The relationship between cognitive functioning and street-crossing behaviours in adults : A systematic review and meta-analysis

Background: Pedestrians are vulnerable road users, with 26 % of global road fatalities being pedestrians (and other vulnerable road users). It is argued that pedestrians are involved in crashes due to errors in decision-making due to deficits in cognitive skills. To date there has limited research into pedestrian decision-making. There currently stands no theoretical model to help understand how cognitive function impacts on pedestrian street crossing decisions.

Objectives: The aim of this review was to synthesize the literature on the relationship between cognitive functioning and street-crossing behaviours, in two population groups: all adults, and older adults with or without a cognitive impairment.

Data sources: Published literature from three databases (PsycINFO, PubMed and Medline) was searched in February 2022. Studies were required to have investigated the relationship between cognitive functioning and street-crossing behaviours.

Results: Nine studies were identified for the systematic review, with four cognitive domains and nine street-crossing behaviours examined. Findings from the systematic review suggested that poorer processing speed and visual attention predicted increased unsafe street-crossing behaviours across the two population groups. Additionally, most studies demonstrated a non-significant relationship between executive function and street-crossing behaviours. Results from the meta-analysis on all adults, demonstrated a small effect size for the strength of the relationship between overall cognitive functioning and street-crossing behaviours, with stronger effects noted in individual domains of selective attention and inhibition.

Limitations: The small number of studies in this space combined with considerable variability in cognitive domains measured, assessment tools utilized, and street-crossing behaviours examined across studies limit conclusions about patterns of the relationship between cognitive functioning and pedestrian safety.

Conclusions: Findings highlight the important role of visual attention in enabling the engagement of safe street-crossing behaviours, which may assist in the development of targeted interventions to reduce risk of harm to pedestrians. Given unexpected findings regarding the influence of executive functioning, as well as limited findings on other cognitive domains such as mental status and memory, future research should aim to elucidate their role in pedestrian safety. Further research into cognitive function and pedestrian street crossing behaviours is critical if we are to develop a theoretical framework for how pedestrians make road-crossing decisions. If we can better understand the factors that influence street crossing decisions, roadway infrastructure and training programs can be developed to improve outcomes for this vulnerable population.

© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).