Why Older Pedestrians Are More Likely to Die in Car Crashes

Older pedestrians are not injured by motor vehicles at a higher rate than younger pedestrians, according to 2023 data from the National Highway Traffic Safety Administration (NHTSA) — but they are more likely to die. Nearly 8,200 pedestrians 65 and older were injured that year, likely an undercount, and over 1,500 died. Their death rate is higher than the average for all ages.

Andrew Rundle, an epidemiologist at Columbia University, said older pedestrians move slower through intersections, have impaired hearing or vision, and react more slowly — making it harder to evade a turning, speeding or signal-running car. He said they also "have greater frailty, loss of muscle mass and fragile bones." Charles DiMaggio, an injury epidemiologist at the New York University Grossman School of Medicine, said a hip fracture that is "unfortunate" in a 45-year-old can be "tragic" in a 75-year-old.

After pedestrian deaths across all ages fell from 1975 to the mid-2000s, progress for older pedestrians has stalled for nearly 20 years; from 2008 through 2024 the fatality rate for pedestrians 70 and older has "stayed stubbornly flat," Rundle said. One factor may be exposure: the National Health and Aging Trends Study found the share of older adults walking for exercise climbed from 60% in 2011 to 65% in 2023.

A newer threat is the rapid growth of e-bikes — a category spanning 28-mph motor-assisted bicycles and heavier, faster machines the industry calls "e-motos." From 2019 to 2022 e-bike injury rates rose by nearly 300%, per an analysis of emergency room data in the American Journal of Public Health. Alcohol is a further factor: about a third of pedestrians killed at night, and about 20% killed by day, had blood alcohol levels indicating intoxication.

A recent study found the risk of older pedestrians dying in collisions was substantially greater in neighborhoods with a high density of walkable senior destinations, such as hospitals, pharmacies, and senior and community centers.