Implication of transit transfer to the older adults: a systematic review

doi:10.21203/rs.3.rs-1525054/v1

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Research Article

Implication of transit transfer to the older adults: a systematic review

https://doi.org/10.21203/rs.3.rs-1525054/v1

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Background: Extensive multimodal transportation network has resulted in widespread use of the transit transfer method of transportation among frequent travelers. In many parts of the world, transferring from one mode of transportation to another provides significant mobility advantage to people, commodities, and services in reaching their destination. However, there are some who have not reaped the benefits of this sophisticated transportation networking system. This study reviewed published articles on the implications of transit transfer on the older adults in order to gain a better understanding of this method of transportation and the nature of difficulties that it caused them.

Methods: The following databases were searched: PubMed, Cochrane, Scopus, ProQuest, WileyOnline, and Ovid. Inclusion criteria was English language, respondents aged 60 and above, living in community, and addressing transit transfer mode of transportations used, and the outcome on older adults. Review paper, letter, book citations, comments, editorials, experimental and animal studies were excluded from this review.

Results: This review included six studies. According to the findings of this study, older adults were able to benefit from transit transfer as transportation method to reach their destination. It can also increase physical activity among the older adults through active commuting. However, older adults encountered a problem with transit transfer since they had to walk to reach each of the transport facilities. Transit transfers have also been shown to expose them to inconveniency pertaining to obstacle they faced while transit transfer.

Conclusion: There are indications of positive and negative implications of transit transfer to older adults. More research should be conducted to further evaluate its risk and outcome to the older adults and to determine effective strategies to improve their intermodal transportation.

Older adults

mobility

transportation

accessibility

physical activity

systematic review

Transportation infrastructure has advanced rapidly in recent decades to meet the needs of a country’s growing population and economy. This extensive transportation network is critical for population growth, development, and economic activities. New transportation networks and lines were added from time to time. It improves connectivity between and within cities and increases people's access to more destinations across the country.

Transit transfer has become a significant norm, particularly for active daily commuters. The use of multiple modes of transportation, such as walking, bicycling, driving, mass transit, taxis, and rideshare in a single trip gives access to more locations and helped in meeting a country's growing travel demand. Its efficacy, however, varies from person to person (1)

Older adults may find it difficult to use the services since they have low physiological performance, poor health, high morbidity prevalence, and were unfamiliar with the extensive transportation network as they spend less time travelling upon retirement (2). Their transport uses may also be hampered by the lack of services, a long walking distance to bus stops and train stations (3) and the high cost of public transport (4). It is especially more challenging for people with functional impairment, those who rely heavily on public transport, and rural older adults from low socioeconomic backgrounds (5).

So, were the older adults able to benefit from the concept of transit transferring? Older adults have always struggled to maintain active mobility within the community. The complex structure of today's transportation network, as well as its poor practicality, have been shown to have an impact on the mobility of the older adults (6). This review will delve into it.

This review will give us a deeper understanding on mobility and transportation of the older adults, particularly on transit transfer. This study will significantly benefit them as it will address the issue concerning their poor community mobility. It is also important for future intervention research and the body of knowledge. It will aid service providers and policymakers in making informed decisions pertaining this issue. The betterment in their quality of life and health, as well as active lifestyle instilled in them, will benefit the economy and social wellbeing of the country.

Review Aim

The purpose of this systematic review was to incorporate current evidence on implications of transit transfer to the mobility of older adults. This review will specifically investigate (i) mobility of older adults as a result of transit transfer; (ii) how it changes mobility preferences and patterns among older adults; and (iii) the effects it has on the wellbeing of older adults.

A systematic search of PubMed, Cochrane, Scopus, ProQuest, Wiley Online, and Ovid for English language publications on the effects of transit transfer on the older adults was conducted. These databases were chosen because among all databases subscribed by the university, they contain many journal articles in health science, life science, and social science and have peer-reviewed services.

MeSH terms and keywords related to three concepts were identified: elderly, transit transfer, and outcome. Each concept's related terms are determined and included in the search string, as shown in Table 1.

For the aforementioned selected databases, a search strategy was developed based on published research papers. Using the "AND" feature, these terms from each concept will be combined. On the topic, grey literature was searched using the search engine's "suggestion" feature. Bibliographies of retrieved articles were also used to find additional studies on the subject.

Table 1

Search string
Elderly*	Transit transfer	Implication
Old age	Transport feeder	Outcome
Old people	Feeder bus	Impact
Older adults	Multimodal transport	Consequence
Geriatrics*	Intermodal transit	Effect
Aging*	Transit commute	Mobility
Aged*	Transit trip	Independent
	Transit usage	Health
	Transit walk	Quality of life
		Physical activity
		Social interaction
		Community participation

*MeSH term

Inclusion and exclusion criteria

Studies involving respondents aged 60 and above, living in a community, and addressing transit transfer mode of transportation usage were included in the review. The studies must also include at least one outcome or impact of transit transfer on the older adults. The exclusion criteria here are studies conducted on older adults living in institutions, age lower than 60 (for example, individuals aged 55 and above are considered older adults in China) and did not include transit transfer and its impact in their studies. Studies conducted on older adults worked as public transport operators/drivers and papers not published in English were also excluded from this review.

Study screening and selection

In total, 4898 results were found across the six databases that were searched. Duplicates, book citations, commentaries, editorials, review articles, and non-English articles were removed. It left 3591 articles to be screened for retrieval using predetermined inclusion and exclusion criteria through titles and abstracts. Further, 325 articles were identified as relevant and attempted to be retrieved. Twelve articles were unable to be retrieved. Three hundred thirteen articles were retrieved and thoroughly evaluated based on the methodology used and the outcome of interest. Finally, seven papers were discovered that looked into the effects of transit transfer on the elderly. Two authors then conducted a full-text review of the articles to be included in this study. Following the review of selected papers, a discussion was held. Figure 1 depicts a summary of the data retrieval process.

Data extraction

Data extraction were focusing on 1) study design; 2) methodology; 3) target population; 4) sample size; 5) outcome measured; 6) study finding; and 7) bias risk. The data was tabulated and risk of bias was investigated.

Presentation of data

A data summary was tabulated, as shown in Table 2. The implications of transit transfer to the older adults were described using the same frequencies, percentages, and measures of association used in the studies.

Study inclusion

In total, 4898 results were found across six databases that were searched. Duplicates, book citations, commentaries, editorials, review articles, and non-English articles were removed. It left 3591 articles to be screened for retrieval using predetermined inclusion and exclusion criteria through titles and abstracts. Further, 325 articles were identified as relevant and attempted to be retrieved. Twelve articles were unable to be retrieved. Three hundred thirteen articles were retrieved and thoroughly evaluated based on the methodology used and the outcome of interest. Finally, six papers were found to delve into study on the effects of transit transfer on older adults. Figure 1 depicts a summary of the data retrieval process.

Characteristics of the included studies

The data of six peer-reviewed studies was analyzed and interpreted. The impact of transit transfer to the mobility of older adults was the key finding in all of the studies that were chosen. Table 1 summarizes the general features of the included studies as well as their research findings. All six included studies were using cross-sectional design. Only four researches conducted were travel survey, whereas the other two were data from general household survey. In terms of the study population, all but one studies were done among general population, while the one study were conducted among older adults community.

Main findings

Table 2

Findings from included studies.
References (n = 6)	Study design	Methodology	Target population & area	Sample size	Outcomes measured	Indicative findings
Yang (Yang, 2018)	Retrospective analysis of cross-sectional data from the Hong Kong’s national survey database.	Data from Travel Characteristics Survey were analyzed using mixed binary logit and conditional logit model.	Older adults aged 60 and above live in Hong Kong	19,703 older adults	Perceived transit transfer	The numbers of transfers are perceived negatively by older adults and do affect their travel behavior. The coefficient of the number of transfers was found to be -1.336 (p < 0.005).
Gong et al. (2018)	Retrospective analysis of cross-sectional data from origin and destination (OD) survey for Melbourne urban rail transit.	Data on origin and destination (OD) survey for Melbourne rail travelers were retrieved and analyzed for their perceived travel conveniency.	General population including older adults age 60 and above.	8149 people	Quantification of transfer penalty of weather on rail transit and its feeder modes	Air temperature and heavy rains causes increase in transfer penalties. Older adults imposed low penalties to transfers from feeder modes to rail service, and perceived high transfer penalties for access than egress journeys.
Chia et al. (2016)	Retrospective analysis of cross-sectional data from South-East Queensland Household Travel Survey.	Travel diary from 8809 individuals selected through multistage sampling was analyzed.	General population including older adults age 60 and above.	8809 people	Walking time decay function	Walking to public transit reduced bus usage among older adults. Every increase in distance to public transport facility after the 9th minute will reduce its use ranging from 23–6%.
Lachapelle & Pinto (2016)	Retrospective analysis of cross-sectional data from Statistics Canada's General Social Survey, Cycle 19.	Computer-assisted telephone interview was conducted for data on respondents’ one-day activities and were analyzed.	General population including older adults age 65 and above.	19597 people	Meeting physical activity recommendations through active transportation	Older adults age 65–74 and 75 and above have odds of 0.52 and 0.79 respectively to achieve recommended duration of physical activity.
Waygood et al. (2015)	Retrospective analysis of cross-sectional data from Osaka household travel survey	Data from previous survey on person trip data was used to analyzed the one-day trip diary.	General population including older adults age 60 and above.	1,027,622 people	Accumulated 30 min of physical activity through active travel	Older couples and single older adults have odd of 1.1082 and 1.01, respectively, to achieve recommended duration of physical activity.
García-Palomares et al. (2013)	Retrospective analysis of cross-sectional data from Madrid household mobility survey by a government agency.	The place of origin and name of the Metro station respondents departed were georeferenced by GIS, and its distances were analyzed.	General population including older adults age 65 and above.	17000 people	Walking time decay function	With every 100m increase in distance to station, there is 7.58% reduction on older adults using the transit. Most older transit users were those living near the stations and benefitted from short distance to access the Metro.

Transit transfer allows older adults to travel to their destination

The use of interconnected transportation networks allows older adults to travel across a larger geographic area independently. It is proven when only 9.24% of Hong Kong's older adults owned a car with another 90% of Hong Kong's older adults use public transports to get around (6). Hong Kong's transportation system had evolved as a transit-oriented metropolis, delivering frequent, reliable, and extensive services to its citizens. The older adults were able to travel to areas with a lot of amenities that they frequented, such as the markets, restaurants, healthcare facilities and even to other cities. As a result, their mobility, flexibility, and independence were enhanced. They also did not have to be worried about becoming immobile once they had to stop driving at a later age.

However, older adults may find it difficult to transfer from one mode of transportation to another. According to a study on walking access to public transportation in Brisbane, older adults have the shortest walking time and are the most sensitive to it (8). They walked for the longest distance of 9 minutes to reach a transportation facility. A one-minute increase in walking time after the ninth minute reduced their likelihood of walking at the given time, with more putting a halt to their plans to visit the location. It put them in transportation disadvantage. While it was reported that approximately 81.69% of public transportation was reachable by foot, older adults' use of public transportation was relatively low in this study, at only about 6% after the ninth minute. Physical deterioration of the older adults making it difficult for them to walk far to access public transportation.

A similar finding was reported among older adults in Madrid (9). A study was conducted to examine walking distances to Metro among different groups of population in Madrid using microdata and a geographic information system (GIS). The findings indicate that older adults were more sensitive to the effect of distance. With every 100 meters of distance from the station, the use of public transportation among the older adults decreased by 7.38%, the greatest percentage reduction among all studied population groups. More, it was discovered that the majority of the older adults who used public transportation were residing in urban areas. Older adults who live further away from the city center had to walk a longer distance to get to the transit station, halting their use of public transportation.

The number of transfers that the older adults have had to endure in order to reach their destination has also been a hardship. A study using a mixed binary logit model was conducted to determine the relationship between making trips and age, among other determinants (6). According to the findings of this study, even among the older adults who frequently use public transports, they have a negative perception to the number of transfers. The coefficient of the number of transfers was found to be -1.336 (p < 0.05). This suggested that older adults perceived increase number of transfers negatively. They might limit their use of public transportation due to the need to transfer. Walking to and from transit station(s), carrying luggage, waiting for transport arrivals, and dealing with the hustle of boarding and alighting of multiple transports in the process of reaching a destination is not as easy for the older adults as it is for other younger cohorts.

Transit transfer promotes physical activity among older adults

Transit transfer is lauded for promoting physical activities among its users. Walking at the start and end of a trip and between transit stations would contribute to the total walking duration and distance. While the average duration, distance, and pace may vary from person to person, walking while in a journey could add to a substantial total of 150 minutes per week of moderate to vigorous physical activity, as recommended by World Health Organization (WHO) for the older adults.

A one-day trip data of 1,027,622 people from the Osaka household travel survey were examined (10). In this studied population, most of them walked to access public transport. Walking trips were associated with 98.4% of bus trips in highly commercial areas and 92.1% in undeveloped areas. Walking trips were associated with approximately 93% of rail trips in highly commercial areas and 88.3% in undeveloped areas. Walking/cycling trips to bus services take an average of 11.5 minutes (± 0.7), while rail transit takes 15.5 minutes (± 0.4). The likelihood of older couples achieving the 30-minute physical activity threshold through active travel were 1.082 (p < 0.05), while the odds of a single older adults meeting the threshold were 1.01 (p > 0.05).

However, another study reported that transit transfer failed to encourage active commuting among retirees (11). A time use survey was conducted on 10,687 Canadians, of whom 12.9% were older adults. The study found that as age increased, the likelihood of meeting the physical activity recommendation decreased. The odd ratio for older adults meeting the physical activity recommendations during transit transfer was reported to be 0.52 (95% C.I: 0.35–0.79) and 0.79 (95% C.I: 0.47–1.34) for older adults aged 65 to 74 and 75 and over, respectively. The majority of those who walked more did so on mandatory trip, such as a trip to an educational institution or workplace. They were found to be less likely to meet physical activity recommendations through active commuting because of the lack of desire to walk for an extended period to access transportation services, nor do they intend to walk far for a leisure trip.

Transit transfers impose penalties to older adults

During their transit transfer, older adults were also subjected to transfer penalty (12). Transfer penalty is the inconveniency quantified by travelers based on their perception of transfer time, cost, comfort, security and other related strains surrounding the transit transfer. An 8-month origin-and-destination (OD) survey on 8149 Melbourne residents, including 610 older adults, was undertaken to assess the time-independent transfer penalty between feeder modes and the rail system. Transfer penalties for older adults were shown to be greater for access journeys than egress journeys. The transfer penalty for the older adults taking buses was found to be an average of 38.3 minutes for the access journey and 15.5 minutes for egress journey. The penalty for transferring from tram to rail transit was 10.4 minutes for access journey and 7.8 minutes for egress journey. This finding depicts the obstacles older adults faced when had to transit transfer, which may create discomfort and discourage them from riding public transport.

This systematic review intended to look into how older adults perceived transit transfers and its implications on their mobility patterns, preferences, and overall well-being. After completing a thorough search for relevant research publications, this study identified just six research papers examining this issue. Results are limited and no consistent pattern were seen due to scarcity of studies. These studies, which mostly were extensions of general population surveys, were conducted in various countries, yielding a diverse set of results from each research setting.

It tells us two things: first, despite calls for an age-friendly environment to prepare us for the ever-growing older adults’ population, there is still a lack of studies focusing on older adults’ mobility and transportation; and second, different countries may not share a common concern on this issue because each country is at different pace of transportation development.

The strong points of this review are as follow: (i) this is the only systematic review done on this issue, (ii) the inclusive and exclusion criteria are well-focused, and (iii) robust outcomes were considered into the study. However, upon completion of this study, findings of this review were found to confined to a few key indicators only, namely on accessibility, physical activity and conveniency of older adults on transit transfer method.

From this review, it was found that older adults can meet their travel needs and go about their daily lives by using multimodal transportation rather than individual automobiles (6). Transit transfer was proven to be able to provide them with greater access to a wider range of goods and services in more locations, allow autonomy and independency for them to move around, and to promote mobility and connectivity among them. With up to 90% of older adults in Hong Kong commuting by this method of transportation and fewer than 10% owning a private vehicle, it simply demonstrated that accessible public transportation is benefitting the older adults. However, there are a few things that need to be addressed. Hong Kong is one of the smallest countries in the world. In comparison to large countries, it is possible for Hong Kong to build strong transportation networks that are extensive, integrated and capable of connecting almost every area of the country. Besides, Hong Kong also enjoys a high economic growth rate. Because of their solid financial gains, they were able to expand their transportation networks and equip them with age-friendly amenities to cater the needs of older adults, especially those with health issues, disability, frailty, and wheelchair-bound. Their policy, which emphasis the vision of 'Transport for All' helped the older adults even more by instituting a concessionary fare plan. Under the scheme, older adults will be charged with a fixed minimum cost for rail, bus, and ferry travel, encouraging usage of multimodal transportation and mobility among them. In a nutshell, the use of multiple transportations among the older adults was influenced not only by their physical capability, but also by the availability, reliability, accessibility, affordability, and functionality of the services offered to them.

Another advantage of transit transfer for older adults is that the walk and cycle to, from, and between stations can contribute to their daily non-vigorous physical activities. The finding of this review, however, revealed that its applicability varies depending on where the study was conducted. While single and coupled older adults in Osaka were highly likely to meet the minimal threshold period of non-vigorous physical activity with odds ratio of 1.1082 and 1.01, respectively (10), the same findings could not be replicated among older adults in Canada, though (11). In this study, the odd ratios of older adults meeting the physical activity threshold were 0.52 for those aged 65 to 74 and 0.79 for those aged 75 and more. They were found to reduce number of trips upon retirement, with many excursions being short-distance and requiring no interchange. However, this study acknowledged to underreporting the total amount of walking time done by transit users. Nevertheless, both studies agreed on the link between home location and built environment with modes of traveling such as distance to access to public transit, availability of pedestrian amenities and locations of services facilities.

While transit transfer was found to be beneficial to the older adults, transferring between modes of transportation can be challenging for them. The distance they must walk to reach a transport facility was cited as an important factor in determining the use of transit transfer. They were able to tolerate only nine minutes of walking to access transport facilities (8). It can contribute to social inequality among them. Older adults who live in urban area, especially near to the station will have great advantage on mobility and transportation. Urban areas have greater street connectivity, transit stops/stations, access to public transportation, transportation options, and nearby facilities and destinations as compared to rural areas (13). More than 44 stops/stations were accessible to 50% of the population living in the city centre as compared to only seven stops/stations for those who live in the suburbs (14). As a result, the preference for public transportation was higher among those who live near a station than those who live farther away (15). Because older adults who reside out of the city areas had to walk a greater distance to reach the stations, it would reduce the likelihood of them using transit transfer method (9).

Older adults were also subjected to transfer penalty during their transit move (12). As transit transfer involved utilization of inter-connected transit networks, they need to make at least one transfer between transportation modes to reach their final destination. These transfers might require older adults to pay more, wait for the next modes, walk lengthy distances, climb stairs or exposing them to crime or inclement weather. Thus, although transit transfer allows them to travel to more destinations, not everyone keen on doing so. The variability of transfer feeders and destination direction also influenced penalty imposed to transit transfer (12). For Melbourne’s older adults who used urban rail transit system, greater transfer penalty was imposed on access than on egress journey. To reach the transit station, majority of them walked, drove, took a bus or tram, accordingly. Then, for the return journey, more travelled by walk, tram and bus, accordingly. While this study did not include determinant for transfer penalty of each feeder taken by older adults, the importance of feeder transportation in gaining access to transit services cannot be understated. By improving feeder transportation, it would help older adults perceived transit transfer more positively.

While this study discovered a dearth of research on this topic, the finding suggested that to attract more older adults to use transit transfer method of transportation, the availability, accessibility and reliability of the services is critical. Besides, the built environment may also have an impact on their participation in active commuting and contribute to the overall effects of older adults’ transit transfer experience (16). Placing transportation infrastructure within decent range would be beneficial in encouraging older adults to use multiple modes of transportation (17). If this is not possible, a sheltered and smooth walkway can help with the walk (18). A rest stop with benches can also improve the convenience of transit transfer for the elderly. The presence of green space and security patrols in the area will encourage seniors to consider transit transfer as a future mode of transportation.

There are many other issues pertaining to transit transfer that need to be studied in the future. Due to limited mobility, because of health or ageing factor, older adults struggled to navigate the terminals' vast corridors, mount stairs and step up and down the platform to reach the transit door. Furthermore, if they are carrying luggage or bringing small kid, this will only add to their burden. The hustle and bustle of transportation terminals, the complexity of the network, and the need to walk and enter multiple vehicles may also be exhausting for the older adults. Because they walk at slower pace, they had to struggle with a hurry to board and disembark from several modes of transportation throughout the interchange to avoid missing a transfer (19). They may also struggle to comprehend information presented, leading them astray. These may all hinder their mobility and transportation use. It could have implication on their self-care, community participation, social interaction, quality of life and health. It might be much worse for older adults who have dementia, frailty and chronic diseases that need frequent travelling for regular medical check-ups. It could lead to deterioration of their health and quality of life. The struggles and their implications on the older adults need to be brought to light in order to better provide them with necessary assistance in promoting mobility among them.

Conclusion

To promote ageing-in-place and healthy ageing for this rapidly growing group, transportation facilitators and barriers among older adults must be better understood. For example, transit transfer was widely regarded as the future of transportation system. While this multimodal concept was successful in transporting a large number of older adults to their desired location, it was not without flaws. Its accessibility, safety, and dependability must all be improved, while the benefits of physical activity should be promoted. Nonetheless, more research into the implication of transit transfers on the older adults is needed.

Limitation

However, this study was bound to some limitations. Only few related articles were found. Besides, due to our restrictive inclusion criteria and rigorous review process when selecting articles, few important articles did not meet the cut due to sample size and sampling method. Lastly, only articles published in English were included.

origin and destination

GIS

geographic information system

WHO

World Health Organization.

Acknowledgements

The authors wish to thank staff of the MyAgeing, Universiti Putra Malaysia for administrative support.

Funding

Ministry of Higher Education (Malaysia).

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Authors’ contributions

All authors conceptualized the systematic review. All authors conducted searches, contributed to the screening of article eligibility and manuscript revision.

Authors’ information

Nur Farhana Mohammed Noor¹, Hayati Kadir Shahar^1,2*, Rahimah Ibrahim^1,3, Zumilah Zainalaludin^1,4, Tengku Aizan Tengku Abdul Hamid¹, Siti Anom Ahmad^1,5, Fakhrul Zaman Rokhani^1,6, Norsidah Ujang⁷, Irwan Syah Md Yusoff⁸ and Siti Aisyah Nor Akahbar¹.

Author details

¹Malaysian Research Institute on Ageing, Universiti Putra Malaysia.

²Department of Community Health, Faculty of Medicine and Health Science, Universiti Putra Malaysia.

³Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia.

⁴Department of Resource Management and Consumer Studies, Faculty of Human Ecology, Universiti Putra Malaysia.

⁵Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia.

⁶Department of Computer and Communication Systems Engineering, Faculty of Engineering, Universiti Putra Malaysia,

⁷Department of Landscape Architecture, Faculty of Design and Architecture, Universiti Putra Malaysia.

⁸Department of Resources Management and Consumer Studies, Faculty of Human Ecology, Universiti Putra Malaysia.

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No competing interests reported.

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Implication of transit transfer to the older adults: a systematic review

Status:

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Abstract

Figures

Background

Methods

Data extraction

Presentation of data

Results

Study inclusion

Characteristics of the included studies

Main findings

Transit transfer promotes physical activity among older adults

Transit transfers impose penalties to older adults

Discussion

Conclusion

Abbreviations

Declarations

References

Competing Interests

Status:

Version 1