Japan has almost the highest proportion of old people in the world, writes David McNeill. How it copes with rising rates of dementia and other problems of ageing will be closely watched.

Perched on a hill in the port city of Yokohama, the Wakabadai apartment complex is a microcosm of Japan’s profound demographic challenges. Built four decades ago, when the economy boomed and the population overflowed from nearby Tokyo, it once housed thousands of young families. Today, the elderly vastly outnumber children: 45 per cent of the 15,000 residents are over 60. Many live alone, and wander the corridors during the day.

Japan is one of the world’s oldest societies, with a median age of 46.5 years. Only Monaco, with its large influx of elderly retirees, is more senior. This ‘catastrophic success’ at lengthening life expectancy raises troubling questions that the rest of the world must also face, says Florian Coulmas, an expert on the demographics of ageing. Who should accept responsibility for people unable to articulate their interests or care for themselves?

Roughly 10,000 dementia sufferers go missing in Japan every year and hundreds turn up dead, or not at all. Those who stroll into the path of a speeding train can suffer a posthumous indignity: a bill for the cost of the accident. One man who lost his father this way recalls staring in disbelief at a carefully itemised invoice from the railway company for ¥7.2 million ($63,400). Late settlements accrued compound interest.

Over five million elderly Japanese suffer from dementia. By mid-century, an alarming 10 per cent of the population could have the condition, warns Dr Toshiharu Ninomiya of Kyushu University. Most of these people live at home, putting enormous strain on relatives. A survey released in 2016 says three-quarters of people looking after elderly family members are at their wits’ end. Many have considered suicide, or worse: in 2015 Japanese police recorded 44 cases of murder, or attempted murder, in such homes.

Japan has made great strides in dealing with its inverted population pyramid. Retirement has been delayed, and the elderly increasingly drive taxis, guard banks and serve in supermarkets. Innovative commercial approaches to dealing with senility flourish. Convenience stores, ubiquitous throughout Japan, have become formal safe havens for wandering pensioners. Phone and car companies have created products with simpler, more intuitive functions.

At the Wakabadai complex, residents have been encouraged to keep an eye on their elderly neighbours to prevent what Japan calls kodokushi (people dying alone). The local authorities are trying to attract more young folk and build stronger community ties. Exercise classes and cognitive therapy are provided to coax older people out of their high-rise flats.

About 12.6 million Japanese aged 60 or older now opt to keep working, up from 8.7 million in 2000. Two-thirds of Japan’s over-65s say they want to stay gainfully employed, according to a government survey. The greying of the workforce is led from the top: the country’s growing ranks of elderly bosses include Fujio Mitarai (81), chairman and CEO of Canon, a camera-maker, and Masamoto Yashiro (87), the chairman and CEO of Shinsei Bank. Tsuneo Watanabe, editor-in-chief of the world’s most-read newspaper, Yomiuri Shimbun, is 90.

Policy and spending lag, however, for those no longer able to work. Funding on long-term care for the elderly, at 1.2 per cent of GDP, is below other rich countries, according to the OECD. One reason is that relatives are still overwhelmingly viewed as the main caregivers in Japan, says Miharu Nakanishi of the Tokyo Metropolitan Institute of Medical Science. Family members often quit work and plough through savings to look after senile parents.

The Wakabadai apartment complex in Yokohama, Japan, home to many residents over 60
The Wakabadai apartment complex in Yokohama, Japan, home to many residents over 60

Professional care might help, but for an acute shortage of nurses. About 130,000 elderly people could be left without beds in care homes in Tokyo alone by 2025, predicts one report. Nursing is poorly paid, and turnover is high. A think tank has floated one desperate solution: moving the elderly out of the capital to less-populated regions. The Japan Policy Council said the task of looking after 5.7 million very old people in Tokyo will overwhelm already stretched services, but the idea raised eyebrows: government ministers were forced to deny that they were bringing back ubasute, the mythical ancient custom of dumping the elderly on mountains to die.

OLD HAND: Japan's elderly high-ranking bosses include Fujio Mitarai (81), chairman and CEO of Canon
OLD HAND: Japan’s elderly high-ranking bosses include Fujio Mitarai (81), chairman and CEO of Canon

More radical approaches are almost certainly on the way. Able-bodied seniors could help relieve a chronic shortage of nursing care for more dependent ones, says McKinsey, a consulting company. Putting 10 per cent of unemployed seniors to work several days a week could give the country 700,000 additional caregivers by 2025, it says in a recent report: ‘One incentive might be to give them priority in admissions to nursing facilities once their turn comes.’

These challenges, and the fear that dementia sufferers might harm not just themselves but others, are focusing minds. Total traffic deaths in Japan have roughly halved over the last two decades, for example, but the number of fatalities involving the over-65s is rising. Shinzo Abe, the Prime Minister, has leapt into action, saying Japan will become a global model for dealing with senility. Among his pledges is better funding for Alzheimer’s research, and more money to train 60,000 doctors in early diagnosis of the disease.

Critics say more could be done. The government still shows little sign of lowering the immigration drawbridge to foreign care workers, who must pass absurdly tough tests. Nakanishi says the entire national strategy for dealing with dementia is fragmented, leaving many elderly stranded between home and institutional care. Above all, there is little government consultation with people who actually take care of the elderly.

Last year, a landmark legal ruling exposed some of the suffering borne silently behind family walls. The Supreme Court threw out an attempt by Japan Railway Co to claim for the costs of an accident involving an elderly man. The company argued that the man’s son and wife were responsible because they ‘did not fulfil their obligation’ to monitor him. It was the first time the court had ruled on the liability of families in dementia cases.

At the very least, says Teruhiko Asaoka, the family’s lawyer, train companies may think twice before suing already pressed relatives. The bigger impact, he predicts, is that Japan will have to look more closely at the burden it imposes on families. The victim, who was 91 when he died, slipped out the door and stumbled onto the tracks after his elderly wife dozed off. A local court had earlier ruled that if his relatives were unable to look after him around the clock, they should have sought professional help.

What many do not realise, says the victim’s son, who asked to remain anonymous, is how expensive and exhausting it is looking after parents who have become children.  Before slipping into senility, his father was kind, smart and funny, he recalls. He deserved better than the ending in life he got. ‘At least his death has forced society to think more carefully about how it treats such people,’ he says.

The Supreme Court ruling exposed a crucial legal question, says Coulmas. ‘State or family – who should and who will accept responsibility and care for legions of people unable, to various degrees, to articulate their interests and care for themselves? Lawmakers will have to provide an answer that is socially acceptable.’ Japan, he says, is ahead of the pack, but before long Western European countries, Italy and Germany in particular, will face similar problems.

Dr David McNeill writes for The Economist, The Irish Times and other international publications, and is co-author of Strong in the Rain, survivors’ stories from Japan’s 2011 earthquake, tsunami and nuclear disaster. He teaches media and politics at Sophia University in Tokyo. Previously he taught at Liverpool John Moores University.

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