"When I need to travel, I feel feverish": Everyday experiences of transport inequalities among older adults in Dhaka, Bangladesh

Mobilities and leisure in later ages: The role of religious tourism in the lives of low-income older women in India

BACKGROUND AND OBJECTIVES

With the expansion of low-income urban areas in low and middle-income countries (LMIC), the recognition of leisure opportunities for older women remains under-researched. This study uses a mobility framework to explore access to leisure for older adults in a low-income neighbourhood in Bengaluru, India.

RESEARCH DESIGN AND METHODS

This ethnographic study included participant observations, 33 in-depth interviews with older adults, and key informants, supplemented by archival research to explore leisure mobility. The paper specifically focuses on a religious tour through rural Tamil Nadu, India, which the primary researcher undertook with a group of older women from one of Bengaluru's oldest low-income neighbourhoods.

RESULTS

We found that community mobilities, such as the annual religious tours, enabled older women to temporarily escape urban hardships and offered them a phase of agency to plan their travel and leisure. Everyday mobility opportunities for travel unrelated to work were often not age-friendly or accessible. The religious tour on the rented bus became a theatre of devotion, a platform for performing spirituality, and a safe environment to sing, dance, and enjoy commensality.

DISCUSSION AND IMPLICATIONS

The study contributes to the literature on how the social lives of economically disadvantaged older women are constrained by local cultural norms and limited opportunities for mobility. The religious tour, along with the process of organising and carrying it out, can be seen as an act of resilience by older women. Policies promoting inclusive ageing and transport infrastructure in low- and middle-income countries must be attuned to forms of mobility that do not neatly fit into categories such as leisure, social, spiritual, or religious.

Older people's challenges accessing health services in central Nepal: a qualitative study using the domain of access framework

BACKGROUND

Low- and middle-income countries face rapid population aging. However, the health system has remained largely unprepared to deliver health services to an aging population. As the population is rapidly aging in Nepal, their challenges and experience should be the focus for health care providers to address these issues. There is a paucity of evidence on barriers and facilitators to accessing health care services among older people in Nepal. The aim of this study was to investigate the challenges that older people experience while accessing health services in central Nepal.

METHODS

This qualitative study was conducted between April and June 2023. In-depth interviews were conducted among older people of a municipality in central Nepal, which were analysed thematically using a deductive-inductive approach based on the theory of access.

RESULTS

Hypertension and diabetes were the most common health problems among the participants. The affordability of health services was a major issue, although there is a health insurance scheme and a major focus on universal health coverage from the Government of Nepal. Other issues included poor acceptability, poor communication between older people and health staff, and poor accommodation due to a lack of elderly-friendly services, including long wait times in the clinic. Living with family was a major facilitator of access to health care services and was interrelated with multiple domains of access.

CONCLUSIONS

This study identified barriers to accessing health care services for older adults in Nepal. We found that the affordability of health services, poor acceptability, poor communication between older people and doctors, and a lack of elderly-friendly services are the key challenges experienced by older people. Older people felt that these barriers were easier to overcome when they had family support. Therefore, for those living with their children, family support was reported as the major facilitator.

"We do not go outside, though We want to": Unequal Access to Public Transport and Transport-Related Social Exclusion of Older Adults in Dhaka, Bangladesh

This study investigated key physical and social barriers to accessing public transport in Dhaka, Bangladesh, and how the unequal accessibility of transport leads to the social exclusion of older adults. Employing a transport disadvantage perspective and drawing on visual surveys and in-depth interviews, the study explores the context and lived experiences of older adults using public transport in their everyday lives. Difficulty in accessing buses due to overcrowding and congestion, struggling to get on rickshaws due to height, avoiding CNG (an autorickshaw) and cabs due to high fares, disliking Laguna (a small four-wheeler human haulier for carrying passengers) for compact seating arrangements, undesirable behavior, and social attitudes discourage older adults from participating in social activities and produce a feeling of social isolation and exclusion. Hence, more inclusive transport policies are essential in low- and middle-income countries to reduce transport-related social exclusion and improve the well-being of older adults.

Barriers and facilitators of public transport use among people with disabilities: a scoping review

Barriers to public transport use may be experienced differently by people with various types of disabilities (e.g., physical, intellectual, cognitive, sensory). Thus, it is important to identify the variable needs within each element of the travel chain. For example, the unavailability or low volume of auditory announcements in a stop or station or on the public transport vehicle may be a barrier to people with visual disability who rely on hearing the information. Consequently, this could provoke negative emotions and unpleasant experiences, which may not be the case for people with physical disabilities. The primary objective was to describe the barriers and facilitators to using public transport experienced by people with disabilities (PWD). The secondary aim was to explore experiences in terms of self-efficacy and satisfaction, when using public transport among people with disabilities. A scoping review was conducted. The search was performed in MEDLINE, TRANSPORT DATABASE, PsycINFO, EMBASE, and WEB OF SCIENCE from 1995 to 2023. Of 6,820 citations identified, 34 articles were included in the review for extraction. The main physical and social barriers included lack of ramp, long walking distance, long waiting time, unavailability of information at bus stop or station, and drivers' negative attitudes towards PWD. Personal factors that prevented the use of public transport included lack of confidence, and decreased satisfaction with public transport use. Strategies such as providing ramps on public transport vehicles, availability of kneeling buses and courtesy of bus drivers, and travel training were considered as enablers to the use of public transport that can lead the improved self-efficacy and satisfaction. In conclusion, this review identified the physical and social barriers and facilitators in travel chain, and highlighted issues related to lack of confidence or self-efficacy and decreased satisfaction when PWD and older adults are using public transport. Identifying and understanding the barriers and facilitators to the use of public transport by PWD is a milestone that may help policy makers and transport operators around the world to develop and implement interventions enabling access, use and inclusion of this mode of transport, as the experiences of PWD when using this mode of transport have an impact on their well-being.

(Im)mobile ageing: risks of exclusion in later life in liminal urban peripheries

Despite the recent policy impetus for age-friendly cities, there is still scope for more geographical insights into ageing in low- and middle-income countries (LMICs). Cities in LMICs, such as Bengaluru (India), are witnessing an increase in the size of the older population in their peripheral urban regions, but there is relatively little understanding of the risks of exclusion in later age in these liminal zones. This study, set in a peripheral ward of Bengaluru, focuses on the experiences of exclusion/inclusion of socio-economically marginalised older adults and their access to work, health care and leisure. The research uses a multidimensional old-age exclusion framework to highlight how the domains of neighbourhood, material resources, mobility infrastructure and social relations influence the risks for social exclusion. We use a qualitative approach by combining behavioural mapping and in-depth interviews. Our findings highlight some ways in which institutionalised exclusion from civic infrastructure accentuates the precariousness of ageing. The rigidity of traditional hierarchies in peri-urban regions has meant that older adults who were poor, women and belonged to marginalised castes experience constrained mobilities to access labour markets, health care and social life, compounding their place-based exclusion. Despite social networks and solidarities, older adults on the periphery faced individualisation of risks while trying to access the basic amenities, thereby falling between the gap of the urban–rural milieu and governance. Age-friendly cities need to accommodate such hybrid transitionary urban processes, in the absence of which, active ageing in these rising peripheries can be impeded.

Unpacking the role of transport inequalities among older adults for accessing healthcare in Bengaluru, India

Mobility, access to transport and healthcare play a crucial part in healthy ageing. However, these often posechallenges for older adults in the global South. This study applies the three concepts of 'motility' (access, competence and appropriation), to explore transport inequalities and barriers to access healthcare services for older adults in Bengaluru, India. The paper draws on interviews with sixty adults, aged 50 years and over, residing in urban Bengaluru. A semi-structured in-depth interview guide was employed to explore the transport inequalities. Applying thematic analysis, we present the mobility and transport barriers to access healthcare. Restricted access to healthcare services due to unavailable and unaffordable transportation resulted in missed appointments, delayed care and deterioration of health conditions. To cope with the barriers, older adults often visited less specialised clinics for regular check-ups and those with financial constraints resorted to self-medication. These actions further deteriorated health and led to adverse health outcomes. Our findings suggest that integrated health and transport policies must be designed to ensure equitable access to transportation services. Enabling older adults to have more independent lives and improve access to preventive healthcare is essential for better health outcomes.