This literature review focuses on human factors issues affecting the safe use of cutaway buses (i.e., a bus body carried by a van or truck chassis) by older adults. Cutaway buses are often used as shuttles for assisted living facilities, in demand–response and paratransit services such as dial-a-ride, and in mainstream public transportation and shuttle systems. Because of the scarcity of data gathered specifically on the subject of U.S. cutaway buses, this review uses international statistics on paratransit, demand–response, special transportation services, and dial-a-ride services as substitutes, because these are the areas of public transportation that most frequently use such vehicles. The first section of the report takes a user-centered approach in reviewing some factors related to older adults' driving cessation and how public transportation systems using cutaway buses help make this life change easier. Also reviewed are the age-related physiological changes that decrease the ability of older adult passengers to withstand a motor vehicle crash and that limit the mobility of older adults in boarding or alighting the bus and navigating the cabin. The second section reviews bus crash statistics to understand what types of injuries and outcomes are associated with older passengers in different types of motor vehicle crashes. Finally, areas of concern and possible solutions to improve the safety of older adults using cutaway buses are presented.
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References
1.
United Nations, Department of Economic and Social Affairs, Population Division.World Population Prospects: The 2010 Revision.New York, 2011.
2.
StuttsJ. C., StewartJ. R., and MartellC.Cognitive Test Performance and Crash Risk in an Older Driver Population. Accident Analysis and Prevention, Vol. 30, 1998, pp. 337–346.
3.
AlbertssonP., and FalkmerT.Is There a Pattern in European Bus and Coach Incidents? A Literature Analysis with Special Focus on Injury Causation and Injury Mechanisms. Accident Analysis and Prevention, Vol. 37, 2005, pp. 225–233.
AustinR. A., and FaiginB. M.Effect of Vehicle and Crash Factors on Older Occupants. Journal of Safety Research, Vol. 34, 2003, pp. 441–452.
6.
DiamantopoulouK., SkalovaM., DyteD., and CameronM.Crash Risks of Road User Groups in Victoria. Report 88. Monash University Accident Research Centre, Melbourne, Victoria, Australia, 1996.
7.
FildesB. N., FitzharrisM., CharltonJ., and PronkN.Older Driver Safety: A Challenge for Sweden's “Vision Zero.”Proc., Australian Transport Research Forum (CD-ROM), Hobart, Tasmania, Australia, 2001.
8.
O'NeillD., and CarrD.Transport, Ageing, and Driving. In Principles and Practice of Geriatric Medicine (PathyM. S. J., SinclairA. J., and MorleyJ. E., eds.), John Wiley and Sons, Inc., London, 2006, pp. 141–149.
9.
MarottolliR., OstfeldA., MerrillS., PerlmanG., FoleyD., and CooneyL.Driving Cessation and Changes in Mileage Driven Among Elderly Individuals. Journal of Gerontology, Vol. 48, No. 5, 1993, pp. 225–260.
10.
PerssonD.The Elderly Driver: Deciding When to Stop. The Gerontologist, Vol. 33, No. 1, 1993, pp. 88–91.
11.
WretstrandA., PetzällJ., and StåhlA.The Safety of Passengers in Wheelchairs in Special Transportation Services Studied with Interviews and Assessments. Technology and Disability, Vol. 15, 2003, pp. 259–269.
12.
CoughlinJ.Aging-in-No-Place: An Examination of Senior Housing and Transportation Accessibility in Metropolitan Boston. Working Paper 2006-4. Massachusetts Institute of Technology New England University Transportation Center and AgeLab, Cambridge, Mass., 2006.
13.
MacKenzieI.The Evolution of “Specialised Schemes” and Their Contribution Towards the Provision of Needs Based Integrated Accessible Passenger Transport Services. Proc., 21st Summer Annual Meeting of PTRC Transport, Highways and Planning, London, 1993.
HendricksonC. C., and MannW. C.Changes over Time in Community Mobility of Elders with Disabilities. Physical and Occupational Therapy in Geriatrics, Vol. 23, 2005, pp. 75–89.
SchmöckerJ.-D., QuddusM. A., NolandR. B., and BellM. G. H.Mode Choice of Older and Disabled People: A Case Study of Shopping Trips in London. Journal of Transport Geography, Vol. 16, 2008, pp. 257–267.
19.
GoodwillJ. A., and CarapellaH.Creative Ways to Manage Paratransit Costs.National Center for Transit Research, University of South Florida, Tampa, 2008. http://www.nctr.usf.edu/pdf/77606.pdf. Accessed June 16, 2014.
20.
RosenbloomS., and StåhlA.Automobility and the Elderly: The Convergence of Environmental, Safety, Mobility, and Community Design Issues. European Journal of Transportation and Infrastructure Research, Vol. 2, 2002, pp. 197–213.
21.
MulleyC., NelsonJ., TealR., WrightS., and DanielsR.Barriers to Implementing Flexible Transportation Services: An International Comparison of the Experiences in Australia, Europe, and USA. Research in Transportation Business and Management, Vol. 3, 2012, pp. 3–11.
WretstrandA., BylundP.-O., PetzällJ., and FalkmerT.Injuries in Special Transport Services—Situations and Risk Levels Involving Wheelchair Users. Medical Engineering and Physics, Vol. 32, 2010, pp. 248–253.
24.
DensonC. R.Public Sector Transportation for People with Disabilities: A Satisfaction Survey. Journal of Rehabilitation, Vol. 66, 2000, pp. 29–37.
25.
ChavassieuxP., SeemanE., and DelmasP. D.Insights into Material and Structural Basis of Bone Fragility from Diseases Associated with Fractures: How Determinants of the Biomechanical Properties of Bone Are Compromised by Disease. Endocrine Reviews, Vol. 28, No. 2, 2007, pp. 151–164.
26.
KemperA. R., McNallyC., KennedyE. A., ManoogianS. J., RathA. L., NgT. P., StitzelJ. D., SimitE. P., DumaS. M., and MatsuokaF.Material Properties of Human Rib Cortical Bone from Dynamic Tension Coupon Testing. Stapp Car Crash Journal, Vol. 49, 2005, pp. 199–230.
27.
GayzikF., YuM., DanelsonK., SliceD., and StitzelJ.Quantification of Age-Related Shape Change of the Human Rib Cage Through Geometric Morphometrics. Journal of Biomechanics, Vol. 41, 2008, pp. 1545–1554.
28.
LauA., OyenM., KentR., MurakamiD., and TorigakiT.Indentation Stiffness of Aging Human Costal Cartilage. Acta Biomaterialia, Vol. 4, 2008, pp. 97–103.
29.
HannanM. T., FelsonD. T., Dawson-HughesB., TuckerK. L., CupplesL. A., WilsonP. W. F., and KielD. P.Risk Factors for Longitudinal Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study. Journal of Bone and Mineral Research, Vol. 15, No. 4, 2000, pp. 710–720.
30.
RidellaS. A., RuppJ. D., and PolandK.Age-Related Differences in AIS 3+ Crash Injury Risk, Types, Causation, and Mechanisms.Proc., 2012 Conference of the International Research Council on the Biomechanics of Industry, Dublin, Ireland, 2012.
31.
AugensteinJ.Differences in Clinical Response Between the Young and the Elderly.Proc., Aging and Driving Symposium, Association for the Advancement of Automotive Medicine, Des Plaines, Ill., 2001.
32.
PadmanabanJ.Crash Injury Experience of Elderly Drivers.Proc., Ageing and Driving Symposium, Association for the Advancement of Automotive Medicine, Southfield, Mich. 2001.
33.
Foret-BrunoJ. Y.Correlation Between Thoracic Lesions and Force Values Measured at the Shoulder of 92 Belted Occupants Involved in Real Accidents.Proc., 22nd STAPP Car Crash Conference, Ann Arbor, Mich., 1978, pp. 271–292.
34.
Foret-BrunoJ. Y., Brun-CassanF., BrigoutC., and TarriereC.Thoracic Deflection of Hybrid III Dummy Response for Simulations of Real Accidents.Proc., 12th Experimental Safety Vehicles Conference, Gothenburg, Sweden, 1989, pp. 650–660.
35.
DejammesM., and RametM.Aging Process and Safety Enhancements of Car Occupants.Proc., 15th Conference on “Enhanced Safety in Vehicles,” Melbourne, Victoria, Australia, 1996.
36.
CunninghamC., HowardD., WalshJ., CoakleyD., and O'NeillD.The Effects of Age on Accident Severity and Outcome in Irish Road Traffic Accident Patients. Irish Medical Journal, Vol. 94, 2001, pp. 169–171.
37.
MorrisA., WelshR., FramptonR., CharltonJ., and FildesB.Vehicle Crashworthiness and the Older Motorist. Ageing and Society, Vol. 23, 2003, pp. 395–409.
38.
GuralnikJ. M., LaCroixA. Z., AbbottR. D., BerkmanL. F., SatterfieldS., EvansD. A., and WallaceR. B.Maintaining Mobility in Late Life: Demographic Characteristics and Chronic Conditions. American Journal of Epidemiology, Vol. 137, No. 8, 1993, pp. 845–857.
39.
JetteA. M., BranchL. G., and BerlinJ.Musculoskeletal Impairments and Physical Disablement Among the Aged. Journal of Gerontology, Vol. 45, 1990, pp. 5203–5208.
40.
StrawbridgeW. J., KaplanG. A., CamachoT., and CohenR. D.The Dynamics of Disability and Functional Change in an Elderly Cohort: Results from the Alameda County Study. Journal of the American Geriatric Society, Vol. 40, 1992, pp. 799–806.
41.
DaleyM. J., and SpinksW. L.Exercise, Mobility, and Aging. Sports Medicine, Vol. 29, 2000, pp. 1–12.
42.
CohenJ. J., SveenJ. D., WalkerJ. M., and Brummel-SmithK.Establishing Criteria for Community Ambulation. Topics in Geriatric Rehabilitation, Vol. 3, No. 1, 1987, pp. 71–77.
43.
Lerner-FrankielM. B., VargasS., BrownM. B., KrusellL., and SchonebergerW.Functional Community Ambulation: What Are Your Criteria?Clinical Management in Physical Therapy, Vol. 6, No. 2, 1986, pp. 12–15.
44.
MitchellC. G. B., and Ling SuenS.Urban Travel, Intelligent Transportation Systems, and the Safety of Elderly and Disabled Travelers. Journal of Urban Technology, Vol. 5, No. 1, 1998, pp. 17–43.
45.
MitchellC. G. B.Features on Buses to Assist Passengers with Mobility Handicaps. TRRL Research Report 137, Transport and Road Research Laboratory, 1988.
46.
BlowerD., and GreenP. E.Type of Motor Carrier and Driver History in Fatal Bus Crashes. In Transportation Research Record: Journal of the Transportation Research Board, No. 2194, Transportation Research Board of the National Academies, Washington, D.C., 2010, pp. 37–43.
47.
Enhanced Coach and Bus Occupant Safety.Task 1.1. Report (Annex).Technical University Graz, Austria, 2001.
48.
Leyland Vehicles Ltd.Passenger Problems on Moving Buses. Transport and Road Research Laboratory Supplementary Report 520. Department of Environment, Department of Transport, Crowthorne, United Kingdom, 1990.
49.
WretstrandA., PetzällJ., BylundP.-O., and FalkmerT.Reducing Non-Collision Injuries in Special Transportation Services by Enhanced Safety Culture. Medical Engineering and Physics, Vol. 32, 2010, pp. 254–262.
50.
BylundP.-O., WretstrandA., FalkmerT., LövgrenA., and PetzällJ.Injuries in Special Transportation Services for Elderly and Disabled—A Multi-Methodology Approach to Estimate Incidence and Social Costs. Traffic Injury Prevention, Vol. 8, 2007, pp. 180–188.
51.
BjörnstigU., AlbertssonP., BjörnstigJ., BylundP.-O., FalkmerT., and PetzällJ.Injury Events Among Bus and Coach Occupants—Non-Crash Injuries as Important as Crash Injuries. IATSS Research, Vol. 29, 2004, pp. 79–87.
52.
KirkA., GrantR., and BirdR.Bus and Coach Passenger Casualties in Non–Collision Incidents. Proc., Traffic Safety on Three Continents Conference, Moscow, Russia, 2001.
53.
MollenkopfH., MarcelliniF., RuoppilaI., FlaschenträgerP., GagliardiC., and SpazzafumoL.Outdoor Mobility and Social Relationships of Elderly People. Archives of Gerontology and Geriatrics, Vol. 24, 1997, pp. 295–310.
54.
MorlokE., NitzbergB., and LaiL.Boarding and Alighting Injury Experience with Different Station Platform and Car Entranceway Designs on U.S. Commuter Railroads. Accident Analysis and Prevention, Vol. 36, 2004, pp. 261–271.
55.
HudenskiR.Public Transport Passenger Accidents: An Analysis of the Structural and Functional Characteristics of Passenger and Vehicle. Accident Analysis and Prevention, Vol. 24, 1992, pp. 133–142.
56.
CampbellA. J., and RobertsonM. C.Implementation of Multifactorial Interventions for Fall and Fracture Prevention. Age and Ageing, Vol. 35, No. 2, 2006, pp. ii60–ii64.
57.
SeemanE.The Structural and Biomechanical Basis of the Gain and Loss of Bone Strength in Women and Men. Endocrinology and Metabolism Clinics of North America, Vol. 32, No. 1, 2003, pp. 25–38.
58.
BergenG., ChenL. H., WarnerM., and FingerhutL. A.Injury in the United States: 2007 Chartbook.National Center for Health Statistics, Hyattsville, Md., 2008.
59.
AugentsteinJ., PerdekE., StrattonJ., DiggesK., and BahouthG.Characteristics of Crashes That Increase the Risk of Serious Injuries.Proc., 47th Annual Association for the Advancement of Automotive Medicine Conference, Barrington, Ill., 2003, pp. 561–576.
60.
NewgardC. D.Defining the “Older” Crash Victim: The Relationship Between Age and Serious Injury in Motor Vehicle Crashes. Accident Analysis and Prevention, Vol. 40, 2008, pp. 1498–1505.
61.
EvansL.Traffic Safety and the Driver.Van Nostrand Reinhold, New York, 1991.
62.
MackayG. M.Biomechanics and the Regulation of Vehicle Crash Performance.Proc., 33rd Annual Association for the Advancement of Automotive Medicine Conference. Baltimore, Md., Oct. 1989, pp. 323–336.
63.
VianoD., CulverC. C., EvansL., FrickM., and ScottR.Involvement of Older Drivers in Multi-Vehicle Side Impact Crashes.Proc., 33rd Annual Association for the Advancement of Automotive Medicine Conference, Baltimore, Md., Oct. 1989, pp. 337–352.
64.
LaituriT. R., PrasadP., SullivanK., FranksteinM., and ThomasR. S.Derivation and Evaluation of a Provisional, Age-Dependent, AIS3+ Thoracic Risk Curve for Belted Adults in Frontal Impacts. SAE Technical Paper 2005-01-0297, 2005. DOI: 10.4271/2005-01-0297.
65.
ZhouQ., RouhanaS. W., and MelvinJ. W.Age Effects on Thoracic Injury Tolerance.Proc., 40th Stapp Car Crash Conference. SAE Technical Paper 962421, 1996. DOI: 10.4271/962421.
66.
MorrisA., and WelshR.Requirements for Crash Protection of Older Vehicle Passengers.Proc., 47th Annual Association for the Advancement of Automotive Medicine. Barrington, Ill., 2003, pp. 165–180.
67.
KentR. W., LeeS.-H., DarvishK., WangS., PosterC. S., LangeA. W., BredeC., LangeD., and MatsuokaF.Structural and Material Changes in the Aging Thorax and Their Role in Crash Protection for Older Occupants. Stapp Car Crash Journal, Vol. 49, 2005, pp. 231–249.
68.
LaituriT. R., HenryS., SullivanK., and PrasadP.Derivation and Theoretical Assessment of a Set of Biomechanics-Based Risk Equations for the Knee–Thigh–Hip Complex. Stapp Car Crash Journal, Vol. 50, 2006, pp. 97–130.
69.
MoranS. G., McGwinG., MetzgerJ. S., AlonsoJ. E., and RueL. W.Relationship Between Age and Lower Extremity Fractures in Frontal Motor Vehicle Collisions. The Journal of Trauma—Injury, Infection, and Critical Care, Vol. 54, No. 2, 2003, pp. 261–265.
70.
RybG., DischingerP., KleinbergerM., BurchC., and HoS.Aging Is Not a Risk Factor for Femoral and Tibial Fractures in Motor Vehicle Crashes. Annals of Advances in Automotive Medicine/Annual Scientific Conference, Vol. 52, 2008, pp. 227–234.
71.
FlannaganC., and RuppJ.How to Best Use CIREN Data—University of Michigan Transportation Research Institute CIREN Team. Presented at the 2007 CIREN Public Meeting, Washington, D.C., 2007.
72.
EbyD. W., VivodaJ. M., and FordyceT. A.The Effects of Standard Enforcement on Michigan Safety Belt Use. Accident Analysis and Prevention, Vol. 34, 2002, pp. 815–823.
73.
SahaiV., PitbladoJ. R., BotaG., and RoweB. H.Factors Associated with Seatbelt Use: An Evaluation from the Ontario Health Survey. Canadian Journal of Public Health, Vol. 89, No. 5, 1998, pp. 320–324.
74.
BakerD. R., ClarkeS. R., and BrandtE. N.An Analysis of Factors Associated with Seatbelt Use: Prevention Opportunities for the Medical Community. Journal of the Oklahoma State Medical Association, Vol. 93, 2000, pp. 496–500.
75.
LernerE. B., JehleD. V. K., BillittierA. J., MoscatiR. M., ConneryC. M., and StillerG.The Influence of Demographic Factors on Seatbelt Use by Adults Injured in Motor Vehicle Crashes. Accident Analysis and Prevention, Vol. 33, No. 5, 2001, pp. 659–662.
76.
OkanoS., MitsuishiH., SukegawaY., and MatsukawaF.Research on Bus Passenger Safety in Frontal Impacts.Proc., 17th International Technical Conference on the Enhanced Safety of Vehicles, Amsterdam, Netherlands, 2001.
77.
GarrettJ. W., and BraunsteinP. W.The Seat Belt Syndrome. Journal of Trauma, Vol. 2, 1962, pp. 220–238.
78.
IntasG., and StergiannisP.Seat Belt Syndrome: A Global Issue. Health Science Journal, Vol. 4, No. 4, 2010, pp. 202–209.
79.
KihlbergJ. K., and RobinsonS.Seat Belt Use and Injury Patterns in Automobile Accidents. Publication VJ-1823-R30, Cornell Aeronautical Laboratory, Buffalo, N.Y., 1967.
80.
United Nations Economic Commission for Europe.Report of the IG/R.66 Meeting. GRSG-94-03. Madrid, Spain, April 21–24, 2008.
RasenackW., AppelH., RauH., and ReitzC.Belt Systems in Passenger Coaches.Proc., 15th International Technical Conference on the Enhanced Safety of Vehicles, Melbourne, Australia, 1996.
83.
CampbellB. J.The Automotive Crash Injury Research Program of Cornell University. Journal of Iowa State Medical Society, Vol. 51, 1961, pp. 760–762.
84.
AlbertssonP., and BjörnstigU.The Bus Crash in Granån, 26 November 2001: An In-Depth Study. (in Swedish) OAG Report No. 116. University Hospital, Umeå, Sweden, 2003.
85.
SulekJ. M., and LindM. R.Fail-Safe Methods for Paratransit Safety. Journal of Public Transportation, Vol. 8, No. 4, 2005, pp. 65–85.
86.
PaganoA. M., and McKnightC. E.Quality of Service in Special Service Paratransit: The User's Perspective. In Transportation Research Record 934, TRB, National Research Council, Washington, D.C., 1983, pp. 14–23.
87.
BrooksB. M., Ruffell-SmithH. P., and WardJ. S.An Investigation of Factors Affecting the Use of Buses by both Elderly and Ambulant Disabled Persons.British Leyland UK Ltd (Truck and Bus Division), Leyland, United Kingdom, 1974.
88.
SchmöckerJ.-D., QuddusM. A., NobleR. B., and BellM. G.Estimating Trip Generation of Elderly and Disabled People: Analysis of London Data. In Transportation Research Record: Journal of the Transportation Research Board, No. 1924, Transportation Research Board of the National Academies, Washington, D.C., 2005, pp. 9–18.
89.
GlassbrennerD., and StarnesM.Lives Saved Calculations for Seatbelts and Frontal Air Bags. DOT HS 811 206. NHTSA, U.S. Department of Transportation, 2009.
90.
BertocciG., DiggesK., and HobsonD.Shoulder Belt Anchor Location Influences on Wheelchair Occupant Crash Protection. Journal of Rehabilitation Research and Development, Vol. 33, No. 3, 1996, pp. 279–289.
