14.4) | 949(18.5) | 0.06 |
| Have not seen a doctor within past 12 months, n(%) | 352(6.2) | 37(6.7) | 315(6.1) | 0.47 |
|
| ||||
| Attend medical visits alone, n(%) | 3229(60.6) | 382(74.2) | 2847(59.2) | <.01 |
|
| ||||
Missing variable counts for the variables in the table are as follows: education level(n=143), Medicaid coverage(n=286), speak language other than English (n=121) section 8 housing(n=28), attend medical visits alone (n=369), have not seen doctor within 12 months (n=13).
Table 2.
Clinical Characteristics and Mobility Status Among Urban-Dwelling Older Adults Categorized by Transit Use Using the National Health and Aging Trends Study (NHATS), United States, 2015
| Clinical Characteristics, n(%) | NHATS Total (n=5696) | Transit User (n=555) | Non-Transit User (n=5141) | P-value |
|---|---|---|---|---|
| Geriatric Factors | ||||
| Sensory Impairments, n(%) | ||||
| Visual Impairments | 588(10.3) | 57(10.3) | 531(10.3) | 0.32 |
| Hearing Impairments | 1309(23.0) | 107(19.3) | 1202(23.4) | 0.95 |
| Dementia Classification, n(%) | <.001 | |||
| Possible | 575(10.1) | 71(12.8) | 504(9.8) | |
| Probable | 621(10.9) | 32(5.8) | 589(11.5) | |
| Frail (Fried Criteria), n(%) | 1102(19.4) | 67(12.1) | 1035(20.1) | <.001 |
| One or more ADL disabilities, n(%) | 1073(19.1) | 73(13.2) | 1000 (19.8) | <.01 |
| Mobility Status | ||||
| Community Ambulator, n(%) | 3876(68.1) | 455(82.0) | 3421(66.5) | <.001 |
| Device Use, n(%) | ||||
| Use Walker | 516 (9.0) | 38(6.9) | 478(9.3) | <.001 |
| Use Wheelchair or Scooter | 466 (8.1) | 21 (3.8) | 445 (8.7) | <.001 |
| Use Cane/No Device | 4714 (87.8) | 496(89.4) | 4218 (82.0) | 0.40 |
| Socioeconomic Status | ||||
| Financial Strain, n(%) | 445(7.8) | 65(11.7) | 380 (7.4) | 0.04 |
| Quality of Built Environment | ||||
| Broken/Cracked Sidewalks Near Home | 3076(55.0) | 170(31.5) | 2906(57.5) | <.001 |
| Access to Technology | ||||
| Does not have working cell phone | 1001 (17.6) | 83(15.0) | 918(17.9) | 0.69 |
| Does not have working computer | 1877(33.0) | 232(41.8) | 1645(32.0) | <.01 |
Abbreviations: ADL=Activities of Daily Living
Missing variable counts for the variables in the table are as follows: one or more ADL disabilities(n=85), continuous sidewalks (n=107), does not have working cell phone(n=1), does not have working computer (n=3).
Several factors were associated in adjusted models with lower likelihood of transit use, notably frailty, inability to walk 3 blocks (non-community ambulator) and use of wheelchairs for mobility (Figure 2). Compared to non-frail older adults, those who were frail had 39% lower odds of reporting recent transit use (OR=0.61, 95% CI 0.41-0.91). Inability to walk at least 3 blocks in the community was associated with a 62% decrease in the odds of reporting recent transit use (OR=0.38, 95% CI 0.26-0.56). Use of wheelchairs was associated with lower odds of recent transit use as compared to those who needed no device or only a cane (OR=0.35, 95% CI 0.19-0.65). Lastly, the quality of the neighborhood-built environment was also a significant factor, with those living in areas with cracked or broken sidewalks having 65% lower odds (OR=0.35, 95% CI 0.27-0.46) of reporting using public transportation use in the last 30 days as compared to those in areas with continuous sidewalks.
Figure 2:
A forest plot of survey-weighted age and sex-adjusted odds ratios (ORs) and 95% confidence intervals (CI) depicts relationships between individual factors and use of public transportation within the last 30 days among older adults in the National Health and Aging Trends Study (NHATS). Variables in red indicate factors significantly associated with lower odds of transit use, those in grey indicate no differences, and those in green indicate factors associated with significantly higher odds of transit use.
DISCUSSION
In this nationally representative cohort, we estimate that 3.1 million urban-dwelling older adults are current public transportation users, with over 600,000 using transit services to access medical care. This is, to our knowledge, the first study to characterize specific clinical characteristics of older adults (e.g., frailty and cognitive impairment) and mobility-related characteristics such as assistive device use among a nationally representative sample of older public transportation users. Four major findings of our work warrant comment. First, older adults who use public transportation are more likely to self-identify as Black or Hispanic, speak a language other than English, and report significant financial strain as compared to non-transit users. Thus, any additional mobility-related, economic, or access related barriers to using public transportation could exacerbate known health disparities for these populations. Second, there are significant disparities in public transportation use by age, with substantially less ridership observed among older adults older than 85 years. This suggests a need to identify, in future studies, whether there are unique challenges to transit use among this important subgroup. Third, older adults who live in neighborhoods with broken and cracked sidewalks are less likely to report recent transit use— this finding warrants further exploration and may need to be addressed in future clinical and policy interventions. And fourth, older adults who are frail, cognitively impaired, or use more restrictive assistive devices such as walkers and wheelchairs were less likely to report using public transportation. Taken together, our findings indicate that the needs of older transit users may need be better centered in future updates to public transportation infrastructure and policy.
This study adds important context to prior work and government reports that have shown growing use of public transportation and other driving alternatives (such as ridesharing) in the United States among older adults.24,25 Other work in NHATS data shows poor access to transportation as a major barrier to social participation among older adults2, but improving uptake of public transportation among older adults may help older adults maintain or even improve participation in meaningful life activities.4 Yet, access to public transportation is uneven among older adults, often across socioeconomic lines and among those living with mobility limitations or disability. In New York City, news reports indicate as many as 25% of public transportation stations lack working elevators and residents in some boroughs (generally, lower income areas) may have to walk or wheel up to an hour to get to an accessible station.26 A recent intervention providing access to transportation services as part of a Medicare Accountable Care Organization initiative showed mixed effects on improving healthcare outcomes1, perhaps owing to a paucity of attention towards interventions specifically designed improve an older adult’s capacity for using transportation services such as training on how to navigate broken sidewalks and curbs in the built environment or confidently get onto a bus using an assistive device. And even restorative interventions, such as physical therapy, targeting improvements in mobility rarely focus on improving use of public transportation. One estimate in NHATS data suggests only 2% of older rehabilitation users received interventions focused on accessing public transportation or other driving alternatives.27 This suggests a major opportunity to improve rehabilitation care for older adults with transportation disadvantage, and better design and target comprehensive transportation interventions for older adults.
Beyond physical impairments, we also found that older public transportation users were more likely to report economic and technological challenges. Nearly a third of public transportation in our study were covered by state Medicaid services and more than 1 in 10 had trouble paying for housing, food, or utilities. Other published work has found the costs of transit are often perceived to be a substantial barrier to use among older adults.28 Older adults who are financially strained or living in poverty may be more likely to experience barriers getting to medical visits or participating in social engagement if they rely on public transportation29,30. This may be additionally concerning for those who wish to attend visits with a caregiver, which could double the round-trip costs on many fixed-route public systems and make travel to frequent medical visits a major source of additional financial strain. While cell phone ownership and usage were similar between transit users and non-transit users, 15% of older adults did not have a working device. In addition, 42% of older transit users in our study did not have a working computer, a higher rate than non-users. Public transportation service providers are increasingly relying on electronic forums such as public websites or mobile applications as a means to users accessing published schedules and providing payments. Thus, those without access to electronic devices may not benefit as fully from transit-related innovations designed to improve access.
Last, our data highlights that public transportation is used largely by older adults who identify as Black or Hispanic, and a disproportionate number of public transportation users speak a primary language other than English. This mirrors findings among younger populations using transportation services primarily for commuting to work.11 Yet, neighborhoods with greater socioeconomic disadvantage, more often those with higher populations of Black and Hispanic residents, are more poorly served by public transportation in terms of both lower density of transit stops and more hazards during the walking commute (e.g., inaccessible walkways and air pollution).11 Disparities in access to public transit is underserved neighborhood may contribute to missed medical appointments which disproportionately affects health and social function among older adults, especially older adults who identify as part of a racial and ethnic minority group.11 While recent federal funding initiatives in the 2021 Infrastructure Investment and Jobs Act have earmarked funds to address transit access for those persons living with a disability16, our findings suggests additional increased attention in implementation of this legislation on equity of transit access among older adults, especially those residing in economically underserved neighborhoods, may be warranted.
Our work has several important strengths and some modest limitations. First, this paper uses a robust nationally representative survey of older adults that uniquely includes data on transportation use in combination with detailed information about mobility disability, clinical characteristics, and socioeconomic status. Our findings, therefore, are generalizable to urban dwelling older adults living in the United States and provide novel insight about older transit users. Second, our study included specific information on assistive device and wheelchair use among older adults, which could inform initiatives in both clinical and advocacy arenas related to accessibility of transportation for older adults with mobility disability.
Our study does have limitations that need to be acknowledged. This is a cross-sectional study and cannot provide causal estimates of how presence or absence of geriatric vulnerabilities specifically impact transit use. However, the associations we observed could inform future clinical and policy efforts in a similar way as other high quality descriptive epidemiological work done using NHATS data.21,31 Second, we were not able to estimate the frequency of public transportation use among older adults, an important variable that should be explored in future studies. Certain transportation modalities such as paratransit wheelchair van services or other non-emergency medical transportation modalities are not specifically captured in NHATS surveys which may contribute to underestimation of public transit users who rely on wheelchairs for mobility. Additionally, 2015 NHATS surveys did not capture use of ride-hailing services such as Lyft and Uber, which occasionally operate in a quasi-public fashion when subsidized by state or local governments. While these numbers are likely small, we may nonetheless be underestimating overall transit use among older adults with these limitations. Last, public NHATS data does not have detailed geographic information that might allow more robust evaluations of environmental facilitators and factors limiting access to public transportation for older adults. Our ongoing work, both quantitative and qualitative, is exploring these domains further. We did however have basic information about the participant’s immediate neighborhood environment, such as the presence of cracked sidewalks, that hint at what environmental affordances may facilitate transit access.
Conclusion:
Our findings indicate more than 3 million urban-dwelling older adults rely on public transit to get around and over 600,000 use transit to get to their regular doctor. Lower transit use was observed among those who are frail, have probable dementia, use assistive devices, and the oldest-old. Older adults who were financially strained, identify as racial or ethnic minorities, and those who speak a language other than English were more likely to have recently used public transit. Older public transit users in the United States are a unique population who have received limited attention in prior studies. Public transportation users may be uniquely vulnerable to transportation disadvantage after medical events, and, as recently demonstrated, during public health crises that curtail or eliminate services (e.g., COVID-19 pandemic). With increasing investment in public infrastructure on the horizon, centering the medical, economic, and social needs of older adults is critical for reducing unmet transportation needs and ensuring urban communities remain age-friendly.
Key Points:
More than 3 million urban-dwelling older adults relied on public transportation to get around in 2015, and more than 20% of these older users depend on public transportation to attend medical visits.
12% of urban-dwelling older public transportation users reported being financially strained.
Frail older adults, those with probable dementia, or those who used assistive devices such as walkers and wheelchairs were significantly less likely to report recent use of public transportation.
‘Why does this matter:
Understanding factors associated with public transportation use among older adults may inform development of transportation interventions more tailored to the unique needs of older riders.
ACKNOWLEDGEMENTS:
Dr. Falvey had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.
Funding/Support:
The National Health and Aging Trends Study was supported by grant U01AG032947 from the National Institute on Aging [NIA] through a cooperative agreement with the Johns Hopkins Bloomberg School of Public Health.
Dr. Falvey was supported during the work by the National Institute on Aging (grant numbers K76AG074926 and P30AG028747) and the University of Maryland, Baltimore, Institute for Clinical & Translational Research (ICTR) and the National Center for Advancing Translational Sciences (NCATS) Clinical Translational Science Award (CTSA) grant number 1UL1TR00309.
Conflicts of Interest:
Dr. Falvey reported grants from the National Institute on Aging, the University of Maryland, Baltimore, Institute for Clinical & Translational Research (ICTR) and the National Center for Advancing Translational Sciences (NCATS) during the conduct of the study.
Grant Funding:
Dr. Falvey was supported during the work by the National Institute on Aging and the Maryland Claude D. Pepper Center (grant numbers K76AG074926 and P30AG028747).
Sponsor’s Role:
The funding agencies had no role in the design, methods, recruitment, data collection, analysis, or preparation of the manuscript.
Footnotes
Conflicts of Interest: Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
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