Bulletin of the World Health Organization

Community-based care for healthy ageing: lessons from Japan

Junko Saito, Maho Haseda, Airi Amemiya, Daisuke Takagi, Katsunori Kondo & Naoki Kondo

Problem

The measures for long-term care prevention that the Japanese government had introduced in 2006 were unsuccessful because of the failures to identify high-risk individuals and to enrol enough participants in the community prevention programme.

Approach

The Japanese government shifted its primary strategy from a high-risk strategy to a community-based population strategy in 2015, by reforming the Long-term Care Insurance Act. This act is focusing on community-based care and social determinants of health. The Act and the government’s plans for long-term care prevention are inspired by a social participation intervention called ikoino saron, that is gathering salons for people older than 65 years. These salons, managed by local volunteers, are held once or twice a month in communal spaces within walking distance of community members’ homes and have a low participation fee. At the gatherings, older people can meet and interact with others through enjoyable, relaxing and sometimes educational programmes.

Local setting

Japan has the world’s largest ageing population, with 27.7% (35.2 million/126.7 million) of people older than 65 years.

Relevant changes

Studies have shown that participation in the salons was associated with a halved incidence in long-term care needs and about one-third reduction in the risk of dementia onset. Evidence also suggests that financially vulnerable older adults were more likely to participate in such interventions. In 2017, 86.5% (1506/1741) of the Japanese municipalities had implemented the salons.

Lessons learnt

Integrated care for long-term care prevention should consider interventions targeting the whole community in addition to high-risk individuals.