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

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.