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Safe System has been the dominant approach to road safety in Victoria for over fifteen years, guiding the development and implementation of policy. Limited attention has been paid to the development and application of Safe System in a public policy setting. The aims of this research were to describe the intentions of Safe System in Victoria, and analyse how well this aligns with models of successful public policy. Using a qualitative approach, semi-structured interviews were undertaken with Australian and international experts (n = 10). These experts represented a range of organisations and leadership levels that were either directly involved in the development or had a detailed understanding of the development of Safe System in Victoria. The interview results were analysed using a policy success model. The findings suggested that Safe System can provide a framework to address road safety in Victoria, however successful public policy needs to ensure that the development of policy addresses the identified problem and that the results are maintained for some time. Safe System meets some of these requirements, but principally lacks explanation for how its overarching approach is meant to be understood and utilised. Practically, road safety professionals need to clarify the purpose of the Safe System concept in order for it to be successfully integrated into public policy. Whilst Safe System requires additional clarification, it has garnered additional interest and debate in road safety and from this perspective has advanced public policy.

This study aimed to assess the feasibility of recruiting injured pedestrians from the emergency department of a major trauma centre, using an in-depth interview shortly post collision. Convenience sampling was used to prospectively recruit injured pedestrians from the Alfred Hospital Emergency and Trauma Centre. Of the 102 injured pedestrians, 39 met eligibility criteria and of these, 30 (77%) consented and completed the questionnaire. Over half of the collisions occurred at an intersection (57%), and of these the most common pre-impact vehicle manoeuvre was a vehicle turning into the street the pedestrian was crossing. In-depth interview during the early post-crash period was a feasible and effective method of collecting detailed data in an accessible sample. However, only 38% of patients met eligibility criteria. To enhance representativeness, supplementing interview data with police-reported crash data, recruiting from hospital wards and crash location assessment is recommended.

This study used the bus incident data in Victoria, Australia to establish the relationship between operational characteristics and the safety performance of bus operators. A series of count models were investigated to account for methodological challenges, including excess zeros and panel data structure. The empirical results highlighted the different effects operational characteristics had on the risk and prevalence of bus incidents. Operators of smaller size, providing non-route services and operating in regional areas had a lower risk of having any reported incidents compared with larger route operators and operators in areas of higher accessibility. In cases where at least one incident had been reported, incident frequency was higher for operators with higher fleet total travel distance, older fleets and better roadworthy performance (this factor being counterintuitive). Findings from this study provide safety regulators with evidence-driven opportunities to enhance bus safety, including improving incident reporting practices, the establishment of a comprehensive database for heavy vehicle operators, and specific efforts targeted at older fleets.

Objective: The objective of this study was to address the uptake of safer vehicles and in-vehicle technologies among older adults through a better understanding of extent and use of safer vehicles ...

Objective The choices cyclists make on which roads to travel on can have a significant impact on their safety. This paper aims to improve our understanding of the broad and subtle influences in route choice amongst cyclists, and describe the strengths and limitations of using naturalistic observational data for this purpose. Method Naturalistic cycling observational data (GPS and video footage) were accessed from a sample of 97 cyclists riding in their natural setting on urban roads in Melbourne, Australia. Using GIS software, GPS traces were utilised in combination with video footage to map and define routes taken by the participants over two weeks (or up to 6 h) of cycling. Results The findings showed that most cyclists travelled on two to three routes and that safety and the environment were important factors. The findings also revealed route variations within the same origin-destination pair, and found that subtle real-time traffic and operational conditions can may influence route choice, with the potential for cyclists to choose less safe routes. Conclusion These findings have implications for route planning strategies and technologies that may improve cyclists’ awareness of the importance of route choice, especially in terms of safety, and inform development of potential resources and technologies that can provide real-time information on specific routes.

Urban arterials and intersections account for a large proportion of high severity crashes in Australia and New Zealand, particularly involving vulnerable road users. Safety gains appear to be slower in these ‘mixed use’ environments than in other areas. Austroads commissioned research to help identify solutions that might be applied on mixed use arterial roads to improve safety through the provision of Safe System infrastructure. The project involved assessment of six case studies around Australia and New Zealand. Concept designs were developed for each of the routes based on analysis of safety issues and the likely safety benefits were assessed. This paper presents information on the safety solutions identified, as well as the broader issues that need to be considered when addressing safety on mixed use urban arterial roads.

Introduction The ability to drive longer and safely are crucial for many older adults. There is a growing evidence on self-regulatory practices amongst older drivers in developed countries, but limited studies are conducted in developing countries. This study aimed to explore self-regulatory practices amongst older Malaysian car drivers and motorcycle riders. Materials and methods A cross-sectional study was conducted amongst older adults aged 60 years and above residing in two states located in the west coast of Peninsular Malaysia using a self-administered questionnaire. Stepwise regressions were performed to identify for key factors associated with driving/riding self-regulation and crash involvement. Multilevel modelling was conducted to examine the clustering effect of respondents recruited from the two states. Results Six-hundred and thirty-seven respondents completed the questionnaire, with over three-quarters of them still driving/riding at the time of data collection. Physical fitness, behavioural and psychological changes experienced with advancing age were important motivators towards self-regulation. Motorcycle riders were found to be at a higher risk of crash involvement, and they were more prone to cease riding compared to car drivers. Conclusions Self-regulatory practices amongst older car drivers and motorcycle riders were found to be different. As such, there is a need to customise evidenced-based approaches to cater for specific age groups and road users, particularly in a developing country like Malaysia, where motorcycle is often considered as an affordable mode of transport and is largely involved in road traffic crashes.

This paper examines the effects of vehicular and operational characteristics on bus roadworthiness. The analysis was based on annual bus inspection data in Victoria, Australia, between 2014 and 2017, consisting of 17,630 inspections of 6,447 vehicles run by 252 operators. A multilevel modeling approach was employed to account for the hierarchical data structure where inspections are nested within vehicles and vehicles within operators. The results offered insights into the effects on bus roadworthiness of characteristics attributable to inspections, vehicles, and operators. The probability of failing an inspection was found to be positively associated with vehicle age and odometer reading. Vehicle make played an important role in roadworthiness outcome, with the performance of different makes varying significantly. Small operators carried the highest risk of failure and large operators the lowest, irrespective of the location of operation. The multilevel analysis revealed that 28.9% of the variation in inspection outcomes occurred across operators and 5.2% across vehicles, which verified the presence of the hierarchical structure. The findings from this study provide safety regulators with solid research evidence to formulate policies aimed at enhancing bus roadworthiness.

It is well established that accidental and non-accidental injuries/child abuse and neglect (CAN) are a major public health problem globally. Not only do they affect individuals, injuries affect families, the community, government and internationally as well. Injuries span throughout childhood and into adulthood. Purpose of this study is to identify what are the difficulties and challenges in identifying and reporting CAN cases at the emergency (ED) department in Malaysian hospitals. Thirty in-depth interviews were conducted at the ED in three major hospitals in the Klang Valley, Malaysia which consists of specialists, medical officers, nurses and medical assistants. The study found that there is a significant gap identified in medical professionals’ knowledge and skills related to understanding, identifying and detecting CAN, particularly among medical officers who are in charge of diagnosis and reports in the hospital. Those who had previous experience or encounters in dealing with CAN cases would have higher suspicion index compared to those who haven’t. Other medical professionals such as nurses and medical assistants although do not have the mandate to diagnose or report of CAN cases, needed to have the basic knowledge and awareness and play more active role in their respective settings.

Unrestrained and unhelmeted occupants are at increased risk of severe injury or death in the event of a crash, and there is evidence that children, particularly in low and middle income countries, have low restraint and helmet wearing rates. Roadside observations of occupants of passing vehicles (7247 cars, vans and taxis and 2897 motorcycles) in nearside lanes were made at seven selected road sites located around the Klang Valley (greater Kuala Lumpur) area representing a variety of demographic locations. The findings revealed an overall low rate of seat-belt wearing in vehicles (front seat drivers: 44.6%; front seat adult passengers: 33.8%; front seat child passengers: 11.8%; rear seat adult passengers: 5.2%; and, rear seat child passengers: 5.8%). For motorcyclists, the majority of adult riders and pillions wore helmets (93.4% and 85.8%, respectively), however a substantial proportion (40%) did not fasten their helmet properly. Of children observed on motorcycles, only 30.5% wore helmets. This study shows low seat-belt and helmet wearing rates, despite enactment of legislation that requires all vehicle passengers to be restrained and for all motorcyclists to wear helmets. This was particularly evident for children (front and rear seating positions) and rear seat adult passengers. It is suggested there is a general lack of awareness of safety and the benefits of restraint/helmet use, and lack of adequate and appropriate enforcement. The implications of the findings are discussed in terms of promoting restraint/helmets use, enforcement of legislation and implementation of technologies to increase appropriate restraint/helmet use.

Background: Emotional distress is becoming a great concern and is more common in both developed and developing countries. It is associated with several disease conditions. Objective: To determine the prevalence of self-perceived emotional distress and its relation to work-related musculoskeletal disorders (WRMSDs) in nurses. Methods: A self-administered questionnaire survey was carried out on 660 female nurses working in public hospitals in the Klang Valley, Malaysia. The validated Malay version of the standardized Nordic musculoskeletal questionnaire (M-SNMQ) was used to identify the annual prevalence of WRMSDs; perceived emotional distress was assessed using the validated Malay short version, depression, anxiety, and stress (M-DASS) instrument. In addition, socio-demographic and occupational profiles of the participants were considered. Factors associated with WRMSDs were identified using logistic regression analysis. Results: A total of 376 nurses completed the survey (response rate 83.3%). 73.1% of the nursing staffs experienced WRMSDs in at least one anatomical site 12 months prior to the study. 75% of nurses expressed emotional distress. Of these, over half also reported anxiety and stress. Multiple logistic regression analysis showed that stress and anxiety significantly increased the risk of WRMSDs by approximately twofold. Conclusion: There were significant associations between emotional distress and WRMSDs. Future longitudinal studies are therefore needed to investigate and identify the sources of emotional distress (non-occupational and occupational) to be used to establish preventive strategies to reduce the risk of WRMSDs.

Quality of Life (QoL) is frequently understood as subjective well-being at both individual and population levels and specific to a country or context. For individuals, mobility afforded by transport is an important predictor of QoL. This paper aims to provide an overview of theoretical approaches, particularly the selection, optimization, compensation (SOC) model, the scales used to measure quality of life, and the scale development of Mobility-related Quality of Life (M-QoL) among older drivers. A pool of items was developed from three sources: i) literature review, ii) Instrumental Activities of Daily Living (IADL) scale and iii) focus group discussion with older drivers. A survey amongst 498 older Malaysian drivers was administered to confirm internal consistency of the scale. Exploratory factor analysis revealed that the developed M-QoL scale consists of 12 items with good internal consistency (α = 0.90), and consists of two subfactors addressing functions of driving and accessibility for independent living. Implications of the findings are discussed, including encouraging continuation of driving for those who are able to drive safely, and provision and use of alternatives to driving to help them achieve maximum mobility. Suggestions for future research are also recommended.

Introduction There is growing evidence to suggest the importance of self-regulatory practices amongst older adults to sustain mobility. However, the decision to self-regulate driving is a complex interplay between an individual's preference and the influence of their social networks including spouse. To our best knowledge, the influence of an older adult's spouse on their decisions during driving transition has not been explored. Materials and methods This qualitative descriptive study was conducted amongst married older adults aged 60 years and above. All interview responses were transcribed verbatim and examined using thematic approach and interpretative description method. Results A total of 11 married couples were interviewed. Three major themes emerged: [1] Our roles in driving; [2] Challenges to continue driving; and, [3] Our driving strategies to ensure continued driving. Older couples adopted driving strategies and regulated their driving patterns to ensure they continued to drive safely. Male partners often took the active driving role as the principal drivers, while the females adopted a more passive role, including being the passenger to accompany the principal drivers or becoming the co-driver to help in navigation. Other coping strategies include sharing the driving duties as well as using public transportation or mixed mode transportation. Discussion Our findings suggest spouse play a significant role in their partners' decision to self-regulate driving. This underscores a need to recognise the importance of interdependency amongst couples and its impact on their driving decisions and outcomes.

Objective: This study set out to provide pretrial data for use in evaluating the benefits of lower speed limits in a local residential area in Melbourne.Methods: An online survey was conducted to a...

Objectives: We encountered an unusual facial laceration wound in relation to motorcycle helmet visor use during our clinical practice. We aimed to assess the prevalence of this unusual facial injury among motorcyclists who sustained facial injuries in selected hospitals and to determine the possible mechanism involved. Methods: We used our prospective cross-sectional substudy involving injured motorcyclists presenting at major trauma hospitals in Southern Klang Valley, Malaysia, between March 2010 and March 2011. of 391 subjects with facial injuries, 2 male motorcyclists sustained this laceration. The wounds were assessed and we believed that each was associated with the helmet visor. One of the visors was collected and the edge was inspected using scanning electron microscopy (SEM). Results: The prevalence of this unusual injury was 0.51% (95% confidence interval, 0.002-0.012) among motorcyclists who sustained facial injuries. Both cases were involved in a head-on collision with their colliding partners and their helmets were intact throughout the crash. The visor in case 1 was intact, but the visor in case 2 was broken. SEM analysis showed that the visor in case 1 had a potential cutting surface. We postulated that with helmet rotation in the forward and downward position and with some degree of visor bending or with a dislodged visor, the sharp-edged visor could potentially severely lacerate the face. Conclusion: This injury affects facial aesthetics and early referral to the facial surgery team is advocated. Documentation of the mechanism of injury, the patient's helmet and visor is obligatory, so that this information can be delivered to the regional road safety authority for preventive measures.

Introduction: The ability to remain safe behind the wheels can become arduous with aging, yet important for sustaining local travel needs. This review aimed to explore safe mobility issues involving older adults and gain a broad understanding of older drivers' self-regulatory driving practices and motivators behind such behavioral changes, including strategies adopted to reduce or cease driving while maintaining safe mobility. Methods: A systematic literature search was performed on 11 online databases for quantitative studies describing self-regulation of driving amongst older adults aged 60 years and above from database inception until December 2018. Data were described narratively and, where possible, data were pooled using random-effects meta-analysis. Results: Of the 1556 studies identified, 54 studies met the inclusion criteria and 46 studies were included in the meta-analyses. All included studies examined car drivers only. Older adults who were single or female were found to be at higher odds of driving cessation. Physical fitness, mental health, social influence, and support systems received by older adults were important driving forces influencing mobility and adjustments made in their travel patterns. Conclusions: Driving self-regulation amongst older adults is a multifaceted decision, impacting mobility and mental health. Therefore, future interventions and support systems should not only create opportunities for retaining mobility for those who have ceased driving, but also promote better psychological and social well-being for regulators and for those who are transitioning from driving to non-driving status. Practical applications: (a) Engage and educate older adults about self-regulation, including strategies that can be adopted and non-car mobility options available. (b) Expand the research focus to explore potential interactions of factors facilitating or hindering the transition process to develop a more comprehensive framework of self-regulation. (c) Encourage ongoing research to formulate, monitor, and evaluate the effectiveness of policies and interventions implemented. (d) Expand the research horizon to explore and understand the perspectives of older adults from developing countries.

With the increasing popularity of cycling generally and availability of new bicycle child carriers, there is an emerging interest in the safety of child bicycle passengers and riders. However, very little is known about the nature and extent of injuries to child bicycle riders and passengers. The aim of this study was to enhance our understanding of child safety in bike transportation and to identify injury patterns and outcomes.Analyses of Victorian hospital data (emergency department presentations and hospital admissions) were undertaken to describe and compare injury outcomes among children aged 0-3 years, 4-6 years, and 7-10 years on bicycles. Data over the 15-year period, July 1, 1999, to June 30, 2014, were examined.A total of 17,859 emergency department presentations and 4,794 hospitalizations were reported for child cyclists under the age of 10 years. The rate of emergency department presentations and hospital admissions per 100,000 population decreased by 1.5% (-2.8 to -0.2%) and 5.0% (-6.5 to -3.4%), respectively. For emergency department presentations, the most commonly injured body parts included the head (34.9%), elbows and forearms (14.6%), and wrist and hands (16.3%). For hospital admissions, the head was again the most commonly injured body region (36.5%), followed by the elbow and forearm (26.7%) and shoulder and upper arm (9.1%). Comparisons of injured body regions between age groups revealed that children aged 3 and under were significantly more likely to sustain injuries to the head that required hospital admissions compared to older age groups. In contrast, older children, between the ages of 7 and 10 years, were significantly more likely to sustain injuries to either the arms, wrists, or hands. Further analysis of the nature of injury revealed that children aged 3 and under had a significantly higher number of open wound injuries compared to older children.This article provides an exploratory and broad overview of the magnitude and severity of injuries among child bike riders and passengers and highlights that younger children are more likely to sustain head injuries compared to older children. This is likely the result of very young children being passengers on bicycles who are constrained in a seat or trailer with little protection or opportunity to mitigate injuries.• Analyses of injury data to understand the nature and extent of injuries to children on bikes as passengers and riders. • Child cyclist injuries as a significant safety issue within Victoria, Australia. • Young children aged 0-3 years experienced significantly more head injuries compared to older children.

Background Good vision is essential for safe driving and studies have associated visual impairment with an increased crash risk. Currently, there is little information about the medical review of drivers with visual field loss. This study examines the prevalence of visual field loss among drivers referred for medical review in one Australian jurisdiction and investigates factors associated with licence outcome in this group. Methods A random sample of 10,000 (31.25 per cent) medical review cases was extracted for analysis from the Victorian licensing authority. Files were screened for the presence of six visual field‐related medical conditions. Data were captured on a range of variables, including referral source, age, gender, health status, crash history and licence outcome. Prevalence analyses were univariate and descriptive. Logistic regression was used to assess factors associated with licence outcomes in the visual field loss group. Results Approximately 1.9 per cent of the 10,000 medical review cases screened had a visual field loss condition identified (n = 194). Among the visual field loss group, 57.2 per cent were permitted to continue driving (conditional/unconditional licence). Primary referral sources were the police, self‐referrals and general medical practitioners. Key factors associated with licence test outcomes were visual field condition, age group, crash involvement and referral to the Driver Licensing Authority's Medical Advisors. Those who were younger had a crash involvement triggering referral and those who were referred to the Medical Advisors were more likely to have a positive licensing outcome. Conclusion The evidence base for making licensing decisions is complicated by the variable causes, patterns, progressions and measuring technologies for visual field loss. This study highlighted that the involvement of an expert medical advisory service in Victoria resulted in an increased likelihood that drivers with visual field loss will be allowed to continue driving. Further research is warranted to explore issues relating to severity of field loss and the capacity for compensation.

Introduction Much of the research on transportation and safe mobility focuses on older adult's thoughts and feelings on driving transition in high-income countries, but there is limited knowledge on this process and its consequences in low-and-middle-income countries. Moreover, there is very little understanding of the transition process involving other forms of transport, specifically the motorcycle. This study aimed to understand the process of driving/riding cessation involving former car drivers and former motorcycle riders, including the motivations that act as driving forces influencing the decision to cease driving/riding, challenges faced during the transition, and strategies adopted to adjust to life without driving/riding. Methods Older Malaysian adults aged 60 years and above who had ceased driving and/or riding were interviewed and responded to questions relating to their decision to stop driving/riding. All interview responses were transcribed verbatim and examined using a thematic approach to identify the factors contributing to this decision. Results Five themes and 16 sub-themes were identified: [1] being a driver/rider; [2] making the adjustment; [3] making the decision; [4] experiencing multiple losses; and, [5] coping with transition. Physical, psychological, and social factors were important contributors to driving/riding cessation. Motorcycle riders were at higher risk of road crash and ceased more readily than car drivers. Renewing license, transitioning from riding to driving, and utilising multiple alternative means of transportation were unique coping strategies adopted during post-cessation phase. Conclusions The current findings suggest that cessation is a transition outcome of self-regulation and a successful transition requires discovery of safer mobility opportunities beyond driving and riding. These findings provide direction for the development of culturally sensitive policy and interventions by taking into consideration travel mode preferences and distribution in countries with mixed travel modes to assist retiring car drivers and motorcycle riders to maintain mobility and access in safety.

Background: The Job Content Questionnaire (M-JCQ) is an established self-reported instrument used across the world to measure the work dimensions based on the Karasek's demand-control-support model. Objective: To evaluate the psychometrics properties of the Malay version of M-JCQ among nurses in Malaysia. Methods: This cross-sectional study was carried out on nurses working in 4 public hospitals in Klang Valley area, Malaysia. M-JCQ was used to assess the perceived psychosocial stressors and physical demands of nurses at their workplaces. Construct validity of the questionnaire was examined using exploratory factor analysis (EFA). Cronbach's α values were used to estimate the reliability (internal consistency) of the M-JCQ. Results: EFA showed that 34 selected items were loaded in 4 factors. Except for psychological job demand (Cronbach's α 0.51), the remaining 3 α values for 3 subscales (job control, social support, and physical demand) were greater than 0.70, indicating acceptable internal consistency. However, an item was excluded due to poor item-total correlation (r

Transport and mobility needs for all aged road users are diverse and may change with increasing age. With an increasing ageing population throughout much of the developed world combined with increasing life expectancies, there is a growing need to understand the transportation requirements of older adults. Moreover, while car use is still the most popular form of transport for older adults, alternative transport modes are offered and promoted, and their use is increasing. This paper explores the characteristics of active transport usage among older adults, defined as persons over 65 years of age, in Melbourne, Australia. Data from the Victorian Integrated Survey of Travel Activity (VISTA) was analysed to undertake the assessment. The analysis revealed that private motorised transport is the predominant mode of transport for older adults, representing approximately 70% of travel. Approximately 22% of travel was made using active transportation, with the majority of these being walking trips. Average trip distance, trip duration and walking speed were found to decrease past the age of 75 years. The analysis shows that the travel patterns of older adults differ from those of younger adults which may reflect the fact that transitions in lifestyle influence their travel needs, destinations and time of travel, or an overall decrease in mobility. The implications of the findings are discussed in terms of ways to improve participation in active transportation and enhance the safe mobility of older active transport users, including a need to enhance the urban environment.

Objectives This study aimed to examine the reliability and validity of the English and Malay versions of the Driving and Riding Questionnaire. Study design An observational study with a mix-method approach by utilising both questionnaire and short debriefing interviews. Methods Forward and backward translations of the original questionnaire were performed. The translated questionnaire was assessed for clarity by a multidisciplinary research team, translators, and several Malay native speakers. A total of 24 subjects participated in the pilot study. Reliability (Cronbach's alpha) and validity (content validity) of the original and translated questionnaires were examined. Results The English and Malay versions of the Driving and Riding Questionnaire were found to be reliable tools in measuring driving behaviours amongst older drivers and riders, with Cronbach's alpha of 0.9158 and 0.8919, respectively. For content validity, the questionnaires were critically reviewed in terms of relevance, clarity, simplicity, and ambiguity. The feedback obtained from participants addressed various aspects of the questionnaire related to the improvement of wordings used and inclusion of visual guide to enhance the understanding of the items in the questionnaire. This feedback was incorporated into the final versions of the English and Malay questionnaires. Conclusion The findings of this study demonstrated both the English and Malay versions of the Driving and Riding Questionnaire to be valid and reliable.

A key tenet of the safety in numbers theory is that as the number of people cycling increases, more drivers will also be cyclists and therefore will give greater consideration to cyclists when driving. We tested this theory in relation to self-reported behaviour, attitudes and knowledge in relation to cycling. An online survey was conducted of Australian drivers (n=1984) who were also cyclists (cyclist-drivers) and drivers who did not cycle (drivers). Cyclist-drivers were 1.5 times more likely than drivers to report safe driving behaviours related to sharing the roads with cyclists (95% CI: 1.1-1.9, p0.01). Cyclist-drivers had better knowledge of the road rules related to cycling infrastructure than drivers; however knowledge of road rules related to bike lanes was low for both groups. Drivers were more likely than cyclist-drivers to have negative attitudes (e.g. cyclists are unpredictable and repeatedly overtaking cyclists is frustrating). Findings from this study highlight the need for increased education and awareness in relation to safe driving behaviour, road rules and attitudes towards cyclists. Specific recommendations are made for approaches to improve safety for cyclists.

Passenger collaboration offers a potential compensatory strategy to assist older drivers who have difficulty driving in unfamiliar areas (wayfinding). This article describes a survey of 194 healthy, community-dwelling older drivers and their regular passengers to investigate how passengers assist drivers, and to identify the characteristics of drivers and passengers who regularly collaborate to assist with wayfinding. Three aspects of passenger assistance were investigated: Pre-trip planning, directional guidance and searching for visual cues. Results revealed a high incidence of collaboration amongst drivers and passengers who regularly drive together. Collaboration was dependent on the perceived wayfinding abilities of the driver by both passenger and driver, suggesting that passengers are more likely to help if they think they will be of assistance. This information provides baseline information on which future research can examine the safety benefits of passenger assistance in wayfinding.

A cyclist crash with an open vehicle door can result in serious injury, sometimes fatal, outcomes. However, little is known about the frequency and range of injury outcomes of this crash type or the contributing factors. In this study, the factors associated with cyclist-open vehicle door collisions in Victoria, Australia were investigated using three complementary data sources: (1) police reported crashes (2000–2011); (2) hospital presentations (2000–2010), and (3) a sample of video footage from a naturalistic study of commuter cyclists in Melbourne (2009–2010). A total of 1247 police reported cyclist crashes and 401 hospital emergency department presentations were analysed. As a proportion of all cyclist crashes, cyclist-open vehicle door crashes accounted for 3.1% (hospital) and 8.4% (police). The majority of cyclists injured were: male (police: 67.1%; hospital: 65.8%); adults aged 18 years or older (police: 97.5%; hospital: 96.3%), and crashes occurred in speed zones up to 60 kph (police: 93.1%). From the naturalistic cycling study, there were 13 door-related events with a rate of 0.59 events per trip. No collisions occurred and in all cases, a potential collision was avoided by the cyclists’ evasive action. Most drivers did not look in the direction of the cyclist before opening the door. While the number of reported crashes is relatively low, cyclists’ exposure to events with potential for this crash type is high. Potential countermeasures to reduce the risk of this interaction/crash type are discussed and include road environment design improvements and road user behaviour programs.

The experiment investigated the extent to which risky street-crossing decisions by older pedestrians can be explained by declines in functional abilities. Sixteen young (age 20-35), 17 younger-old (age 60-67), and 18 older-old (age 70-84) participants carried out a street-crossing task in a simulated two-way road environment and took a battery of tests assessing perceptual, cognitive, and motor abilities. Older-old pedestrians were more likely than young and younger-old participants to make decisions that would have led to collisions with approaching cars, especially when traffic coming from two directions was approaching at a high speed. Regression analyses identified several functional performance measures as predictors of these dangerous choices. Walking speed, which determined the time needed to cross, was shown to play the most important role. Time-to-arrival estimate, which informed the pedestrians about the time available for crossing, was found to be the second most predictive factor. Visual processing speed and visual attention abilities assessed via the UFOV® Test also came into play, allowing participants to focus their attention on the relevant available information and to make timely, correct decisions. Attention shifting was the fourth significant predictor, allowing pedestrians to adapt their crossing strategy to the oncoming road-traffic information. The results suggest that the greater risk of being involved in a collision as age increases calls for a multi-dimensional explanation combining age-related physical, perceptual, and cognitive performance declines. These findings have implications for improving older pedestrians' safety in terms of speed limits, road design, and training.

Some older drivers experience difficulties driving whilst wayfinding in unfamiliar areas. Difficulties in wayfinding have been associated with poorer driving performance and reduced driving mobility. The objective of the current study was to identify cognitive and demographic predictors in older drivers of perceived wayfinding difficulty, avoidance of unfamiliar areas and the use of wayfinding strategies. Five hundred and thirty-four drivers aged 65 years and over (excluding those with dementia or Parkinson's disease) completed a mail-out survey. Drivers commonly reported difficulties with wayfinding, with 59.5% reporting their abilities as poor or fair rather than good. Those significantly more likely to report difficulty were older, reported poorer health and cognition, and had less driving experience. A small proportion of drivers reported regularly avoiding unfamiliar areas (13.8%); these drivers were significantly more likely to be female and to report poorer wayfinding abilities. The most common wayfinding strategies regularly used by older drivers were using a street directory whilst driving (61.9%) and pulling over to check the map (55.1%). Regular passenger guidance (23.9%) or use of a navigation system (9.9%) was less common. The implications of this study are wide and include collecting further information about: (1) the role of cognitive processes in wayfinding ability; (2) the relationship between perceived wayfinding difficulty and restriction of driving in unfamiliar areas; and (3) older drivers' preferences for different wayfinding strategies.

This study investigated parents' attitudes, knowledge and behaviours relating to safe child occupant travel following new Australian legislation regarding child restraint system (CRS) and motor vehicle restraint use for children aged 7 years and under. A questionnaire exploring attitudes, knowledge and behaviours regarding general road safety, as well as safe child occupant travel, was completed by 272 participants with at least one child aged between 3 and 10 years residing in the Australian state of Victoria. Responses to the questionnaire revealed that participants' attitudes, knowledge and behaviours towards road safety in general were fairly positive, with most participants reporting that they restrict their alcohol consumption or do not drink at all while driving (87%), drive at or below the speed limit (85%) and 'always' wear their seatbelts (98%). However, more than half of the participants reported engaging in distracting behaviours 'sometimes' or 'often' (54%) and a small proportion of participants indicated that they 'sometimes' engaged in aggressive driving (14%). Regarding their attitudes, knowledge and behaviours relating to safe child occupant travel, most participants reported that they 'always' restrain their children (99%). However, there was a surprisingly high proportion of participants who did not know the appropriate age thresholds' to transition their child from a booster seat to an adult seatbelt (53%) or the age for which it is appropriate for their child to sit in the front passenger seat of the vehicle (20%). Logistic regression analyses revealed that parents' knowledge regarding safe child occupant travel was significantly related to their attitudes, knowledge and behaviours towards road safety in general, such as drinking habits while driving and CRS safety knowledge. Based on the findings of this study, a number of recommendations are made for strategies to enhance parents' attitudes, knowledge and behaviours relating to safe child occupant travel, as well as for future research.

This study investigated the behavioural, attitudinal and traffic factors contributing to red light infringement by Australian cyclists using a national online survey. The survey was conducted from February to May 2010. In total, 2061 cyclists completed the survey and 37.3% reported that they had ridden through a signalised intersection during the red light phase. The main predictive characteristics for infringement were: gender with males more likely to offend than females (OR: 1.54, CI: 1.22-1.94); age with older cyclists less likely to infringe compared to younger cyclists 18-29 years (30-49 yrs: OR: 0.71, CI: 0.52-0.96; 50+ yrs: OR: 0.51, CI: 0.35-0.74), and; crash involvement with cyclists more likely to infringe at red lights if they had not previously been involved in a bicycle-vehicle crash while riding (OR: 1.35; CI: 1.10-1.65). The main reasons given for red light infringement were: to turn left (32.0%); because the inductive loop detector did not detect their bike (24.2%); when there was no other road users present (16.6%); at a pedestrian crossing (10.7%); and 'Other' (16.5%). A multinomial logistic regression model was constructed to examine the associations between cyclist characteristics and reasons for infringement. Findings suggest that some cyclists are motivated to infringe by their perception that their behaviour is safe and that infrastructure factors were associated with infringement. Ways to manage this, potentially risky, behaviour including behaviour programmes, more cyclist-inclusive infrastructure and enforcement are discussed.

Child injury, regardless of intent, is a major public health issue in Australia and elsewhere. Child protection and injury prevention policies and practices are implemented in most countries in an attempt to manage and reduce the incidence of both intentional and unintentional injuries. While these systems are thought to assist in improving protection from violence, injury and neglect, one of the major limitations in understanding the effectiveness of child protection policy in Australia is a lack of reliable national data on child abuse and neglect. As a result there is a lack of an appropriate evidence base on which to guide the development of effective policies. A particular area where official figures may under-represent the true prevalence of child deaths is those which result from homicide. This article provides a review of the recent literature on child homicide, abuse and neglect, with the overall aim of understanding more fully the reasons for the possible under-representation of child homicides and provides recommendations to address this problem in Australia. Improvements in methods of identifying at risk children in addition to systematic investigations of child deaths to understand the risk factors and underlying contributing factors are required.

This study determined the rate and associated factors of red light infringement among urban commuter cyclists. A cross-sectional observational study was conducted using a covert video camera to record cyclists at 10 sites across metropolitan Melbourne, Australia from October 2008 to April 2009. In total, 4225 cyclists faced a red light and 6.9% were non-compliant. The main predictive factor for infringement was direction of travel, cyclists turning left (traffic travels on the left-side in Australia) had 28.3 times the relative odds of infringement compared to cyclists who continued straight through the intersection. Presence of other road users had a deterrent effect with the odds of infringement lower when a vehicle travelling in the same direction was present (OR=0.39, 95% CI 0.28-0.53) or when other cyclists were present (OR=0.26, 95% CI 0.19-0.36). Findings suggest that some cyclists do not perceive turning left against a red signal to be unsafe and the opportunity to ride through the red light during low cross traffic times influences the likelihood of infringement.

For many older adults in most of the Western world, continued mobility (with associated health, well-being, independence and quality of life) means access to a private vehicle, either as a driver or as a passenger. However older driver serious injury and fatality rates per distance travelled are higher than middle-aged drivers, and crash and injury rates are likely to increase in the coming decades as a result of the ageing population, increased car ownership and overall travel amongst older people. Evidence suggests that contributory factors to this high risk are (for most) frailty, (for some) the high proportion of driving in urban areas, and (for a few) reduced fitness to drive as a result of medical conditions and associated functional limitations. Australasia has recently adopted the ‘Safe System’ approach which aims to manage vehicles, the road infrastructure, speeds, and the interactions between these components, to ensure that when crashes do occur, crash energies will remain at levels that minimize the probability of death and serious injury. A system which aspires to achieving Safe System objectives cannot ignore the challenges that older road users pose – and will pose – to the transport system. This paper discusses the so-called ‘older driver problem’, presents crash data and evidence of the impacts of driving location and reduced fitness to drive on crash risk, and recommends countermeasures within the ‘Safe System’ context, with particular reference to urban road design and operation.

Most licensing jurisdictions in Australia currently employ age-based assessment programs as a means to manage older driver safety, yet available evidence suggests that these programs have no safety benefits. This paper describes a community referral-based model license re assessment procedure for identifying and assessing potentially unsafe drivers. While the model was primarily developed for assessing older driver fitness to drive, it could be applicable to other forms of driver impairment associated with increased crash risk. It includes a three-tier process of assessment, involving the use of validated and relevant assessment instruments. A case is argued that this process is a more systematic, transparent and effective process for managing older driver safety and thus more likely to be widely acceptable to the target community and licensing authorities than age-based practices.

Speeding remains a major contributor to trauma on our roads, held to be a major factor in around one-third of fatal crashes and over 10 percent of all crashes (Bowie & Walz, 1994; Fildes & Lee, 1993). This study reviewed speed management strategies and key factors that should be considered through a comprehensive review of the literature. One of the most frequently used methods of managing travel speeds is the posted speed limit. The primary purpose of the speed limit is to advise drivers of the maximum reasonable and safe operating speed under favourable conditions, therefore considered to be a road safety measure. Further, speed limits are designed to be (i) related to crash risk, (ii) provide a reasonable basis for enforcement, (iii) fair in the context of traffic law, and (iv) accepted as reasonable by most road users. Traditional approaches to setting speed limits (e.g. engineering approach using the 85th percentile speed) are compared with an alternative view to setting speed limits: the Safe System approach. This approach requires that all aspects of the system work together for the safest possible outcome, with speed representing a critical component. The findings suggest that there are some inherent issues in traditional speed limit setting guidelines, particularly as drivers lack awareness of the true relationship between speed and road trauma, under-estimate crash and injury risk and over-estimate what is a safe speed, and that there is often a mismatch between environmental cues and speed limits. There are opportunities to review and strengthen speed management policies and practices with a view to creating environments that promote safe behaviour rather than relying on drivers/riders to decide what is a safe speed, complemented by strengthened Police enforcement and increased community knowledge and awareness of the importance of speed to road trauma.

Significant reductions in road trauma among young drivers could be achieved if they drove safer vehicles. Parents are likely to play a critical role in the access, timing of vehicle purchase, available budget, and vehicle choice for the young driver’s first vehicle. However, little attention has been directed to understanding the most effective communication strategies to encourage young drivers and their parents to purchase and use safe vehicles. This study was undertaken to examine existing strategies in Australia and provide recommendations for improving communication initiatives. A two-staged study was undertaken including in-depth consultation with representatives from key road safety stakeholders groups to identify current initiatives, and development of conceptual model to identify current and potential improvements to communication strategies. The findings of the consultation phase showed that a sporadic and un-coordinated approach was used regarding the promotion of key messages for purchase and use of safe vehicles and there was some suggestion that the communication medium, content and message style may not reach the target audience in the most effective way. Stakeholder representatives were unanimous in the argument that parents play an integral role. A conceptual framework was developed, depicting key stakeholders in Australia and the various interactions across stakeholders. This was instrumental in identifying areas where effective communicative initiatives and resources could be considered to increase the purchase and use of safe vehicles, including development of a widespread and accessible website and inclusion of vehicle safety choices in young driver education and training programs. The results of the study suggest that a National Framework that co-ordinates government and non-government activities and initiatives aimed at encouraging the purchase and usage of safer vehicles by parents and young drivers should be developed. The methodology can be applied to other countries to develop similar communication campaigns.

Engaging in active transport modes (especially walking) is a healthy and environmentally friendly alternative to driving and may be particularly beneficial for older adults. However, older adults are a vulnerable group: they are at higher risk of injury compared with younger adults, mainly due to frailty and may be at increased risk of collision due to the effects of age on sensory, cognitive, and motor abilities. Moreover, our population is aging, and there is a trend for the current cohort of older adults to maintain mobility later in life compared with previous cohorts. Though these trends have serious implications for transport policy and safety, little is known about the contributing factors and injury outcomes of pedestrian collision. Further, previous research generally considers the older population as a homogeneous group and rarely considers the increased risks associated with continued ageing.Collision characteristics and injury outcomes for 2 subgroups of older pedestrians (65-74 years and 75+ years) were examined by extracting data from the state police-reported crash dataset and hospital admission/emergency department presentation data over the 10-year period between 2003 and 2012. Variables identified for analysis included pedestrian characteristics (age, gender, activity, etc.), crash location and type, injury characteristics and severity, and duration of hospital stay. A spatial analysis of crash locations was also undertaken to identify collision clusters and the contribution of environmental features on collision and injury risk.Adults over 65 years were involved in 21% of all pedestrian collisions. A high fatality rate was found among older adults, particularly for those aged 75 years and older: this group had 3.2 deaths per 100,000 population, compared to a rate of 1.3 for 65- to 74-year-olds and 0.7 for adults below 65 years of age. Older pedestrian injuries were most likely to occur while crossing the carriageway; they were also more likely to be injured in parking lots, at driveway intersections, and on sidewalks compared to younger cohorts. Spatial analyses revealed older pedestrian crash clusters on arterial roads in urban shopping precincts. Significantly higher rates of hospital admissions were found for pedestrians over the age of 75 years and for abdominal, head, and neck injuries; conversely, older adults were underrepresented in emergency department presentations (mainly lower and upper extremity injuries), suggesting an increased severity associated with older pedestrian injuries. Average length of hospital stay also increased with increasing age.This analysis revealed age differences in collision risk and injury outcomes among older adults and that aggregate analysis of older pedestrians can distort the significance of risk factors associated with older pedestrian injuries. These findings have implications that extend to the development of engineering, behavioral, and enforcement countermeasures to address the problems faced by the oldest pedestrians and reduce collision risk and improve injury outcomes.

BACKGROUND: Much of the research into cyclist safety in Australia has focused on behaviour with less focus on the impact of the urban transport environment on cyclist safety. A greater understanding of the urban transport system and the improvements needed to create a safer cycling environment are essential if cyclists are to be safe and increased cycling participation targets are to be achieved. The proposed study will use existing cyclist crash data along with unique cyclist exposure data to develop road infrastructure prototypes that improve cyclists' safety and evaluate the effectiveness of these prototypes in a cycling simulator. METHODS AND DESIGN: This study will be conducted in two Australian cities namely Perth and Melbourne as both cities have policies that strongly advocate cycling. Two methods of data collection will be employed: (1) in-depth crash investigations of injured cyclists; and (2) video footage of cyclist exposure through a naturalistic cycling study of non-injured cyclists. The findings from these two methods will be used to develop new urban road design prototypes which will be tested with a sample of cyclists and motorists in safe environment namely, a cycling simulator and a driving simulator. DISCUSSION: By designing and evaluating safer environments for cyclists, this study will identify solutions that reduce the risk of road trauma and importantly, support this alternative mode of transport and thereby contribute to a reduction in traffic-related emissions and pollution and enhance sustainable economic and social connectivity.

This paper describes a survey of self-regulatory driving practices of 656 drivers aged 55 years and older. Types and prevalence of self-regulatory behaviours were examined and key characteristics of self-regulators were identified. Overall, the majority of drivers reported being very confident in potentially difficult driving situations and relatively few avoided these situations. The most commonly avoided situations were driving at night (25%), on wet nights (26%) and in busy traffic (22%). There was a strong association between drivers’ avoidance of and confidence in specific driving situations (e.g. night driving) and ratings of relevant functional abilities (e.g. vision for night driving). Logistic regression modelling revealed that those most likely to adopt avoidance behaviour were female, 75 years and older, not the principal driver in the household, had been involved in a crash in the last 2 years, reported vision problems and had lower confidence ratings. Implications for promotion of safe driving practices are discussed.

Older drivers are currently over-represented in severe injury crashes at intersections due in part to increases in frailty and functional disabilities that occur with age. Moreover, this rate is expected to increase as older people drive more and the population ages. Road design plays a major role in road safety and is likely to contribute to the driving difficulties of the elderly because of the general lack of consideration of the needs of older road users. Intersections, in particular, stand out as a major problem for older road users. This paper reviews age-related performance deficits that affect driving and describes a crash ‘black-spot’ site analysis that examined the relationship between intersection design features (believed to influence the safety of older drivers) and the older driver crash experience in Australasia. A number of intersection design problems for older drivers were identified and recommendations for changes in road design features and traffic management practices that have the potential to reduce crash and injury risk for older drivers at intersections are made.

The over-representation of intoxicated pedestrians in serious injury and fatal crashes compared to non-intoxicated pedestrians may be due, in part, to the effects of alcohol on the ability to select gaps in the traffic for safe road-crossing. An experiment is described that tests the effectiveness of an experimental approach to elicit road-crossing responses among groups of intoxicated (BAC = between 0.05% and 0.10%, mean = 0.07%) and sober adults (BAC = 0.00%). Some subtle effects of alcohol on road-crossing decisions were found, particularly at higher BAC levels of 0.07–0.10%. Highly intoxicated participants showed some lack of awareness of impairment, a tendency to engage in risky road-crossings, and difficulty integrating speed and distance information in a timely manner, necessary to select safe gaps in the traffic. These results are discussed in terms of the effect of alcohol impairment on perceptual and cognitive capacities and the ability to compensate for impairment. Importantly, this study has established a methodology on which further research can be conducted to examine the road-crossing behaviour of those with high levels of BAC and other forms of impairment.

The over-representation of older pedestrians in serious injury and fatal crashes compared to younger adults may be due, in part, to age-related diminished ability to select gaps in oncoming traffic for safe road-crossing. Two experiments are described that examine age differences in gap selection decisions in a simulated road-crossing environment. Three groups of participants were tested, younger (30-45 years), young-old (60-69 years) and old-old (>75 years). The results showed that, for all age groups, gap selection was primarily based on vehicle distance and less so on time-of-arrival. Despite the apparent ability to process the distance and speed of oncoming traffic when given enough time to do so, many of the old-old adults appeared to select insufficiently large gaps. These results are discussed in terms of age-related physical, perceptual and cognitive limitations and the ability to compensate for these limitations. Practical implications for road safety countermeasures are also highlighted, particularly the provision of safe road environments and development of behavioural and training packages.

This study applied geospatial analysis to explore spatial trends in cycling-related injury in Melbourne, Australia, in order to identify an area where injury density was reducing against expectation. The crash characteristics and cycling environment of the identified area were examined to better understand factors related to cycling safety.Two methods were used to examine spatial trends in cycling-related injury. Firstly, cycling injury density was calculated using a kernel density estimation method for the years 2000 to 2011. This was used to examine patterns in injury density across Melbourne over an extended time period. Secondly, absolute change in injury density was calculated between 2005 and 2011. From this, a geographical area presenting a reduced injury density was selected for a case study, and crash characteristics of the area were obtained for the observational period. This led to discussion on which changes to the cycling environment, if any, may be associated with the reduced injury rate.Injury density in Melbourne had been progressively increasing between 2000 and 2011, with a nearly 3-fold increase in the peak injury density over that period. Decreases were observed in some locations between 2005 and 2011, and a geographical area to the southeast of Melbourne experienced a more significant decrease than others. This appeared to be associated with a combination of behavior and road infrastructure change, although a lack of data to verify change in cycling exposure prevented more definitive associations from being established.The apparent positive response of the injury rate to behavior and road infrastructure interventions is promising, yet the injury rate is unlikely to achieve the government's road safety target of 30% reduction in serious injuries by 2022. Moreover, the number of injuries sustained at the most common crash location appears to be increasing. Further research is necessary to discern which specific features of the urban road infrastructure have an effect on the risk of injury to a cyclist and which combination of features is consistent with a safe cycling environment.

Objective This study examined the relationships between psychosocial work factors and risk of WRMSDs among public hospital nurses in the Klang Valley, Malaysia. Methods We conducted a cross-sectional study among 660 public hospital nurses. A self-administered questionnaire was used to collect data on the occurrence of WRMSDs according to body regions, socio-demographic profiles, occupational information and psychosocial risk factors. 468 questionnaires were returned (response rate of 71%), and 376 questionnaires qualified for subsequent analysis. Univariate analyses were applied to test for mean and categorical differences across the WRMSDs; multiple logistic regression was applied to predict WRMSDs based on the Job Strain Model’s psychosocial risk factors. Results Over two thirds of the sample of nurses experienced discomfort or pain in at least one site of the musculoskeletal system within the last year. The neck was the most prevalent site (48.94%), followed by the feet (47.20%), the upper back (40.69%) and the lower back (35.28%). More than 50% of the nurses complained of having discomfort in region one (neck, shoulders and upperback) and region four (hips, knees, ankles, and feet). The results also revealed that psychological job demands, job strain and iso-strain ratio demonstrated statistically significant mean differences (p

Some older drivers experience difficulties wayfinding whilst driving in unfamiliar areas. A navigation system (GPS) may be an effective strategy to help improve older adults’ driving performance whilst wayfinding, however little is known about the use or potential safety and mobility benefits/disadvantages of these technologies by older drivers. This paper examined older Australian drivers’ attitudes about potential acceptability (before use) and acceptance (following use) of navigation systems, and whether these attitudes affected intention to use. Two complementary studies were conducted; (i) a survey of 434 older adults who had not previously used navigation systems; and (ii) a pre-post study of usability and acceptance of a contemporary navigation system among a convenience sample of 20 older adults with limited or no previous experience with navigation systems. Drivers who reported wayfinding difficulties were more likely to report willingness to use a navigation system in the future, while other demographic characteristics, such as age, gender and educational level were not predictive. Some drivers indicated that they were satisfied with their current wayfinding methods and did not see a need to use navigation systems. Other barriers to acceptability and acceptance included concerns about how well a navigation system would perform and whether it would be distracting. In contrast, concerns about usability and learnability were less important for acceptance.

Background Motorcycle fatalities constitute the majority of road traffic deaths in Malaysia. The aims of this study were to describe the pattern of fatal injuries among Klang Valley fatal motorcyclists and to describe the factors associated with fatal (vs non-fatal) injuries. Methods A cross-sectional analysis was performed on data from a case series of injured (fatal and non-fatal) motorcyclists recruited from Klang Valley between 14th March 2010 and 13th March 2011. Fatal cases in the cases series were identified from the Police files. Non-fatal cases were recruited from five major hospitals in the study region. Information used in the analyses were obtained from Police crash reports, hospital medical records, and Coroner's records of the participant sample. Results Of the 177 fatal cases, 142 (80.2%) were categorised as instantaneous death while 35 (19.8%) cases were categorised as experiencing delayed death. Thirty two percent of the cases had a Maximum Abbreviated Injury Score (MAIS) of 5 with head injury being the most common cause of death. Significant predictors of fatal (vs non-fatal) injury included ethnic groups, monthly income, alcohol and drug use and road type. Alcohol and drug use was shown to be the strongest predictor with adjusted odds ratio (AOR) of 14.77 (95% CI 3.32–65.65). Conclusion Factors related to the motorcyclists, road user behaviour and the road environment as well as pre-hospitalisation emergency care must be addressed efficiently in low and middle income countries to reduce the number and severity of motorcycle-related injuries.

DA 2011 - 6th International Driving Symposium on Human Factors in Driver Assessment, Training and Vehicle Design, TAHOE, ETATS-UNIS, 27-/06/2012 - 30/06/2012; Older pedestrians are well known to be over-involved in road crashes compared to younger pedestrians. This study investigates the extent to which risky street-crossing decisions in older pedestrians can be explained by agerelated declines of cognitive, perceptual and physical abilities. Three age groups of participants (young, young-old, old-old) were evaluated in a street-crossing task and performed a series of functional tests. The results showed that agerelated slowing in walking speed as well as a decline in cognitive flexibility and in visual acuity play a substantial role in risky decisions by the elderly. The implications of these findings, particularly in the development of a mixed physical-cognitive training to enhance the older pedestrians' road crossing decisions in complex environments, are discussed.