Aging Populations: Developing Solutions
he following is the summary of a breakout session that was part of the 2018 Annual Conference.
- Moderator: Leona Hiraoka, President & CEO, Keiro
- Mikio Aoki, Director of Commercialisation of Public Services, Ministry of Economy, Trade, and Industry (METI), Japan
- Ryuji “Rick” Watanabe, Advisor, ASO Corporation (Tokyo, Japan)
Ms. Leona Hiraoka, President and CEO of Keiro in Los Angeles, California, welcomed the participants to the Breakout Panel Discussion of Aging Populations: Developing Solutions and introduced the members of the panel. Ms. Hiraoka explained that due to the ageing lifespans of populations in both Japan and the United States, society must prepare for the economic, social and individual impacts of the change in demographics. As a result of breakthroughs and advancements in technology, our lifespans may exceed our ability to ensure an adequate quality of life.
In the United States, there are 1.5 million Japanese Americans. The demographic is most numerous in the 18-to-64-year-old range. The United States needs to prepare for this multitude of generations which will become the “older adults in the United States.” The Japanese American population represents a larger percentage of the total US population of which is over 65 years of age.
The Japanese American population is unique regarding its racial composition, proportion of elderly, location of birth and number of languages spoken. There are concerns for the future ageing Japanese American generation pertaining to the services and culturally-sensitive care.
Social isolation is becoming a problem worldwide which is having huge financial and economic impact. As well as this, there an impact on the families of elderly persons regarding careers, finances and making their own families. In Japan, the elderly often dies alone or find new ways to socialize.
In the United States, research into social isolation is being done by Dr. Carla Perissinotto with Keiro. Social isolation is often defined as a quantifiable lack of human contact, however, Dr. Perissinotto, a pioneer in the field, suggests it is subjective. An AARP study shows that social isolation can be seen in 17 percent of American aged 50 and over. Social isolation has been shown to be dangerous with increased risks of: dementia, diabetes, cardiovascular disease, longer hospitalizations, nursing home admission, decline in function, and death. The costs associated with the medical care and institutional admission of socially isolated persons have significantly increased.
Keiro is an organization founded in Los Angeles by the Japanese American community. To serve the people in the Los Angeles, Orange and Ventura counties, it has decided to facilitate solutions for “aging at home.” Keiro places emphasis on the care-giving generation. It has a palliative care program directed at the Japanese community along with a telephone phone network which helps to re-engage socially-isolated adults.
Mr. Mikio Aoki, Director of Commercialisation of Pubic Services, Ministry of Ministry of Economy, Trade and Industry (METI), presented on insights on positive solutions and innovations for aging populations in Japan. The remit of healthcare solutions lies with METI because the Ministry of Health, Labour and Welfare is a regulator, whereas METI functions as an industry promoter which responds to the business requirements of healthcare.
Japan had the largest proportion of ageing population in 2015, with Germany and Italy having a similar demographic. In Japan, the proportion of people aged 65 or older is 26 percent, which is called a “super-aged society.” The historic proportion of young people has been displaced by aged people in the 21st century. Therefore, Japan needs to restructure its legacy social security system.
People who are independent at the age of 65 continue to lead a healthy life, whereas those who are less independent will lead a less healthy life. While there is nominal difference between males and females; politicians, chief executives and farmers form a group shown to be exceptional as they are healthy throughout their entire lives. Thus, social participation and physical activity are key factors for a healthy life. People desire a long and active life. Although, care services are inevitably needed, Japan seeks to shorten the period in which care is provided.
The policy for prevention and life-support-type health care systems is shifting from the orientation of traditional medicine on diseases with single-target agents to prevention and lifestyle intervention. Effectives of drug and treatment satisfaction is high for diseases with single-target agents. However, both effectiveness of drugs and treatment are low for lifestyle and aging-related diseases. Thus, prevention could be effectual for lifestyle and aging-related diseases. The data of the transition of symptoms from a healthy individual to death show that prevention is vital. Effective prevention remains disputed among the medical community and lifestyle industry. Therefore, lifestyle data and medical data must be integrated.
The issue of an aging society can be solved by innovation. A new ultrasound technology can predict urination timing. As a consequence, elderly people can be more mobile and regain confidence. In addition, AI technology can be used to help with seeing, touching and talking with dementia patients. Eyewear with video capabilities can be used to detect eye contact and the direction that caregivers are looking when communicating with the afflicted. The independence of the elderly in Japan trends towards dependence overtime. Thus, treatment should also encourage independence. AI can be used to identify individualized and effective treatments through big data.
Concerning dementia related diseases, Machida City assigned dementia supporters from a pool of volunteer students who take photographs of suspected dementia patients on the streets. These photographs are compared with an AI database. This technology was developed through an open innovation platform named Acorn. Furthermore, a study of Hisayama, Fukuoka showed that the prevalence of Alzheimer’s disease significantly increases with time. In addition, a cohort study in Japan highlighted that sugar metabolism was a risk factor in Alzheimer’s disease. The Hisayama study also showed that the Mediterranean diet, tofu and dairy are beneficial for reducing the damage of Alzheimer’s whereas rice was detrimental, in accordance with the aforementioned cohort study findings. METI aims to promote more of these kinds of studies by collecting technology and availing the use of facilities. These studies will be connected and the data shared as dementia is an issue worldwide with treatments focused on prevention and communication.
Mr. Ryuji “Rick” Watanabe, Advisor, ASO Corporation, Tokyo, Japan, presented the challenges in dealing with the current and future aging population in Iizuka, Fukuoka. Mr. Watanabe began by explaining the history and development of ASO Corporation. Currently, the ASO Corporation owns and operates various medical facilities and other healthcare services companies.
Mr. Watanabe highlighted the cultural and practical differences in medical care and insurance between Japan and the United States. Another major consideration is the advanced nature of the aging population in Japan. The location and background of Iizuka were introduced by Mr. Watanabe.
Although the population of Iizuka is aging, improvements to an elderly person’s daily life is beneficial in the stage before they require care. The city provides testing and classes for caregivers and the elderly to correctly identify this period. Nowadays, medical care can no longer be completed in hospital. Moreover, the shrinking size of Japanese families also compounds the issue of aging at home and receiving care from family members.
The ASO hospital in Iizuka is a large flagship hospital which covers general and acute care. It collaborates with other local hospitals to bring home visits and end-of-life care. In 2018, the ASO Group formed the group Community Hospital Japan to serve its region where its patients can live as they choose.
Along with palliative care and community hospitals, ASO Group provides opportunities for innovation and collaboration to identify unrecognized needs. This collaboration is expanding through the Iizuka region. With the facilities and services of the Iizuka Hospital, Kaita Hospital, home care services and Iizuka Medicolabo, ASO Group provides an integrated care model, alongside a multitude of other businesses, such as medical education, entertainment services, real estate, construction and energy.
A member of the audience asked if other Japanese policies have been implemented to make systematic change in communities.
Mr. Aoki suggested that the policy was not single-issue, rather a complete restructuring was needed. First, Japan must change its labor norms of lifelong employment as social engagement is needed for individuals to remain healthy after 65 years old. However, the pension system does not incentivize outward engagement or employment. In addition, the elderly is availed of discounts of medical costs which burden the workforce. The government is aiming for “society 5.0” and the “fourth industrial revolution.” It seeks to solve social problems using IT technology, particularly in healthcare.
A second member of the audience questioned the direction of causation of loneliness and higher costs in medical care.
Ms. Hiraoka answered that currently researchers are investigating that very question.
Mr. Watanabe noted the historical and cultural differences between Japan and the United States towards individuality and family ties. Advances in community led initiatives for frailty checks may be of benefit.
Ms. Hiraoka asked for clarification of baseline medical coverage between Japan and the United States.
Mr. Watanabe explained that Japan offers a care management system which is enacted once a patient requests it. They are appointed a care manager who interviews them at their home and decides the level of care needed. There are a total of seven levels and each level has a different level of monetary support.
Ms. Hiraoka stated that in the United States, problems of interaction may be solved even from the level of assistance provided at level one in Japan which includes food shopping assistance.
Another member of the audience inquired as to the specific constituent of rice that contributes to dementia, and if there were similarities with bread and pasta.
Mr. Aoki stated that as it was a cohort study the mechanism was not identified, however a connection may lie between dementia and diabetes.
A different member of the audience warned of the possible interpretation of innovation to mean technological innovation as often technological improvements, in fact, proliferate loneliness.
Another individual from the audience asked if the Kaita Hospital was profitable with 40 primary care doctors.
Mr. Watanabe claimed that the Kaita Hospital was profitable because it fulfills the requirements of society. Furthermore, the real benefit of expensive technology must be addressed. Mr. Watanabe agreed the comments that innovation can not only come from technology.
Mr. Aoki added that the rate of investment has been raised which will lead to more home visits. Independent nurses who visit communities are another new voluntary initiative.