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Extending Healthy Longevity in Japan

As a rapidly aging society, Japan is facing a supply and demand imbalance that can lead to deterioration of health services. A community-based approach that aims to extend healthy longevity among seniors would help to prolong their need to seek specialized care in overstretched hospital settings.
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Katsura Tsuno (second from left) discussing "Integrating Community Care in Aging Societies to Achieve Healthy Longevity" at the 2023 AVPN conference

Japan, like much of East Asia, is rapidly becoming an aging society. By 2040, the percentage of Japanese people aged 65 and over is predicted to reach 35%—the highest in the country’s history—while the working population will shrink to 54%. According to high-level research conducted by the Johnson & Johnson Center for Health Worker Innovation (the Center) the growing elderly population and declining birthrate are accelerating the risk of an imbalance between supply and demand in the country’s health system, leading to a rapid deterioration of health services.

The research found that Japan’s healthcare-related social issues will increase as 2040 approaches and birthrate declines. These issues include decreased contact between the elderly and health workers, leading to missed opportunities for disease prevention; a growing health worker shortage; accelerated social isolation among the elderly; and increased social security costs, ultimately risking the sustainability of the entire health system.

Managing these demands requires a change of approach to the elderly population: positioning them not as a burden but instead as active contributors to a vibrant society. To do this, we need to engage community-based health workers, including nurses, to support older citizens’ physical health and psychosocial well-being, thereby increasing healthy longevity.

What is healthy longevity?

Healthy longevity is an indicator that measures a person’s average life expectancy minus the period they spend in a cared-for state (such as being bedridden or having dementia). Thus, health longevity is the period when people can be independent from any social support or care from family members or professional caregivers. At present in Japan, healthy longevity is roughly 8-12 years shorter than life expectancy.

By extending healthy longevity, we can create societies where people live healthy lives, reduce medical and nursing care expenses, increase participation by older people in social activities, mitigate the burden on declining workforces, and lower the financial burden on social security systems. In this way, we can both strengthen supply and control demand, easing the pressure on health systems.

The role of community-based nurses in extending healthy longevity

In order to extend healthy longevity, we must encourage the adoption of a healthy lifestyle among the elderly and introduce preventative care for disease, frailty and mental well-being.

With institution-based health workers and nursing care facilities under increasing pressure, community-based nurses have a crucial role to play in maintaining and improving the health of Japan’s elderly population. Although not officially engaged in Japan’s public health system, community-based nurses are deeply integrated into the communities they serve and coordinate closely with public health centers, clinics and local governments. By diversifying the work of these health workers to include local healthcare services for the elderly, we can create opportunities to maintain strong physical and psychosocial health, mitigate social isolation and prevent the onset of frailty.

While there is currently a shortage of community-based nurses in Japan, research conducted by the Center found that there is an opportunity to increase that number by engaging young nurses who have left hospital-based roles due to lifestyle conflicts and by mobilizing retired nurses who are willing to play community roles as a second career. Furthermore, healthy and active senior citizens can be engaged as peer supporters.

At the same time as improving physical health, we can boost psychosocial health and reduce loneliness by providing community-based opportunities for the elderly to volunteer, learn and engage as productive members of a vibrant society.

Programs putting this approach into practice

At the Johnson & Johnson Center for Health Worker Innovation, we aim to prove the validity of this approach to healthy longevity by convening actors already working in the space. For example, the Center was delighted to support the AVPN Global Conference held in Kuala Lumpur last month, where I joined a panel discussion on Integrating Community Care in Aging Societies to Achieve Healthy Longevity.

Other participants on the panel included Akiko Yata, founder of Japanese social startup Community Nurse Company, which uses familiar neighborhood venues such as cafes, gas stations, and mobile vendors, to engage and provide preventative care to elderly people who might otherwise not have regular access to healthcare. “Our team is challenged to make community-based nursing a part of our society, with the aim of creating ‘daily joys and fun’ together as a member of the community and achieving physical and mental health and security in the process,” said Yata.

Community Nurse Company works seamlessly with local citizens, stakeholders and healthcare systems to innovate and create new service models in each community, contributing to the well-being and health of the lonely. Community nurses who no longer work in medical institutions, community residents, the elderly and retired nurses can also participate in Community Nurse Company’s programs as facilitators.

We were also joined on the panel by Irene So, Executive Director of ZeShan Foundation, which focuses on identifying untapped resources and capacities in communities around Hong Kong, which also has an aging population, predicted to reach 40.6% people aged 65 and over by 2050. The foundation’s mission is to increase elderly people’s capacity to take charge of their own health via initiatives such as engaging volunteers to deliver basic healthcare supplies and provide simple check-ups to elderly people who live in difficult-to-reach villages in the region’s notoriously steep mountains.

As a rapidly aging society, the current approach in Japan’s healthcare system that is mostly structured to support those already sick and frail is a high-risk model that is not sustainable when we are already facing a health workforce shortage. A preventative community-based approach that focuses on maintaining health and wellness among healthy and active seniors also addresses the rising challenges of social aging and loneliness. By engaging more community-based nurses we can help keep our elders vibrant and connected and prolong their need to seek specialized care in overstretched hospital settings.