Introduction
The Irish population is getting older, and so too is the motorcyclist population. In Ireland although motorcycles represent a very small proportion of the total number of licensed vehicles (1.4%)1, motorcyclists are consistently over represented in road fatality and injury statistics. In 2014, motorcyclist fatalities in Ireland were 28.45 times greater than those of private car drivers and passengers per mile travelled1. The total number of licensed vehicles recorded on Irish roads on 31st December 2015 was 2,570,294, of those 36,974 were motorcycles, rising from 26,085 in 1985 and 30,638 in 20001. However, growth in motorcycle popularity is slowing in recent years and the number of motorcycles being registered for the first time is reducing. In 2015, only 2830 motorcycles were registered for the first time compared to 7420 in 20072. Older car drivers have an excellent safety record3: older motorcyclists, however, appear to be a particularly vulnerable group and have attracted less recognition. Several studies internationally have documented a rise in fatalities and injuries in older motorcyclists4,5,6. Motorcycling has changed significantly over the last few decades. More people are riding for pleasure rather than for commuting or transport7. Older motorcyclists generally have greater purchasing power and choose to ride more expensive larger capacity engine motorcycles. A substantial proportion of this group are returning riders, who despite presumed depreciation of their riding skills in the intervening years, resume motorcycling on more powerful motorcycles than they ever rode previously. We sought to examine older motorcyclists in Ireland: to see if older motorcyclists are particularly vulnerable road users, if older motorcyclists are being affected by a disproportionate rise in injuries and fatalities, as in other countries8,4,5 and what factors could potentially be responsible for this. We reviewed the existing literature relating to this subject and we collected and examined data from the Central Statistics Office, the Road Safety Authority and Irish hospital information recorded by HIPE.
Methods
We obtained data from the Healthcare Pricing Office which records details of Irish hospital admissions regarding hospitalised motorcyclists including type of injury sustained, length of stay, and fatality rate. We also analysed data provided by the Central Statistics Office and the Road Safety Authority relating to the number of registered motorcycles, engine capacity of registered motorcycles, the type and nature of collisions, and injury and fatality rates per age. In the previous literature, we reviewed, there was considerable variability in the definition of an “older motorcyclist” with different papers considering riders aged from above 40 to above 65 to be “older motorcyclists”. For the purposes of this study, we generally considered riders aged 55 and over to be “older motorcyclists”.
Results
Fatalities and Injuries
In developed countries in recent years, the proportion of injuries and fatalities involving older motorcyclists has increased4,5,6. The majority of fatal collisions on Irish roads still involve younger motorcyclists9. The number of older Irish motorcyclist fatalities is low so the conclusions we can draw are limited. While fatalities involving younger riders appear to be progressively declining, the number of older motorcyclist fatalities is relatively constant9 (see figure 1). From 2005 to 2007, there were 28 fatalities in riders ≤24, compared to 6 aged ≥55. From 2012 to 2014, there were 16 fatalities in riders ≤24 compared to 6 aged ≥55. The vast majority of motorcyclist fatalities, both young and old, are men. Between 2007 and 2015, 12 female motorcyclists (3 of whom were ≥55) died in motorcycle accidents compared to 181 men9.
Non-fatal injuries are similarly less common in older age groups in Ireland. However, the number of non-fatal injuries is increasing disproportionately in older motorcyclists. In 2005, 17 motorcyclists over the age of 55 were injured compared to 31 in 201210 (see figure 2). This is similar to trends in other developed countries. In the EU, between 2004 and 2013, motorcyclists fatalities fell in all age groups except the ≥50 age group11. In a study of 1.4 million motorcyclists attending US emergency departments, the percentage of injuries in motorcyclists aged ≥65 increased from 2.96% in 2001 to 7.1% in 20086.
Injury Severity
Many studies in other countries have found older motorcyclists have higher mortalities and suffer more severe injuries. They have higher injury severity scores, longer lengths of stay in hospital, longer lengths of stay in ICU, more complications and increased complexity of fractures5,6,12,13. 992 motorcyclists were hospitalised in Ireland between 2012 and 2014. Motorcyclists aged between 30 and 49 years and ≥50 had a longer length of stay compared to riders <30, but there was no significant difference between the ≥50 group and the 30-49 group. In 2014, the mean length of stay was 8.29 days for the ≥50 group, 7.5 days for the 30-49 group and just 3.75 days for the <30 group14.
Injury Pattern
In Ireland, the most common location of injury is the knee and lower leg followed by injuries to the head and neck, shoulder and upper extremity, abdomen and lower arm14. Injuries to the abdomen/lower back, hip and thigh and head or neck are associated with the longest length of stay in Ireland. Other studies have shown that head, thoracic and abdominal injuries are associated with the greatest severity and mortality5,6, . Older motorcyclists are significantly more likely than younger riders to sustain thoracic and head injuries5,15. Riders ≥40 are nearly twice as likely to die from head injuries and abdominal injuries13. Injuries at all sites are more severe in older adults5.
Types of crash
In Ireland, older motorcyclists are more likely to be fatally injured in a collision with another vehicle, rather than a stationary object, compared to younger motorcyclists. Between 2007 and 2015, 4 motorcyclists aged ≥55 died in single vehicle collisions compared to 9 ≤24 and 16 aged 25 to 34 (see tables 1 and 2)9. Single vehicle collisions are more likely to be the result of rider error16, suggesting that older motorcyclists are generally safer riders.
Larger motorcycles
In Ireland, as in most other developed countries7 larger motorcycles have become more popular. The percentage of motorcycles with an engine capacity of 750cc or greater increased from 39.6% in 2007 to 46.7% in 20152. Approximately two thirds of motorcycles registered in the last 8 years have been greater than 501 cc. Other studies have shown that older adults are more likely to purchase motorcycles with large engines than young adults13. Older motorcyclists generally have greater purchasing power and can afford the more expensive powerful motorcycles. In addition, many older motorcyclists ride their vehicles for leisure purposes rather than commuting and choose more powerful motorcycles for this purpose7. Motorcycles with larger capacity engines are likely associated with higher crash rates and more injuries17.
Discussion
Older riders are still less likely to be involved in a collision compared to younger riders. However, while injuries in the overall motorcyclist population have declined in recent years, injuries have risen in older motorcyclists. Motorcycle fatalities in older motorcyclists are low, so conclusions are limited, but while younger motorcyclist fatalities are falling, older motorcyclist fatalities are relatively constant. National licensing data does not indicate the number of motorcycle licence holders who are actively riding, and therefore it is difficult to quantify the number of older motorcyclists on Irish roads. Much of the increase in older motorcyclist injuries is likely due to the increased proportion of older motorcyclists on the road, as is the case in other countries18. Irish licensing data does not indicate whether motorcycle licence holders are actively riding or not and we were unable to ascertain the number of motorcyclists of different age groups actively motorcycling. It would be useful if this data were available to put the increased proportion of older motorcyclist injuries into the context of the increasing age of motorcyclists in general.
Older motorcyclists that crash, suffer more serious injuries with longer lengths of stay in hospital compared to younger riders. Physiologic changes associated with aging may increase the severity of injuries sustained by older motorcyclists and increase the likelihood of mortality. Loss of bone strength, decreased chest wall elasticity and reduced physiological reserve are associated with more severe injuries in trauma6. Many older motorcyclists have age related comorbidities which are known to predict poorer outcomes in trauma patients5. Older motorcyclists are more likely to ride for recreational purposes. Thus, they are more likely to crash on higher speed roadways and in rural areas, which may also partially explain the greater severity of their injuries. Recreational riding is associated with double the crash risk of commuting or general transport19. In Ireland, the majority of fatal motorcyclist collisions occur at the weekend during summer months20. Larger motorcycles are becoming more common among older motorcyclists. Larger capacity engines have been associated with a higher risk of crashing and greater injury severity13. It is difficult to assess whether the riding habits of those riding powerful motorcycles or the properties of the motorcycles themselves are associated with the increased crash and injury severity risk. Further evaluation of the impact of more powerful motorcycles in older motorcyclist fatalities would be worthwhile. Using power to weight ratio, rather than engine displacement would more accurately reflect how powerful a motorcycle is21.
It is likely that a significant proportion of older motorcyclists in Ireland are returning riders, who rode in their youth and resume riding later in life. These motorcyclists tend to purchase motorcycles with large capacity engines in spite of a possible loss of skill in the intervening years7, ride fewer miles per week and are more likely to ride for recreational purposes22. National licensing data do not differentiate between continuing and returning riders. Further study of this subgroup of older motorcyclists would be useful to evaluate their impact on trends in injuries and fatalities. It has been suggested that older motorcyclists and older car drivers are more likely to crash due to changes associated with aging including poorer vision, balance and reaction times. There is no evidence to this and indeed, both older motorcyclists and older car drivers have been consistently found to be less likely to crash compared to their younger counterparts1,3.
Training courses for older motorcyclists and returning riders may reduce crashes by improving riders’ skills and promoting safe riding behaviour, although there is a lack of firm evidence to support this23. Many interventions have been demonstrated to be effective in preventing injuries and fatalities in both younger and older motorcyclists: road infrastructure and conditions, wearing helmets, motorcycle and rider conspicuity, enforcing speeding and alcohol laws and electronic aids such as ABS5,24,25. Stricter licensing laws have been implemented but these may decrease crashes by reducing the number of motorcyclists on the road rather than making motorcyclists safer riders23. The process of obtaining a licence to ride a motorcycle in Ireland is now much more convoluted and expensive which likely discourages potential younger riders from motorcycling and has contributed to the proportional increase in older compared to younger Irish motorcyclists. Motorcyclists are more vulnerable road users than car occupants. Both the vulnerability of older motorcyclists and the importance of motorcycling as a leisure pursuit and means of transport should be acknowledged. Irish road safety strategies and trauma services need to develop preventive and treatment strategies to protect the growing cohort of older motorcyclists to ensure they can travel on our roads safely.
Correspondence:
Prof O’Neill, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin D24 NR0A, Ireland:
Email: [email protected]
Phone: +35314143215
Conflicts of interest:
No conflict of interest to declare
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