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Lessons from Japan on an ageing population
Publication Date : 08-10-2013
In 20 years, Singapore will have the same demographic profile as Japan has today. In other words, about one in four people will be over the age of 65.
And in Japan, the picture is not pretty. Unless the right steps are taken and changes are made early, Singapore will face the same problems that Japan is trying to handle now.
Japan has more than 50,000 people aged 100 years and older, with the vast majority living in nursing homes. These homes also have many patients who are in their late 70s and early 80s, and who could remain in nursing care for two or three decades more.
At one home in Tokyo that Health Minister Gan Kim Yong visited last month, the oldest resident was 116 years old.
Over the past 70 years, the lives of the Japanese have lengthened by about 35 years. In itself, this is good, since it means people are living longer.
But unless they remain healthy for the bulk of their lives, the number of people who will need care in their later years will go up.
Between 2000 and 2012, the number of elderly needing home care and care in institutions in Japan tripled - from 1.49 million to 4.45 million.
As there is nothing so far to indicate that the Japanese have reached their ultimate lifespan - currently an average of 86 years for women and 82 for men - the number of people requiring help in their old age will likely continue to grow as the young-old join the ranks of the old-old.
But despite their longer lives, more Japanese are dying each year than are being born. Japan's population last year declined by 212,000, the biggest drop on record.
Projections by the Japanese government indicate that if the current trend continues, the population will decline from its current 127.5 million to 116.6 million by 2030, and 97 million by 2050.
This could badly impact the country's economic growth as it means there will be a smaller working population. Unlike Singapore, Japan does not have a large pool of foreign workers to bolster its flagging workforce. Language is one of the barriers.
Japan's woes don't end there. Not only is the population shrinking, but it is also moving away from the "ideal" pyramid shape where there are many young people supporting relatively fewer older people.
It is now apple-shaped, with a big number of middle-aged people. By 2060, this will change to become top-heavy - many older people supported by relatively fewer younger adults, with even fewer young people in the pipeline.
Japan and Singapore are responding by trying to keep people's disability years, or years lived with severe ailments, to a minimum by assisting the elderly to remain healthy and independent for as long as possible.
That way, longer lives would be more meaningful as the elderly enjoy a better quality of life. It would also reduce their need for care services - except perhaps for the last handful of years, rather than for a decade or two, as some people now require.
Professor Junichiro Ohgata of Tokyo University's Institute of Gerontology has also suggested redefining the working age group.
If people continue to work beyond the age of 65, it will increase the group of workers while shrinking the group of elderly people being supported. Instead of retiring at 65, as they now do, they should be encouraged to continue working till they are 75, he said.
Keeping people in the workforce for a longer time has an additional benefit, he said. It will not only boost the work pool, but also give older people the motivation to carry on, and to keep themselves healthy.
The institute is involved in several projects concerning the elderly, including the "Smart City", a custom-built estate some 40km away from metropolitan Tokyo for about 400,000 older people. It has all the necessary support services, such as medical care, home help, social support group and accessible, barrier-free transport, so they can continue to live a good life in the community despite their increasing frailty.
The institute also has a project which finds work for people in their 70s - called second-life careers - such as running a cafe or growing vegetables in a climate-controlled container.
But the project is still in the pilot phase, so it is not known if such jobs can be profitable or even self-sustaining.
But so far, the university has found that people who continue working are generally healthier than those who don't.
Although the jobs they are doing may not be contributing much to the economy, Prof Ohgata said working keeps them away from nursing homes, which is a major benefit.
With more older people expected to need considerable help in their daily lives, the Japanese government recently announced that the sales tax will go up from the current 5 per cent to 8 per cent, to help the country cope with its mounting debt.
Meanwhile, Japan needs to divert people from its shrinking workforce to look after the dependent elderly - either in nursing homes or to provide home-care services for them.
Even with the use of technology to make caring for the dependent elderly less onerous, the staff-to-patient ratio remains high: one staff member to two to three patients when looking after the more able patients; and one staff to one patient for the more dependent ones, as well as the wealthier patients willing and able to pay for the service.
This is what awaits Singapore - unless things change.
What needs to be done is easy to identify: People here need to have more children, everyone needs to remain in good health, and the working age needs to be extended.
What's tougher is getting the desired results.
But it is obvious that it is not something the Government can do alone. Singaporeans themselves must realise the consequences of inaction.