Two particular areas of concern in addition to the more well researched aspects of accident patterns in the ageing population are those of non-collision injuries in public transport and single pedestrian accidents. Although the research base for these forms of accidents is slender, the data are consistently suggestive of a significant need for both concern and further research, and to ensure that the factors underlying these accidents are addressed so as to enhance preserved safe mobility for older Europeans. A particular impetus is also given by the possibility that current policies in some European countries, such as medical screening of older drivers, may give rise to increased use of both public transport and walking. A search was undertaken on the Transportation Research Board TRID, MedLine (PubMed), CINAHL and PSYCHINFO databases using the search terms: a) ‘non-collision’, bus, public transport, injuries, accidents, and b) falls, older people, single pedestrian accident. The resulting papers were screened for relevance to one or both topics. One of the earliest studies reviewed accident data over a period of 12 months supplied by 30 bus operators, and covering about 30000 vehicles in the UK in 1980. Fifty-six per cent of the passenger injuries were sustained in non-collision accidents and 43 per cent of these occurred to passengers who were estimated to be over 60 years of age. This general pattern is reflected in research from Sweden, USA and Ireland. Although falls among older people have been recognized as a significant public health issue for many decades in Europe, a relatively new interest in traffic medicine is the extent to which these occur outdoors and particularly in geographical areas which can be considered to form part of the traffic environment. The greatest challenge to delineating the extent of the problem is that these injuries and deaths are poorly captured in official statistics: most road traffic accident databases do not capture single-pedestrian accidents, and most falls and hip fracture databases do not capture the location of the fall, whether indoors, in garden/yard, or the traffic environment. This is despite the fact that ICD-10 classification systems commonly used in the developed world can code for an outdoor fall, but is frequently not recorded. One of the largest studies available, (MOBILIZE in Boston USA), is a longitudinal analysis of a population aged 70 and over which indicated that indoor falls occurred mostly among the older old, and outdoor falls occurred predominantly among the younger old and fitter people with higher levels of activity. Indeed, this heterogeneity is also likely to apply also to measures to prevent both falls and single-pedestrian accidents among older people. There is mounting and consistent evidence, albeit on a slender research portfolio, that non-collision injuries on public transport and single pedestrian injuries represent a significant risk to the health and well-being of older Europeans. It is of critical importance that traffic injury recording systems are broadened, to include both types of accidents. (Author/publisher)
Samenvatting