Towards a model for understanding the pedestrian behaviours of older adults with and without cognitive impairment: A systematic review

Older pedestrians are over-represented in crash statistics and those with cognitive impairment (CI) are potentially at greater risk. Prior research has focused on examining individual pedestrian behaviours, and to date there has been no mapping of the stages of behaviour that pedestrian engage in when crossing the road. This study had two aims; firstly to map the pedestrian behaviours of older adults and use this to develop a theoretical understanding of the stages of street crossing, and secondly to better understand the role that key demographic characteristics including age, sex and cognitive status have on the pattern of street crossing behaviours for older adults. Published studies available on PsycINFO, Medline, and Scopus up to April 2024 were included in the review. Studies included a measure of pedestrian behaviour and participants over the age of 60 years. Forty studies met the inclusion criteria, and they examined 11 different behaviours. These mapped on to three stages of street crossing: the approach, step off, and crossing. There was evidence that older adults, particularly females, are much more cautious at the approach stage than younger adults, however they are more unsafe during the step off and crossing stages. A small amount of evidence shows that older pedestrians with CI had poorer safety across all three stages than those without CI. Speaking a common language for the stages of street crossing is beneficial for identifying areas to target improvements. There are opportunities for targeted training and practical road designs to be implemented to improve older adult pedestrian safety. Further research to examine other predictors of pedestrian behaviours beyond demographic factors, such as, perceptual, cognitive, and physical predictors of safe road crossing would be beneficial.