Aging in place, stranded in space: An analysis of health care access via public transportation in Elliot Lake

The population of Elliot Lake in Northern Ontario, Canada is old and getting older, and small and getting smaller. It is Canada’s most severely shrinking city and is home to the nation’s third oldest population. In 2017, the city published a five-year Age-Friendly Action Plan to improve Elliot Lake in eight domains, including health care and transportation. This study assesses older adult access to health care facilities via Elliot Lake’s existing public transportation service. We outlined the geography of health care facilities in Elliot Lake and determined that the community’s two main health care facilities were not within walking distance of most neighbourhoods with large older adult populations. Through a buffer analysis, we demonstrated that 76% of older adults live within 150 m of a bus stop, while 96% live within 400 m of a bus stop. Using the novel Older Persons Walking and Transit Audit, we found that the city’s inconsistent use of age-friendly features along walking routes and at bus stops, such as bus shelters, sidewalks, and adequate lighting, discourages older adult public transportation use and creates barriers to accessing health care. Finally, we developed municipal-level recommendations to improve health care access via public transportation in Elliot Lake.