Community Matters – are our communities ready for ageing?

Seminar 1: ‘Getting out and about’

Tuesday 11th March

This event is kindly supported by Age UK

#communitymatters

Malcolm Dean

This event is kindly supported by Age UK

#communitymatters

Phil Rossall

Research ManagerAge UK

This event is kindly supported by Age UK

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David Sinclair

Assistant Director, Policy and Communications

ILC-UK

This event is kindly supported by Age UK

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Dr Charles Musselwhite

Associate ProfessorUniversity of Swansea

This event is kindly supported by Age UK

#communitymatters

Community Matters: are our communities ready for ageing: Getting out and about

Setting the scene – where are we now and where do we want to be

Dr Charles Musselwhite

Associate Professor/Reader in Gerontologyc.b.a.musselwhite@swansea.ac.uk

www.drcharliemuss.com

A reduction in mobility can result in an increase in isolation, loneliness and depression and an overall a poorer quality of life. (Fonda, et al., 2001; Ling and Mannion, 1995; Schlag, et al., 1996)

More miles driven per person

Source: DfT (2002, 2006, 2010)

Older people are more healthy and active as a cohort than ever before and as such are also more mobile (Tomassini, 2004).

Increasing hypermobile society, where services, shops, work and families are increasingly dispersed

Increasingly reliant on the car

Growth in % licence holders over 70 years

1995/97 1998/00 2002 2005 2010 2011 20120

500

1000

1500

2000

2500

3000

3500

4000

4500

Miles driven GB

60-69 70+ All ages

Mile

s driv

en/p

erso

n/ye

ar G

B

+77%

+37%

-8%

1975/76

1985/86

1989/91

1992/94

1995/97

1998/00

20022003

20042005

20062007

20082009

20102011

2012-

10

20

30

40

50

60

70

80

90

% of GB licence holders over 70

femalemale

W-H

• Especially by car

Source: Musselwhite, C. and Haddad, H. (2010). Mobility, accessibility and quality of later life. Quality in Ageing and Older Adults. 11(1), 25-37.

PRIMARY MOBILITY NEEDSPractical/utilitarian Needs

e.g. get from A to B as safely, reliably, cheaply and comfortably as possible.

SECONDARY MOBILITY NEEDSSocial/affective Needs

e.g. The need for independence, control, to be seen as normal.Linked to status, roles, identity, self-esteem. Impression management

On giving-up driving this level of needs is adversely affectedIsolation, no longer part of society, no longer feel normal

TERTIARY MOBILITY NEEDSAesthetic Needs

e.g. The need for the journey itself for relaxation, visit nature, use and test cognitive skills

A reduction in mobility can result in an increase in isolation, loneliness and depression and an overall a poorer quality of life.

On giving-up driving this level of needs is adversely affectedNot so easy to ask for discretionary travel

On giving-up driving – this level of need is usually met friends accessible transport public transport teleshopping?

“Well Dorothy and David from number 3 take me shopping every week, we all go, we have a bit of a time of it you know, it’s a kind of outing. I never expected that. ” (Female, gave-up driving at 80)

“It’s hard to explain I suppose. You just don’t seem like you belong. I suppose yes there are feelings that you might be ready for the scrapheap now. The first step to it, you know”(Male, given-up driving at 76)

“You can’t ask other people to take you out for “a drive”. They’d think you’d lost their senses. Anyway they have got better things to be doing with their time, then ferrying me about just for the sake, like”(female, gave-up driving at 80)

Traditional Categorisation of Trip Purposes

10/

“Essential”

Tourist“Discretionary”

U T

I L

I T Y

Travel for Utility• Time wasted: to be

minimised• Distance to be overcome• Destination-focussed• Routine• Often Essential, Productive

Not

‘T

rans

port’

Travel for Tourism• Novel• Enriching• Less destination focussed

Eco

nom

ic

Pri

orit

y

Economic

Priority

Prolong safe driving?

To consider...• Therefore in general terms, the more complex road environments are, the higher the accident

involvement for older drivers.• ‘Self-explaining’ roads which include perceptual cues are needed e.g.

• “This is a ‘quick win’ area, in which many of the benefits are likely to extend beyond older drivers to the rest of the driving population”. (Box et al., 2011)

• To help older people stay driving later on in their life, should we design an infrastructure to help them be safe? – Would it be a safer environment for everyone?

12

Change the infrastructureSelf-explaining roads

Dashboard sign display (with user prioritisation)

Head-up sign display (with user prioritisation)

Head-up display of current vehicle speedAudible speed cue (driving speed)Audible warning when reach actual speed limitIntelligent Speed Adaptation

GLARE AND LUMINANCE

Night vision enhancementHead-up displayDashboard display

EXTERNAL DISTRACTIONS

MAINTAINING A CONSTANT SPEED

Change the vehicleIncrease the automation?

Musselwhite, C. and Haddad, H. (2008). Prolonging safe driving through technology. Final Report. UWE research report

Change the law: Restrict driving

Re-take driving testStricter medical test

No to extra testsOther than for prompting

Self-regulation?Works well, but the future with working later? More car centric society?

Retest elderly drivers to

make sure they are still

safe behind the wheel, new

report urges

Number of older car users

set to surge, report says

Elderly drivers should be

banned from motorways,

says road safety charity

Grabowski et al (2004)

USA – Vision tests, road tests, more frequent licence renewals, in person renewals no difference

Langford et al (2008) Victoria (no age controls) and New South Wales (medical assessment 80+ and on road test 85+)

No sig diffs for older or other road users

Mitchell (2008) Across Europe lowest fatality rates for this age group occur in two of the countries (UK and the Netherlands) with more relaxed procedures

Siren and Meng (2012)

introduction of age-based cognitive screening starting from the age of 70 in Denmark in May 2006, in a population-based study.

Whilst collision rates for car drivers did not significantly change across any age group. the collision rate for older vulnerable road users in the post-implementation period increased significantly: by 38%.

Langford et al., (2004).

In Sydney (where there is mandatory assessment from 80 years onwards) and Melbourne (in which there are no age-based controls)

older drivers in Sydney (with age-based controls) had higher collision risks per licence and per times spent driving than those in Melbourne (who had no controls).

Change the driverEducation:

Improves self-awarenessTraining, educationFeedback from others, the environment,

cars

But how aware are you in wider social context?Who would want to be educated?Who would bear the cost?Who would attend?Age discrimination?

How to improve self-awarenessCognitive testsOn-road testsClassroom/group workRole of ADIsPhysiological test?Cognitive testsOn-road tests

Do the courses work?Evidence?How would the evidence look?

CourseMust allow self-reflectionMust allow chance for failMust encourage strategies to adopt to help self-regulationMust provide help with alternatives

Involve Forum of Mobility Centres

Look for champions and leadersAA Drive TechWessex DriveAbility

 

Musselwhite, C.B.A. (2010). The role of education and training in helping older people to travel after the cessation of driving  International Journal of Education and Ageing 1(2) , 197-212Musselwhite, C. (2011) Successfully giving up driving for older people. Discussion Paper. International Longevity Centre - UK. 

Leaving the vehicle behind

MultimodalRe-engage in immediate

locale

Literal Potential Virtual Imaginative

Successful at giving-up driving

Plan in advance

Trial and error

Support of family and friends

“I’ve re-discovered my local area. Which is great. I forgot what the village has to offer. In fact I think it is better than a few years ago. But not using the car has forced me to use more local things.” (female, aged 75)

“The bus out is a real bit of fun. I go on it with friends... and we have a day out” (female, aged 70)

Musselwhite, C.B.A. and Shergold, I. (2013). Examining the process of driving cessation in later life. European Journal of Ageing. 10(2), 89-100

Help with giving-up driving

• Bus use• Unprecedented cuts in services• Growth of community transport

Issues:-• Must communicate the benefits of

free bus pass– Wider economic and social benefits

to individuals and society– Need to map return on investment

• Quality of service• For aesthetic purposes – just getting

out and about

Improving bus use

Formal information

Alternative transport provided locally

Timetable of buses

Location of bus stops

Walking area

Real time information

Informal information

Does the bus leave when it says it does?

Ease of carrying shopping/luggage on a bus?Ease of getting a seat on a bus?

State of the pavements for walking?

Provision of benches, formalised crossing areas, toilets etc.Feeling of safety using transport/walking?

Attitude of bus driver

Musselwhite, C.B.A. (2010). The role of education and training in helping older people to travel after the cessation of driving  International Journal of Education and Ageing 1(2) , 197-212

It is estimated there are around 300,000 mobility-scooter users in the UK(DfT, 2010c). Very positively received by users as they help maintain freedom and independence (e.g Barham et al., 2006; DfT, 2010c; Steyn and Chan, 2008).

Issues:-Who uses them?Insurance and safety?But do they replace walking and effect health?Thoreux (2011) perform worse than non-users.

The role of mobility scooters

DfT Minimum crossing speed 1.22m/s (88% not walking fast enough!)

Walking

TERTIARY TRAVEL NEEDSAesthetic Needs

Pleasantness/desirability of neighbourhood open spaces (trees,

plants, waterscapes)SECONDARY TRAVEL NEEDS

Social NeedsA place to make a statement and interact e.g. suitable spaces to socialize. Inter-generational

community important

PRIMARY TRAVEL NEEDSPractical Needs

Large, open, un-crowded, low level of noise. Lack of nuisance.

Well maintained paths for movement. Facilities and amenities.

Only 11% walk as fast or faster than DfT recommendations for pedestrian crossing timeOnly 6% of femalesFaster if higher socio-economic background, healthy and confidentAgrees with previous research (Asher et al., 2012, Newton and Omerod, 2007). fear of not being quick enough to cross the road is known to restrict people leaving the home or limit their accessibility when out and about (IDGO 2013; Lord et al., 2010; Zijlstra, 2007).

Make streets attractive

Musselwhite, C.B.A. (2014). Environment-person interactions enabling walking in later life Proceedings of the 46th Annual UTSG Conference, Transport Operations Research Group, Newcastle University, 6th January

Conclusion

• Transport is more than just A to B

• Provision beyond the car must reflect diverse patterns of travel and individual need.

• How to help break the giving-up driving = poorer health and wellbeing correlation

• Integration: within travel training, within provision and services.

• Multimodality from a young age.

• Increasing need to prove mobility is important (and the wider economic and social benefits).

• Future: – Novel solutions. ITN America. – Re-inventing existing solutions: Taxis/cycling– Milton Keynes Pods– Nature of working later? Health and fitness of society? Falling out of love with the car? Will we even have

cars? – Role of Virtual mobility?

Professor Catharine Ward-Thompson

DirectorOPENspace Research Centre

University of Edinburgh

This event is kindly supported by Age UK

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Getting Out and About:where are we now and

where do we want to be?Catharine Ward Thompson

Professor of Landscape Architecture Director of OPENspace Research Centre

The research centre for inclusive access to outdoor environments

Inclusive Design for Getting Outdoors - Creating Age-friendly Outdoor Environments

Mobility, Mood and Place (MMP) explores how places can be designed collaboratively to make mobility easy, enjoyable and meaningful for older people.

Evidence: What we know

Evidence: What we know• The pedestrian experience is vitally important to older people,

who are most often on foot when out and about. • Poor quality environments are seen as increasing falls risks and

can exacerbate the challenges of socio-economic deprivation and social isolation

• A supportive environment – one that makes it easy and enjoyable to get outdoors – is associated with a range of physical, mental and social well being outcomes

• Living within 10 minutes’ walk of a pleasant local park, and having easy and enjoyable routes to get there, makes a big difference to likely levels of walking and satisfaction with life

• People living in care homes are very much less likely to get outdoors than those living in their own homes

• Physical exercise has a more beneficial effect on older people in delaying brain shrinkage than ‘mental exercise’

• Older people’s wellbeing is enhanced by having an accessible outdoor space and a green view.

Gaps in research and policy

Gaps in research and policy• What level of environmental quality in the residential street,

park or local neighbourhood is sufficient – good enough to support health and quality of life for older people?

• Can environmental improvements alone be demonstrated to increase levels of outdoor activity in older people? If so, what kind?

• Does outdoor activity per se reduce social isolation as well as enhance physical and mental health?

• What are the positive qualities/assets that encourage people to go out, remain active, and give them pleasure into very old age?

• What levels and types of public lighting might make a difference to older people’s outdoor access at night? Is this a sensible strategy to pursue or a waste of investment?

• What is a minimum acceptable standard of residential open space provision to ensure opportunities for wellbeing are maximized into very old age?

Image courtesy of Sustrans

Five things that might fix some of these issues

Image courtesy of Sustrans

Five things that might fix some of these issues1 Rationalise the planning system so that non-mandatory features

such as open space/green space don’t ‘slip through the cracks’ and get lost. An appropriate minimum standard of access to green space might be based on the Accessible Natural Greenspace Standard (ANGSt)

2 Recognising the physical and mental health benefits of access to green space, place a mandatory requirement for residents in care homes to have access to gardens and assistance to enjoy them.

3 Recognising the health benefits of access to green space, place spending on green space under the umbrella of health and so ringfence it. It requires a commitment to recurrent spend.

4 Place a mandatory requirement on private developers to provide suitable green space in housing developments on-site.

5 Create a set of national standards for road crossings incorporating types, siting, and maintenance with a mandatory requirement on local authorities to adhere to such standards.

Sophie Handler

Research and Planning OfficerAge-Friendly Manchester

Chair RIBA working group on Ageing

This event is kindly supported by Age UK

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Getting Out and About in older age

What do we know?

1. the ‘amplification of impact’the disproportionately disabling impact of obstructive, urban

environments on older people

2. ‘alienation’ from urban surroundings > cities structured to meet needs of a working age demographic> the vital but often neglected role of older people in planning and

design processes> the less visible impact of urban environments on people’s

identity, sense of self and belonging in older age

3. the inherent value of public spaces the value of spaces that can be used, shared and appropriated

(even in older age)

What are the gaps in research and policy that we need to fill?

1. Scale and sustainability developing sustainable policies that connect city-wide

programmes to the fine grain of community-led initiatives – in ways that support older people in getting out and about over the long-term

2. Developing policies that think beyond the physical what kinds of programmes, policies and initiatives might be

developed together with older people to support and encourage older people to feel more confident in getting out and about?

3. Alternative forms of urban design practicewhat can we learn from creative, relational forms of design

practicein encouraging older people to ‘lay claim’ to their urban

surroundings?

If you were a minister, what are the five things you would do fix some of these issues?

1. Encourage original urban researchwork with funding councils to support innovative and creative inter-

disciplinary practice-led research and collaborations

2. Champion best practice promote and disseminate best practice on creating age-inclusive spaces

– to inform and animate public debate

3. Support Local Authoritiessupport programmes and initiatives that share learning between cities

across the UK (develop a learning infrastructure and resource for local authorities across the UK)

4. Engage Professional Bodieswork with professional bodies to build an ageing lense into professional standards and practice

5. Promote integrated Age-Friendly Cities approach sponsor programme development of Age-Friendly Cities and

Communities (based on the integrated WHO approach)

Dr C.G.B. "Kit“ Mitchell

Co-chairTransportation Research Board's

Committee on Accessible Transportation and Mobility

This event is kindly supported by Age UK

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Mobility – what we know

• As we age, we make fewer journeys;

•

• The reduction is almost wholly due to

fewer car driver journeys;

• Older people are more than average likely to live in low density areas;

•

• By age 80, about 10% of male and 20% of female drivers will have surrendered their licence.

Trips per year for men and women in Great Britain 2011-12

Men WomenCar driver

Car passenger

Other Walk

Bus

-

200

400

600

800

1,000

1,200

40-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Jour

neys

per

yea

r .

Age group

40-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+0

200

400

600

800

1,000

1,200

10 100 1,000 10,0000

5

10

15

20

25

30

35

40

PERCENTAGE POPULATION RETIRED GREAT BRITAIN 2008

Population density people per sq.km.

Pe

rce

nta

ge

of

retir

em

en

t a

ge

.

50 55 60 65 70 75 80 85 900

5

10

15

20

25

30

35

40

PERCENTAGE OF CAR DRIVERS WHOSE LICENCE HAS LAPSED

Men

Polynomial ( Men)

Women

Age

Re

du

ctio

n in

lice

nce

ho

ldin

g f

rom

.

pe

ak

for

coh

ort

.

Mobility – what we do not know

• What we can do to help older women continue to drive safely and without stress, at least locally;

•

• How to encourage older people to settle in areas where they will not be wholly car dependent;

Mobility – suggestions for Minister

• Require drivers over 70 to submit an optician’s certificate with licence renewal;

•

• Encourage and support local authority schemes for older driver voluntary checks;

• Study the US guidelines for highway design for older drivers, to introduce appropriate sections here.

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 - 79

80+0

200

400

600

800

1,000

1,200

1,400WOMEN

21-29

30-39

40-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+0

100200300400500600700800900

1000

CAR DRIVER JOURNEYS PER LICENSED DRIVER 2011-12

Men

Women

Age group

Ca

r d

rive

r jo

urn

eys

pe

r d

rive

r

. p

er

yea

r .

21-29

30-39

40-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+0

2

4

6

8

10

12LENGTH OFCAR DRIVER JOURNEYS 2011-12

Men

Women

Age group

Le

ng

th o

f ca

r d

rive

r jo

urn

eys

, m

iles

.

Community Matters – are our communities ready for ageing?

Seminar 1: ‘Getting out and about’

Tuesday 11th March

This event is kindly supported by Age UK

#communitymatters