Can electric-powered carts used in public transportation change long-term care risk among older adults?: evidence from a 2-year follow-up survey.

backgroundAmid rapid population aging in Japan, declining public transport use has created substantial barriers to older adults' mobility and independence. Such services address first-/last-mile gaps and enable social participation, which are key determinants of healthy aging in community settings. We examined whether Green Slow Mobility (GSM)-a low-speed electric cart used as community public transport-was followed by differences in future long-term care need.

methodsWe analyzed data from 599 community-dwelling older adults (59.3% women; mean age 74.6 years) in two municipalities with different service conditions: Oji town, where GSM operation was stably maintained, and Kawachinagano city, where GSM experienced a 4-month suspension followed by reduced frequency. At the 1-year survey, participants using GSM at least once per month were classified as users; others as nonusers. Long-term care risk was measured at baseline and at 2 years with a validated 0-48-point scale (higher scores indicate greater risk); the 2-year score served as the primary outcome. To address confounding, we conducted propensity-score matching on sex, age, and baseline risk (standardized difference < 0.25) and then estimated municipality-stratified linear regressions. Model 1 adjusted for baseline risk; Model 2 additionally adjusted for education, subjective economic status, household composition, and marital status. Robustness analyses applied stricter matching (standardized difference < 0.10).

resultsIn Oji town, users had significantly lower risk scores at 2 years than nonusers (B = - 2.31, 95% CI - 4.35 to - 0.28, p = 0.027). In Kawachinagano city, no significant difference was observed (B = 0.28, 95% CI - 0.74 to 1.32, p = 0.581). Findings were directionally consistent in the robustness analysis with stricter matching: Oji town B = - 2.72 (95% CI - 5.25 to - 0.18, p = 0.037); Kawachinagano city B = 0.38 (95% CI - 0.69 to 1.44, p = 0.490).

conclusionsUnder conditions of stable operation, regular GSM use was followed by lower long-term care risk among older adults. The absence of a difference in the municipality with suspended and reduced service suggests that continuity and frequency of operation are important factors. These results underscore the importance of maintaining reliable, sustainable community transport when designing mobility systems for super-aged societies.