The efficacy of training to improve road safety in elderly pedestrians: A systematic review

Elderly pedestrians are involved in disproportionately more vehicle–pedestrian crashes than younger age groups. Training programs have been found to be effective in training children in pedestrian behaviours that improve their safety, however there is no consensus on whether older adults benefit from training. This systematic review aimed to identify whether training is effective for older adult pedestrians through analysis of training type, modalities, and the lasting effects of training. A systematic search of Medline, PsycINFO, and Scopus was conducted in March 2022 and updated in September 2023. Eight studies met the criteria all of which were high quality. Four distinct training types were found: physical (e.g., training physical strength or balance), behavioural (e.g., training specific pedestrian safety behaviours), cognitive (e.g., training reaction time and executive functioning), and educational (training knowledge about pedestrian safety behaviours). Physical training types were found to be most effective, followed by behavioural, cognitive, and educational respectively. Twelve pedestrian behaviours were measured across the eight studies. Reaction time was the most effectively trained outcome, followed by missed crossing opportunities. Errors of stimuli, median accepted time gap, initiation time and crossing were not effectively trained. The effects of training were maintained at follow-up for missed crossing opportunities only. There was preliminary evidence of potential efficacy of training for specific pedestrian safety behaviours, however, the long-term efficacy of training was not promising. Theory-driven research is needed to better understand why some behaviours are more trainable than others. More research is also needed to determine the real-world generalisability if training is to be recommended for older adult pedestrians.