Many Seniors Rely on Public Transportation to Drive Healthcare Access

More than 3 million seniors in the United States reported recently using public transportation, with over 600,000 turning to these services for healthcare access, according to a new study led by University of Maryland School of Medicine (UMSOM) researchers.

Attending healthcare appointments and participating in social activities are essential elements of healthy aging, but involvement is often limited by a lack of transportation, researchers stated.

Access to transportation is a top social determinant of health. Past studies have shown that transportation barriers are one of the leading causes of missed appointments for seniors. Public transportation may bridge these gaps and drive health equity for the senior population.

To conduct the study, researchers analyzed data about over 5,600 seniors from the National Aging and Trends Study, a nationally representative survey of Medicare beneficiaries aged 65 and older.

Nearly 1 in 10 seniors who live in cities reported using public transportation, and 20 percent of those respondents said they relied on trains and buses to access their scheduled doctor appointments. 

Despite public transportation being a potential health equity driver, these faulty public infrastructures also cause concern as potential access barriers due to their broken-down infrastructure and accessibility issues.

Researchers found that many senior public transit users are left to weather extreme heat, flooding, or cold conditions for over 25 minutes as they wait. When severe weather impacts public transit, it can deepen existing health inequalities. Additionally, such factors could worsen chronic conditions like heart failure, kidney disease, or diabetes.

“While our data was collected before the Covid pandemic, we know the pandemic disrupted public transportation, which is still continuing due to financial strain, staffing shortages, and cutbacks to transit services across the county,” study senior author Jason Falvey, DPT, PhD, Assistant Professor of Physical and Rehabilitation Science at UMSOM, said in a press release. "We worry about the impact that this disruption is having on the nearly 700,000 older Americans who rely on subways and buses to get to their medical appointments.”

Surpassing weather challenges, accessibility posed the biggest barrier to public transit. Seniors who use wheelchairs were 65 percent less likely to use public transit than those who didn’t, likely because public transit does not make accommodations for such medical equipment.

The study findings also showed that older adults who lived in areas with cracked or broken sidewalks were far less likely to use public transit, which may amplify other known barriers to transit use, including malfunctioning elevators at underground or elevated train stations.

“Disruptions to public transportation may widen health care disparities for Black and Hispanic older adults who are more likely to rely on these services,” said Mark T. Gladwin, MD, vice president for Medical Affairs at the University of Maryland, Baltimore. "We have an imperative to invest in transportation infrastructure because it is a vital public health need for our most vulnerable populations in Baltimore and beyond.”

Addressing the infrastructure needs of the United States is a long-term endeavor that will require costly investments.

Currently, ridesharing services have risen in popularity in an effort to remove transportation as a barrier to care, especially for those who cannot access public transit.

Earlier this year, CVS Health partnered with Uber Health to provide transportation support to patients seeking access to medical care, work, or an educational program.

Additionally, in 2021, Lyft launched non-emergency medical transport arms, Lyft Pass for Healthcare. The program lets patients schedule their own rides, which is helpful when patients have medical needs they didn’t expect.

“Transportation, where we focus our day-to-day here at Lyft, is unto itself a social determinant of health, but it's also a conduit to others, it's all interrelated,” Buck Poropatich, the head of Lyft Healthcare, said during an Xtelligent Healthcare Media’s Social Determinants of Health Virtual Event, which was separate from the Lyft Pass for Healthcare announcement.

“And a lack of transportation is going to amplify things like food insecurity, social isolation, unemployment, et cetera,” he added. “So, transportation cannot be an afterthought; it has got to be a starting point for these conversations if you're going to think about holistically, solving or addressing some of these gaps and some of these needs.”