Transit-oriented development for older people: Does using multiple public transport options improve their physical and mental health?


  • Yao Du Department of Urban Planning and Design & Urban Analytics and Interventions Research Lab, The University of Hong Kong
  • Guibo Sun Department of Urban Planning and Design & Urban Analytics and Interventions Research Lab, The University of Hong Kong
  • Mei-po Kwan Department of Geography and Resource Management, The Chinese University of Hong Kong



Transit-oriented cities often use urban rail transit (e.g., metro) to lead public transport development (TOD), which might overlook other public transport options (e.g., bus) that matter for the health and wellbeing of older people. We investigate older people’s public transport use patterns and how multiple public transport options are related to the physical and mental health of older people.

In the case city of Hong Kong, which is well-known for its metro-led transit-oriented development, we collected questionnaire data from 826 older people on their public transport use behaviors, route environment to normally used stops/stations, and physical and mental health. We used univariate analysis to measure explanatory factors (P<0.25). We applied multivariable linear regression models with several sensitivity analyses to test the associations among public transport use, route environment, and health outcomes, adjusting for covariates of individual factors, physical activity, and self-reported chronic disease.

We found that (1) using multiple public transport options was positively associated with better physical health (p<0.001); (2) mixed metro and bus users had the highest physical activity (high level with MET-mins/week>3,000, 75%) as well as the best physical health (physical component summary (PCS) >50, 41.42%) and mental health (mental component summary (MCS) > 50, 68.28%), compared to bus-only or metro-only users; and (3) for mixed-mode users, pedestrian crowdedness was negatively associated with physical health (p < 0.01), while satisfaction in sidewalk width was positively related to mental health (p=0.038).

We found that older people prefer multiple public transport options rather than the metro-dominated single-mode, and this travel preference benefits the physical and mental health of this population. Our research helps deepen the understanding of public transport use and associated health outcomes among older people and has policy implications for TOD planning concerning the aging population.


Avila-Palencia, I., Int Panis, L., Dons, E., Gaupp-Berghausen, M., Raser, E., Götschi, T., … & Nieuwenhuijsen, M. J. (2018). The effects of transport mode use on self-perceived health, mental health, and social contact measures: A cross-sectional and longitudinal study. Environment International, 120, 199–206.

Barnett, D. W., Barnett, A., Nathan, A., Van Cauwenberg, J., & Cerin, E. (2017). Built environmental correlates of older adults’ total physical activity and walking: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 1–24.

Böcker, L., van Amen, P., & Helbich, M. (2017). Elderly travel frequencies and transport mode choices in Greater Rotterdam, the Netherlands. Transportation, 44(4), 831–852.

Boschmann, E. E., & Brady, S. A. (2013). Travel behaviors, sustainable mobility, and transit-oriented developments: A travel counts analysis of older adults in the Denver, Colorado, metropolitan area. Journal of Transport Geography, 33, 1–11.

Census and Statistics Department. (2020). Hong Kong annual digest of statistics. Hong Kong: Census and Statistics Department.

Cerin, E., Barnett, A., Cheung, M., Sit, C. H. P., Macfarlane, D. J., & Chan, W. (2012). Reliability and validity of the IPAQ-L in a sample of Hong Kong urban older adults: Does neighborhood of residence matter? Journal of Aging and Physical Activity, 20(4), 402–420.

Cerin, E., Sit, C. H. P., Zhang, C. J. P., Barnett, A., Cheung, M. M. C., Lai, P., … & Lee, R. S. Y. (2016). Neighborhood environment, physical activity, quality of life and depressive symptoms in Hong Kong older adults: A protocol for an observational study. BMJ Open, 6(1), e010384.

Chen, F., Wu, J., Chen, X., Zegras, P. C., & Wang, J. (2017). Vehicle kilometers traveled reduction impacts of transit-oriented development: Evidence from Shanghai City. Transportation Research Part D: Transport and Environment, 55, 227–245.

Cui, J., Loo, B. P. Y., & Lin, D. (2017). Travel behavior and mobility needs of older adults in an aging and car-dependent society. International Journal of Urban Sciences, 21(2), 109–128.

Du, Y., Sun, G., Choe, E. Y., & Kwan, M. P. (2022). Mediation effects of social isolation on pathways connecting public transport use with subjective wellbeing among older people. Journal of Transport and Health, 25.

Duncan, M., Horner, M., Valdez-Torres, Y., & Wood, B. (2021). Promoting transit-oriented development for older adults: A survey of current practices among transit agencies and governments in the U.S. The Journal of Transport and Land Use, 14(1), 255–276.

Ettema, D., Gärling, T., Olsson, L. E., & Friman, M. (2010). Out-of-home activities, daily travel, and subjective well-being. Transportation Research Part A: Policy and Practice, 44(9), 723–732.

Forsyth, A., Oakes, J. M., Lee, B., & Schmitz, K. H. (2009). The built environment, walking, and physical activity: Is the environment more important to some people than others? Transportation Research Part D: Transport and Environment, 14(1), 42–49.

Friman, M., & Olsson, L. E. (2020). Daily travel and wellbeing among the elderly. International Journal of Environmental Research and Public Health, 17(7).

Green, C. P., Heywood, J. S., & Navarro, M. (2016). Traffic accidents and the London congestion charge. Journal of Public Economics, 133, 11–22.

He, S. Y., Tao, S., Hou, Y., & Jiang, W. (2018). Mass transit railway, transit-oriented development and spatial justice: The competition for prime residential locations in Hong Kong since the 1980s. Town Planning Review, 89(5), 467–493.

He, S. Y., Thøgersen, J., Cheung, Y. H. Y., & Yu, A. H. Y. (2020). Aging in a transit-oriented city: Satisfaction with transport, social inclusion and wellbeing. Transport Policy, 97, 85–94.

Hong, A., Boarnet, M. G., & Houston, D. (2016). New light rail transit and active travel: A longitudinal study. Transportation Research Part A: Policy and Practice, 92, 131–144.

Jiao, L., Shen, L., Shuai, C., Tan, Y., & He, B. (2017). Measuring crowdedness between adjacent stations in an urban metro system: A Chinese case study. Sustainability, 9(12), 1–14.

Kamruzzaman, M., Shatu, F. M., Hine, J., & Turrell, G. (2015). Commuting mode choice in transit-oriented development: Disentangling the effects of competitive neighborhoods, travel attitudes, and self-selection. Transport Policy, 42, 187–196.

Kendrick, D., Drummond, A., Logan, P., Barnes, J., & Worthington, E. (2015). Systematic review of the epidemiology of non-collision injuries occurring to older people during use of public buses in high income countries. Journal of Transport and Health, 2(3), 394–405.

Khreis, H., Warsow, K. M., Verlinghieri, E., Guzman, A., Pellecuer, L., Ferreira, A., … & Nieuwenhuijsen, M. (2016). The health impacts of traffic-related exposures in urban areas: Understanding real effects, underlying driving forces and co-producing future directions. Journal of Transport and Health, 3(3), 249–267.

Lam, C. L. K., Tse, E. Y. Y., & Gandek, B. (2005). Is the standard SF-12 Health Survey valid and equivalent for a Chinese population? Quality of Life Research, 14(2), 539–547.

Langlois, M., Wasfi, R. A., Ross, N. A., & El-Geneidy, A. M. (2016). Can transit-oriented developments help achieve the recommended weekly level of physical activity? Journal of Transport and Health, 3, 181–190.

Lau, C. Y. (2019). Approaching the public transport: An elderly view. Hong Kong: University of Hong Kong.

Laverty, A. A., Webb, E., Vamos, E. P., & Millett, C. (2018). Associations of increases in public transport use with physical activity and adiposity in older adults. International Journal of Behavioral Nutrition and Physical Activity, 15(31), 1–10.

Li, Z., & Hensher, D. A. (2013). Crowding in public transport: A review of objective and subjective measures. Journal of Public Transportation, 16(2), 107–134.

Loo, B. P. Y., & Lam, W. W. Y. (2012). Geographic accessibility around health care facilities for elderly residents in Hong Kong: A microscale walkability assessment. Environment and Planning B: Planning and Design, 39(4), 629–646.

Mackett, R. (2017). Older people’s travel and its relationship to their health and wellbeing. Transport and Sustainability, 10, 15–36.

Mackett, R. L., & Thoreau, R. (2015). Transport, social exclusion and health. Journal of Transport and Health, 2(4), 610–617.

McCarthy, S., & Habib, M. A. (2018). Investigation of life satisfaction, travel, built environment and attitudes. Journal of Transport and Health, 11, 15–24.

Mokhtarian, P. L. (2019). Subjective well-being and travel: Retrospect and prospect. Transportation, 46, 493–513.

Moran, M., Van Cauwenberg, J., Hercky-Linnewiel, R., Cerin, E., Deforche, B., & Plaut, P. (2014). Understanding the relationships between the physical environment and physical activity in older adults: A systematic review of qualitative studies. International Journal of Behavioral Nutrition and Physical Activity, 11(1), 1–12.

Mouratidis, K., & Yiannakou, A. (2022). COVID-19 and urban planning: Built environment, health, and well-being in Greek cities before and during the pandemic. Cities, 121, 103491.

Muley, D., Bunker, J., & Ferreira, L. (2009). Investigation into travel modes of TOD users: Impacts of personal and transit characteristics. International Journal of ITS Research, 7(1), 3–13.

Musselwhite, C., Holland, C., & Walker, I. (2015). The role of transport and mobility in the health of older people. Journal of Transport and Health, 2, 1–4.

Nieuwenhuijsen, M. J., Khreis, H., Verlinghieri, E., Mueller, N., & Rojas-Rueda, D. (2017). Participatory quantitative health impact assessment of urban and transport planning in cities: A review and research needs. Environment International, 103, 61–72.

Nieuwenhuijsen, M. J., Khreis, H., Verlinghieri, E., & Rojas-Rueda, D. (2016). Transport and health: A marriage of convenience or an absolute necessity. Environment International, 88, 150–152.

Paluska, S., & Schwenk, T. (2000). Physical activity and mental health. Sports Medicine, 29(3), 167–180.

Pan, H., Li, J., Shen, Q., & Shi, C. (2017). What determines rail transit passenger volume? Implications for transit-oriented development planning. Transportation Research Part D: Transport and Environment, 57, 52–63.

Rambaldini-Gooding, D., Molloy, L., Parrish, A. M., Strahilevitz, M., Clarke, R., Dubrau, J. M. L., & Perez, P. (2021). Exploring the impact of public transport including free and subsidised on the physical, mental and social well-being of older adults: A literature review. Transport Reviews, 41(5), 600–616.

Reinhard, E., Courtin, E., Van Lenthe, F. J., & Avendano, M. (2018). Public transport policy, social engagement and mental health in older age: A quasi-experimental evaluation of free bus passes in England. Epidemiol Community Health, 72, 361–368.

Rissel, C., Curac, N., Greenway, M., & Bauman, A. (2012). Key health benefits associated with public transport: A rapid review. Glebe, Australia: Sax Institute.

Ryan, J., & Wretstrand, A. (2019). What’s mode got to do with it? Exploring the links between public transport and car access and opportunities for everyday activities among older people. Travel Behavior and Society, 14(October), 107–118.

Satariano, W. A., Guralnik, J. M., Jackson, R. J., Marottoli, R. A., Phelan, E. A., & Prohaska, T. R. (2012). Mobility and aging: New directions for public health action. American Journal of Public Health, 102(8), 1508–1515.

Schorr, A. V., & Khalaila, R. (2018). Aging in place and quality of life among the elderly in Europe: A moderated mediation model. Archives of Gerontology and Geriatrics, 77, 196–204.

Shelton, B., Karakiewicz, J., & Kvan, T. (2011). The making of Hong Kong: From vertical to volumetric. London: Routledge.

Shrestha, B. P., Millonig, A., Hounsell, N. B., & McDonald, M. (2017). Review of public transport needs of older people in European context. Population Aging, 10, 343–361.

Simons, D., Clarys, P., de Bourdeaudhuij, I., de Geus, B., Vandelanotte, C., & Deforche, B. (2013). Factors influencing mode of transport in older adolescents: A qualitative study. BMC Public Health, 13(323), 1–10.

Song, S., Yap, W., Hou, Y., & Yuen, B. (2020). Neighbourhood built environment, physical activity, and physical health among older adults in Singapore: A simultaneous equations approach. Journal of Transport and Health, 18(May), 100881.

Stefansdottir, H., Næss, P., & Ihlebæk, C. M. (2019). Built environment, non-motorized travel and overall physical activity. Travel Behavior and Society, 16(1432), 201–213.

Sun, G., Du, Y., Ni, M. Y., Zhao, J., & Webster, C. (2021). Metro and elderly health in Hong Kong: Protocol for a natural experiment study in a high-density city. BMJ Open, 11, e043983.

Sun, G., Haining, R., Lin, H., Oreskovic, N. M., & He, J. (2015). Comparing the perception with the reality of walking in a hilly environment: An accessibility method applied to a university campus in Hong Kong. Geospatial Health, 10(1), 340.

Sun, G., Webster, C., & Chiaradia, A. (2017). Objective assessment of station approach routes: Development and reliability of an audit for walking environments around metro stations in China. Journal of Transport and Health, 4, 191–207.

Sun, G., Webster, C., & Zhang, X. (2019). Connecting the city: A three-dimensional pedestrian network of Hong Kong. Environment and Planning B: Urban Analytics and City Science, 48(1), 1–16.

Sundling, C., Nilsson, M. E., Hellqvist, S., Pendrill, L. R., Emardson, R., & Berglund, B. (2016). Travel behavior change in old age: The role of critical incidents in public transport. European Journal of Aging, 13, 75–83.

Szeto, W. Y., Yang, L., Wong, R. C. P., Li, Y. C., & Wong, S. C. (2017). Spatio-temporal travel characteristics of the elderly in an aging society. Travel Behavior and Society, 9, 10–20.

Titheridge, H., Achuthan, K., Mackett, R., Solomon, J., Journal, S., … & Mackett, R. (2009). Assessing the extent of transport social exclusion among the elderly. Journal of Transport and Land Use, 2(2), 31–48.

Transport Department. (2014). Travel characteristics survey 2011 final report. Hong Kong: Transport Department.

Van Cauwenberg, J., de Bourdeaudhuij, I., de Meester, F., van Dyck, D., Salmon, J., Clarys, P., & Deforche, B. (2011). Relationship between the physical environment and physical activity in older adults: A systematic review. Health and Place, 17(2), 458–469.

van Holle, V., van Cauwenberg, J., Simons, D., Clarys, P., Goubert, L., Nasar, J., … & Deforche, B. (2012). A study using walk-along interviews to explore the environmental factors related to older adults’ walking for transportation. Journal of Science and Medicine in Sport, 15, S269.

Ware, J., Kosinski, M., & Keller, S. (1995). SF-12: How to score the SF-12 physical and mental health summary scales. Boston: The Health Institute, New England Medical Center.

Webb, E., Laverty, A., Mindell, J., & Millett, C. (2016). Free bus travel and physical activity, gait speed, and adiposity in the English longitudinal study of ageing. American Journal of Public Health, 106(1), 136–142.

Windle, G., Hughes, D., Linck, P., Russell, I., & Woods, B. (2010). Is exercise effective in promoting mental well-being in older age? A systematic review. Aging and Mental Health, 14(6), 652–669.

Wong, R. C. P., Szeto, W. Y., Yang, L., Li, Y. C., & Wong, S. C. (2017). Elderly users’ level of satisfaction with public transport services in a high-density and transit-oriented city. Journal of Transport and Health, 7, 209–217.

Wong, R. C. P., Szeto, W. Y., Yang, L., Li, Y. C., & Wong, S. C. (2018). Public transport policy measures for improving elderly mobility. Transport Policy, 63, 73–79.

Xue, C. Q., & Sun, C. (2018). How much development can a rail station lead? A case study of Hong Kong. International Journal of High-Rise Buildings, 7(2), 95–109.

Yang, L. (2018). Modeling the mobility choices of older people in a transit-oriented city: Policy insights. Habitat International, 76(February), 10–18.

Yen, I. H., Flood, J. F., Thompson, H., Anderson, L. A., & Wong, G. (2014). How design of places promotes or inhibits mobility of older adults: Realist synthesis of 20 years of research. Journal of Aging and Health, 26(8), 1340–1372.

Zhu, P., Ho, S. N., Jiang, Y., & Tan, X. (2020). Built environment, commuting behavior and job accessibility in a rail-based dense urban context. Transportation Research Part D: Transport and Environment, 87, 102438.


Additional Files



How to Cite

Du, Y., Sun, G., & Kwan, M.- po. (2022). Transit-oriented development for older people: Does using multiple public transport options improve their physical and mental health?. Journal of Transport and Land Use, 15(1), 729–753.