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Geriatrics and Older People in Japan

Department of Geriatric and Respiratory Medicine, Tohoku University School of Medicine, Sendai, Japan.

Address correspondence to Hidetada Sasaki, Department of Geriatric and Respiratory Medicine, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, 980-8574 Japan. E-mail: dept{at}geriatr.med.tohoku.ac.jp

I enjoyed reading "A Brief History of Geriatrics" (1). I understand why geriatrics is one of the most interesting subjects since the ancient era, and appreciate the efforts of people to establish gerontology. But I found little description about Japan. Therefore, I will comment on a brief history of Japanese geriatrics and conditions for Japanese older people.

In 1713, Mr. Ekken Kaibara published a book Yohjoh Kun (a bible for longevity) when he was 84 years old. He described many principles such as not eating to a full stomach. Since then, Japanese have seen succeeding principles of longevity written by him from generation to generation. Finally, Japan established the world's longest life span. Life expectancy is a final goal of human culture. It takes about 5 years to elongate life expectancy by 1 year (2). The average life expectancy of Japanese people is approximately 5 years longer than that of American people, which suggests a superb Japanese culture. Medical costs are 7% of the Gross National Product in Japan, which is about half of that in the United States. Furthermore, the number of disabled older people in Japan is much less than half of that in the United States (3). Oriental food may be another potential element for longevity, but daily stimulation such as talking, hearing, and enjoying a family-mediated society with a young generation, provided by their family in their remaining life, might be important for living longer. Longevity may decrease medical costs (4). A growing older population would not disturb Japanese productivity in the future (5). Therefore, historically Japan has developed an ideal social system for older people.

Revised public long-term care insurance began in 2000 in Japan. This new system has been thought to be a type of epoch-making revolution for Japanese women in that it can release family caregivers, in particular the oldest son's wife, from generations of strong Confucian-induced chains. However, this new insurance may produce similar results in the proportion of disabled older people in Japan being close to that of the United States in the near future.

Twenty medical universities have departments of geriatric medicine out of 80 medical universities in Japan. The National Institute of Longevity Science, started in March 2004, is the final and sixth national Institute of Medicine in Japan. The Japan Gerontological Society started in 1959, consisting of the Japanese Geriatric Society and the Japan Socio-Gerontological Society. Medical costs for older people have increased year by year and show a much higher rate of increase than the medical costs for people aged younger than 64 years. More people are interested in gerontology every year. Now the Japan Gerontological Society has 13,940 members and consists of six societies: Japanese Geriatric Society, Japan Socio-Gerontological Society, Japan Society for Biomedical Gerontology, Japanese Society of Gerondontology, Japanese Psychogeriatric Society, and Japan Society of Care Management.

Japan has published the second largest number of papers on aging research in the world, following the United States (6). Since life is limited, geriatrics itself is limited in establishing longevity (7). The science of care for older people should also focus on establishing further longevity and quality of life for older people in Japan.

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