Session 2: Active ageing: Facilitating older persons ... · Strengthening of regional power and...

TOKYO METROPOLITAN INSTITUTE OF GERONTOLOGY

TOKYO METROPOLITAN INSTITUTE OF GERONTOLOGY Research Team for Social Participation and Community Health

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Masataka Kuraoka Ed.D.

Nov. 6-7, 2015

Session 2: Active ageing: Facilitating older persons’ participation in cultural, economic, political, and social life


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Instrumental Self-Maintenance

Intellectual Activity

Social Role

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72

74

76

78

80

82

84

86

88

90

92

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

Average Life Expectancy

Population (in thousands) 0～14 yrs old 15～64 yrs old 65 yrs or older

12.8%

62.1%

25.1%

39.9%

50.9%

9.1%

Women’s Average Life Expectancy

Men’s Average Life Expectancy

Source: National Institute of Population and Social Security Research,


3 3

0

10

20

30

40

50

60

70

80

¥0

¥200,000

¥400,000

¥600,000

¥800,000

¥1,000,000

¥1,200,000

19

75

19

76

19

77

19

78

19

79

19

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

SocialSecurityExpenditure

Social Security Expenditure for the elderly Social Security Expenditure for child and familyhundreds of million yen

%

32.9%

68.7%

3.8% 5.6%

Source: National Institute of Population and Social Security Research, “Social Security Expenditure for the elderly, fiscal years 1973-2009” and “Social Security Expenditure for the child and family, fiscal years 1975-2009”.


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Both sexes

Female Male Both sexes

Female Male Both sexes

Female Male

Japan 2013 84 87 80 26 29 23 75 78 72

2012 84 87 80 26 29 23 75 77 72

2000 81 85 78 25 27 22 73 76 70

1990 79 82 76 23 25 20

Source: Global Health Observatory (GHO) data


Article 2. (Basic Objective) The basic objective of measures for the aging society is to create a society as described in the following items. i) A fair and energetic society where people can be ensured that they have the opportunity of participating in diverse social activities or working throughout their lives. ii) A society where people are respected as important members throughout their lives where local communities are formed based on the spirit of independence and solidarity. iii) An affluent society where people can live peacefully and with fulfillment throughout their lives.

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Social Role

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The Basic Law on Measures for the Aged Society (Law No.129, 1995).

Article 3. (Duties of the National Government) Article 4. (Duties of Local Governments) Article 5. (Efforts of People) Article 6. (General Principles Concerning Measures) Article 7. (Legislative Measures, etc.)

General Principles Concerning Measures for the Aged Society


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General Principles Concerning Measures for the Aged Society (revised in 2012)

i. Change of Awareness on “Elderly Persons”—How to

conceptualize them

ii. Establishment of social security system for securing peace of mind in people’s old age

iii. Utilization of will and capability of the aged

iv. Strengthening of regional power and realization of stable regional society

v. Realization of safe and peaceful living environment

vi. Preparation for “Age of a 90-year lifespan” from the younger time and realization of generation circulation

Fundamental Principles


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Longer healthy life expectancy / Closing the health gap

Improving QOL Improving social environment

Preventing long-term care or delaying it

Social participation and contribution by the elderly

• Maintaining and promoting physical, mental and social functions

• Preventing geriatric syndrome such as dementia, locomotive syndrome, depressive mode, homeboundness, and low nutrition

• Good food and nutrition • Physical activity and strength • Social participation and social

network

<Individual behavior change> <Achieving good social environment>

• More opportunities for social participation, securing a fair society, improving access to support for health (public health, medical, and care services).

• Health promotion based on community networks


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The Case of Yokohama City


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Amendment of the Long-Term Care Insurance Law (2006)

• Establishment of Prevention-oriented System

• Establishment of Community General Support Centers

Health Education on individual, group or community basis • Physical activity • Nutrition • Social participation • Volunteering

Health promotion programs for healthy elderly

1. Population Approach

Screening using uniform check-list Falls, lower nutrition, homeboundness, cognitive decline, depressive mood

Long-term care prevention program for high-risk persons

2. High-risk Approach


Localized, comprehensive, single point of access centers for the entire elderly population Established in 2006 ⇒ 4,323 centers in 2012 Located in every junior high school district Public health nurse, chief care manager, and certified social worker assist

the elderly


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Amendment to the Act on Stabilization of Employment of Elderly Persons in 2004 and 2012

1. Abolition of the scheme to exclude some of their employees from coverage by the continued employment system

2. Expanding the scope of companies employing persons covered by the continued employment system

3. Announcing the name of companies in breach of the obligation

The policy promotes the hiring of workers over 60 years old. Since 2013, companies have to employ people who wish to work after the retirement at age of 60.


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2.4% 2.8%

3.1% 3.4% 3.4%

4.2%

4.8% 4.9% 5.2%

5.5% 5.5%

4.9% 4.6%

4.3% 3.9%

4.1%

5.3% 5.4%

4.9% 4.6%

4.3%

6.3% 6.5% 6.7% 6.8%

7.0% 7.1% 7.3% 7.3% 7.3% 7.3% 7.3% 7.4% 7.6%

7.8% 8.2%

8.5% 8.7% 8.8% 8.8%

9.3%

9.9%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

0

2,000

4,000

6,000

8,000

10,000

12,000

Population in Labor Force

Population aged 15 years old and over Labour force Unemployment rate 65 in labor force(in ten thousand)

Modified from Historical data 2 Population aged 15 years old and over by labour force status - Whole Japan Source: Ministry of Internal Affairs and Communications, Statistics Bureau


53.3 46.1

68.8

47.3

23.3

9.8 25.2

14.4

35.1

48.9

13.1 3.5

0.6

3

22.1 17.4

13.8 13.5 14.3

1.6 7.8 2.5 2.7 10.5

1.4

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Japan USA Korea Germany Sweden

In a question to elderly over 60 years old, and currently not employed, as to why they would like to work in the future,

Source: Cabinet Office “7th International Comparison Survey on Elderly Life and Attitude 2010”

“As a source of income”

“For health and to prevent aging”

“For making friends and colleagues through working”

Working as active aging to improve quality of life

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Social Participation and Health


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Social Role

Fujiwara Y, et al. Arch. Gerontol. Geriatr. 2003;36:141-153.

8 year longitudinal survey in a suburb in Tokyo


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Social Role

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People who volunteered and who have hobbies maintain their independence

Do volunteer

Do not volunteer

Volunteer Activity and Independence

Years Followed

Tokyo Metropolitan Institute of Gerontology-Longitudinal Interdisciplinary Study on Aging (TMIG-LISA)

Do Hobbies/ Lessons

No Hobbies/Lessons

Hobbies and Lessons and their relation to Independence

Years Followed


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Had a Job

No Job

Change in the basic ADL scores

People who had a job maintain their independence

Years Followed


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Learning method to select good picture books, practicing to read fluently, understanding the state of today’s children, theories and practices of volunteer activities

Nagahama,

Chuo-ku,

Suginami-ku

Toshima-ku

Ota-ku

Bunkyo-ku,

Itabashi-ku

Kita-ku

Fuchu

Tokyo

Kawasaki,

Yokohama,

Read Aloud Picture Books Training Program (designed by TMIG Social Participation Team)


Building Body, Expression, Reading Comprehension etc.

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Voice Training

Participants in group create a 30 min program and perform it in the last seminar

Flexibility Training Reading Comprehension

Solo Performance


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Understanding human memory and how you train in daily life from lecture, texts, games and songs.

Telephone Game Memorizing Texts


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Reading picture books to kids in a community center

Reading at nursery school


Effect on Seniors

Psychological Effect Physical Effect Cognitive function Effect

• Self-esteem • Self-efficacy • Social Support and

Network

• Increased physical activities by participation

• Warming up before reading • Voice training

• Executive function • Language function • Memory function


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0

5

10

15

20

25

30

35

BL 6か月後

（講座修了後）

24ヵ月後

論理的記憶Ⅱ

（物語の30分後の遅延再生）

Pre-test 6 months 24 months

Logi

cal M

emo

ry II

(d

elay

ed v

erb

al m

emo

ry)

p<.001

p<.001

前期介入群

後期介入群

Volunteer activity

The elderly participants improved and retained the delayed verbal memory.

RCT Group 1

RCT Group 2


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公民館 Kominkan

生涯学習センター Lifelong Learning Centers

カルチャースクール Culture School

大人向け個人塾 Cram School Business

通信教育 Correspondence Learning

学校支援地域本部 School Support Regional Headquarters

ボランティアセンター Volunteer Center

14,681 centers in 2011

In 2013 3,527 headquarters, 8,342 coordinators

Home Econ Class

Field Trip Assistant

First grader Support

Elementary school students performing at daycare service center


Japan USA South Korea Germany

2005 2010 2005 2010 2005 2010 2005 2010

53.4% 51.7% 32.3% 33.1% 72.5% 74.2% 46.2% 42.9%

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from 7th International Comparison Survey of the Daily Life and Attitudes of Elderly Persons source: Cabinet Office

“Never participated”


• Social and economical needs for the elderly’s productivity (work, social participation and social contribution) is high.

• Older people’s health has improved enough to respond to such needs.

• The needs and improvement of health supported by the policies and system drive Active Aging in Japan.

• However, the gap in health between those who are involved in activities and those who are not widens.

• More inter-section collaboration from national to local level is necessary.

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Session 2: Active ageing: Facilitating older persons ... · Strengthening of regional power and...

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