How Japan care for their ageing population
Written by Sophie Murray, Head of Nutrition and Hydration for Sunrise Senior Living
Japan sees the population being the longest living of any country – I was fortunate enough to visit this amazing country and see for myself what may contribute to positive health and longevity. My trip comprised of visiting care facilities including a nursing home and a care facility with day care and residential care, as well as health visits in the community. I was also fortunate to hear leading professors speak about the research of probiotics in the elderly as well as emerging studies. Within this trip we consumed many traditional dishes, many of which were raw foods and fermented foods - absolutely delicious!
Care of the elderly
Whilst Tokyo itself was a bustling city of road systems and buildings on various layers (roads above and below you!), we were taken to a busy area just outside the city and near to the government funded flats where a number of residents were elderly. Here we were taken to a large department store named Eion. The supermarket chain caters only for over 50s. The food in smaller portion sizes, single item foods, older person’s gym, older person health based pharmacy, café which was extremely accessible, optician, clothing which may appeal to an older generation, small cooking equipment such as pans and ladles, continence products and so forth indicated this was thought through to help individuals live in their own home for as long as possible with appropriate shopping trolleys that were higher than the UK standard deep trolleys. There were seats throughout the shop to stop and take a pause if needed. In itself this was a social hub – all indoors and easy and also very appealing too for under 50s, a category I can still fall in to for a few more years!!
We made a visit to a care facility which housed a children’s nursery, a day facility to dine for those who may find cooking more difficult, a shop, a residential facility all of which was funded by the community for the community – a cooperative in its truest sense which also ran a comprehensive support system for the local community, largely for the elderly to help them manage at home. Care support assistants were referred to as lifestyle workers, visiting people at home and walking the dog with them, helping them cook and carry out tasks which may be of a social nature to help prevent isolation, as much as physical care and support. The cooperative was an opt in system, whereby workers paid to join and could earn from those needing their services, which may be care or hairdressing or sewing and housework. Those receiving care also bought in and could have started by being on the workers cooperative to eventually needing the services of the cooperative and in its 30th year, now saw multigenerational members.
The main kitchen provided meals on wheels services too, cooked on premises although home delivery bulk foods were also available to be delivered and these could be joint purchased by the cooperative to aid costs.
One could rent welfare equipment from there too and there was a household repair service which included gardening or replacing air conditioning filters – the smaller jobs that could become difficult for some. There was a clothing alteration service so individuals who may have changed size did not have to repurchase clothing. I asked about malnutrition and was informed this was not seen as an issue as there were so many preventative steps.
The workers collective carried out welfare and nursing, supporting all aspects of household affairs and this included transportation to and from appointments. Many of the workers have other jobs too and carry out an element of voluntary work. This facility was built with the cooperatives money raised or donated – none from government which was their choice and some contributed more than others.
We visited Me-byo Valley Biotopia, a facility contributing to the areas health enhancement, by using technology and interaction to identify early warning signs of ill health and treat them. They took an approach which involved 3 themes: food, exercise and the senses, connected to nature.
Yakult Central Institute informed us that Dr Shirota, whom the Lactobacillus casei Shirota (a strain of lactic acid bacteria) is named after, studied microbiology at university and, in 1935, cultured a bacterial strain which survived the intestines. This also led to the term Shirota-ism, based on the principles he followed which were that a healthy intestinal tract leads to a long life, prevention philosophy, and good health is affordable.
In 2016, Yakult commenced studies with JAXA (Japan Aerospace Exploration Agency) and NASA with regards to using probiotics in a space project as part of the astronauts dehydrated foods, knowing that in space physiological changes occur including muscle atrophy, reduced bone mass and immune suppression.
Professor Naomi Alba from Department of Nutrition and Life Science at Kanagawa gave statistics regarding life expectancy in Japan (87 and 80 years for women and men respectively) and the top causes of death were cancer, heart disease, pneumonia and senility.
She spoke about trials conducted using a fermented milk drink containing L.casei Shirota and a yoghurt and this led to me reading more research in the area – an anaylsis of 178 elderly subjects showed a more diverse microbial population in those living in the community and the least in a residential care setting. Diversity was attributed to factors such as medication and poor quality diets low in fibre. Low diversity is linked to poorer health outcomes.1
Professor Eric Claassen from the University of Amsterdam spoke about lactic acid research, and about the numerous studies that have been carried out including in military personnel, shift workers, people who are obese, and people with cancer.
He spoke of the hierarchy of evidence leading to a health claim and why, with thousands of bacterial strains, studies were difficult to pinpoint on bacterial strain alone, although they were coming through. The dosage of bacteria is often far greater in studies than are given in many standard capsules or foods and he spoke about which array of foods should provide bacterial diversity – particularly how different bacteria feed on different sugars, ie. simple sugars Vs complex sugars like GOS (galactooligosaccharide) and FOS (fructooligosaccharide). He spoke of faecal matter transplant now becoming more popular too and gave some links to this.
In 1963 Yakult introduced a door step delivery scheme to promote Yakult through Japan. They strive to support health as well as making a health check to residents too and participating in crime watch schemes.
I was absolutely fascinated from this trip – and was also fortunate to taste many products and return home without jet lag!
1) Wilson and Avery (2017) Network Health Digest 7:17-19