Social isolation and physical activity mediate associations between free bus travel and wellbeing among older adults in England

Background: Aims of this study were: (i) to examine relationships between free bus travel and wellbeing, and (ii) to assess the extent to which these associations can be explained by two key potential mediators: social isolation and physical activity. Methods: Data were from the English Longitudinal Study of Ageing (n=5,861). Linear regression models tested associations between (i) concessionary bus pass (CBP) ownership and (ii) frequency of CBP use and three measures of wellbeing (quality of life, life satisfaction, depressive symptoms), adjusting for age, sex, marital status, socioeconomic status and limiting long-standing illness. Mediation analyses tested the role of (i) social isolation and (ii) physical activity in each association between CBP ownership/use and wellbeing. Results: Ownership and use of a CBP was significantly associated with better quality of life (both p<0.001), higher life satisfaction (both p<0.01) and fewer depressive symptoms (both p<0.01). Mediation models revealed significant indirect associations of CBP ownership (all p<0.001) and use (all p<0.05) via social isolation on wellbeing. There were also significant indirect associations of CBP ownership (all p<0.01) and use (all p<0.001) via physical activity on wellbeing. Social isolation explained 7.7-20.1% of the total association between free bus travel and wellbeing, and physical activity explained 9.0-17.4%. Conclusions: Ownership and use of a CBP are associated with better quality of life, higher life satisfaction, and fewer depressive symptoms in older adults in England. Associations between free bus travel and wellbeing are partly explained by an increase in physical activity and a reduction in social isolation.