Among elderly men living alone in Japan, 15% speak to one person or fewer every fortnight, while about 30% feel they have no “reliable persons” they can turn to for simple help such as changing a lightbulb.
The striking figures, taken from a survey by Japan’s National Institute of Population and Social Security Research, highlight the issue of social isolation among the elderly, which has been gaining increasing attention in the country.
The rapidly ageing population — 28% of Japanese are over 65, the highest in the world — poses numerous challenges for policymakers, but social isolation is a problem that is hard for government-led programs to address.
Instead, say experts, community-driven initiatives rolled out to suit local conditions tend to be more successful. But what’s already getting results, and how can government encourage more?
The Japanese central government publishes an “Annual Report on the Ageing Society” which provides a snapshot of population and housing trends.
It notes a “remarkable” increase in the proportion of over-65s living alone in the past few decades. The share of over-65 women living alone nearly doubled from 11.2% in 1980 to 20.3% in 2010. Among men, the proportion rose from 4.3% to 11.1% over the same period.
Dr Hiroshi Murayama, from the Institute of Gerontology at the University of Tokyo, says numerous studies show social isolation is linked to adverse health outcomes such as increased mortality risk and the onset of diseases.
In Japan, there’s also rising discussion of the problem of “kodokushi” — a solitary death at home which may go unnoticed for days or even weeks. “Social isolation causes not only adverse health condition but also a sad death,” Murayama says.
He believes that bonds in Japan, including kinship and local community cohesion and neighbourhood ties, have weakened in recent times, a trend he suggests was exacerbated by the economic crash of the 1990s that led to more than a decade of stagnation.
One obvious area for community engagement is via senior citizen groups, which are prevalent in Japan.
There are 100,000 clubs with approximately 5.9 million Japanese older adults as members, according to a recent paper co-authored by Murayama. These groups aim to promote the health of members and to encourage participants to help one another and contribute to the local community through activities such as volunteer cleaning duties.
But it’s important to find people who fall through the gaps of such social structures, with interventions to encourage social participation.
Murayama says government-led programs to prevent social isolation are “rarely done well”. He believes this is because government and public sector officers are reluctant to intrude on an individual’s privacy.
“To tackle social isolation, it is necessary to enter into one’s daily life or privacy,” he explains. “Therefore, the government-led programs rarely get success.”
The town of Taketoyo, 45 minutes from Nagoya, found a way to achieve results. It set up “salons” around the community to provide physical exercises and enjoyable social activities like poetry writing and recreational games.
The municipal government supported the initiative by providing meeting space, financial assistance, and publicity, as explained in a book chapter about the initiative.
About a third of participants reported feeling happier, while they also enjoyed meeting new friends and learning health tips, a survey found.
Ritsumeikan University Professor Yoko Otsuka says similar activity hubs known as “community cafes” have sprung up around Japan.
“There are a lot of community cafes and actually anyone can join,” she says, adding that these venues focus on welcoming the elderly, people with disabilities, and family caregivers.
“They go to their community cafe and chat and share the stress [with the other attendees] and then they become happy. That kind of community cafe also takes on quite an important role to avoid old people’s social isolation.”
Other programs have sought to enlist postal service and gas company employees in checking up the welfare of elderly residents. For example, the government of Nerima City – in Tokyo’s north – set up a “watch-over service” with a number of private, nonprofit and volunteer organisations.
Postal service and gas company employees are meant to “report abnormalities such as a large accumulation of uncollected mail in a mail box that they have found when they visit households to deliver mail and read the gas meter to the consultation centre for the elderly”, according to the central government’s white paper.
Murayama says the programs that have had most success involve various types of organisations and people, such as neighbourhood associations, volunteer groups, non-profits, healthcare and welfare professionals, community residents, and local governments.
“Social isolation is influenced by many factors – for example, financial problems, health conditions, family conditions, personality, and social relationships – therefore, only an approach from a single organisation/actor is not often effective,” Murayama says. “Multiple approach/assessment would be better.”
Therefore, in Hikarigaoka, an area within Nerima City, a “community council” of the residents’ associations and housing management associations have also set up a watch-over service.
When participating residents get up each morning, they place magnets at their front doors saying “I am fine”. Volunteers look out for the stickers each day and move them to inside the residents’ letterboxes, the government white paper explains, creating a cycle that allows people in trouble to be identified quickly.
Murayama and Otsuka both call for more locally driven programs, tailored to conditions on the ground.
Social isolation is influenced by many factors, notes Murayama. “Therefore, collaboration among multiple organisations would be necessary,” he says.
Murayama adds that an approach focusing only on the elderly would be inadequate. Promoting other activities that foster a friendly atmosphere in the community would reduce isolation among other groups, too.
“Social isolation is not a problem of the individual, but a problem of the society,” Murayama says. — Daniel Hurst
(Picture credit: Unsplash)