Non-collision injuries on buses and mobility loss in later life: An ecological narrative review

Public transportation is essential for older adults' mobility, access to health services, autonomy, and social participation, yet non-collision injuries and falls inside buses represent a major and under-recognized barrier to its use in later life. Contributing factors are well documented separately, but how they interact to create compounded barriers remains poorly understood. Without an integrative approach, single-factor interventions are unlikely to reduce injury risk or prevent mobility loss. This review adopts an ecological framework of five thematic clusters to synthesize these interactions. Methods This structured narrative review searched PubMed, AgeLine, Web of Science, and Scopus alongside Google Scholar, covering 2000 to 2026. Non-collision injuries and falls in public buses were examined through five thematic clusters: vehicle interior design; driver behavior and operations; instability, fear, and avoidance; digital ticketing and information access; and ecological determinants and transport equity. After deduplication, 31 references were retained. Papers covering multiple clusters formed the basis for the ecological synthesis. Results No retained paper covered all five thematic clusters. Coverage reached a maximum of two, most commonly vehicle interior design and driver behavior. Social determinants and transport equity appeared exclusively in gerontology literature, absent from transport engineering databases. Digital and information barriers were represented by no retained paper, confirming that a full ecological synthesis has never been attempted. Conclusions Non-collision injuries are predictable and preventable yet remain under-recognized in transport safety frameworks. Age-inclusive transportation requires reframing interior stability as a core accessibility dimension through proactive universal design, reflecting a broader societal commitment to transport equity.