Points of View The Aging of the Population and the Elderly
Minoru Ito, Senior Researcher, Pharmaceutical and Industrial Policy Research Institute
1. Introduction
One of the important goals of next-generation health care is "extension of healthy life expectancy. In order to realize this goal, the center of gravity of healthcare should shift from "diagnosis and treatment," which focuses on curing diseases, to "pre-disease and prevention" and "coexistence," in which people live their lives with as few restrictions as possible even if they suffer from diseases. 1) In the previous two issues (No. 62) 2) and the previous issue (No. 63)3) of the Policy Research Institute News, the author reported that the number of people who are suffering from cancer and other diseases is increasing, and that the number of people who are living with cancer is also increasing. 1) The author reviewed "symbiosis" with diseases such as cancer and dementia in the previous two issues of the IPSJ News (No. 62)2) and No. 63) 3). In the future, I would like to shift the focus of my research to "pre-disease and prevention. When considering "prevention" from the perspective of "extending healthy life expectancy," one of the main players is the elderly. It has been pointed out that the elderly have been "rejuvenated" in recent years, and it is necessary to first understand the current situation of the elderly. In this issue, we have conducted research with the aim of understanding the current status of aging and the elderly in Japan.
2. Situation of the aging population
The White Paper on Aging is published annually by the Japanese government to provide information on the state of aging in Japan. The 2021 White Paper on Aging Society4) (hereinafter referred to as "White Paper") was released on June 11, 2021. Figure 1 shows trends and future projections of the aging population. This figure shows the total population, the age structure divided into four categories, the aging rate (the percentage of the population aged 65 and over), and the percentage of the population aged 65 and over supported by the population aged 15-64 (hereafter, the "support ratio"), based on birth-medium and death-medium estimates. The total population is estimated to have declined consistently since 2015, falling below 100 million in the 2050s and reaching 88.08 million in 2065. Meanwhile, the aging rate, which was 26.6% in 2015, will continue to rise and reach 38.4% in 2065. In addition, the ratio of people to be supported by the elderly is estimated to decline from 2.3 in 2015 (2.3 persons of working age for each person aged 65 and over) to 1.3 in 2065. The White Paper's description of the aging of the population can be seen as a major problem in the future.
So, what will be the course of aging in Japan in the longer term? The National Institute of Population and Social Security Research, which served as the basis for the white paper, presents the "Population Projections for Japan's Future (2017 Estimates) 5) as a reference projection up to the year 2115 (Figure 2). (Figure 2)
As a result, the total population will consistently decline to 50.56 million in 2115. Meanwhile, after reaching 38.4% in 2065, the aging rate will remain almost unchanged for more than 50 years (38.5% in 2115), and the support ratio will be almost stable at 1.3. In the estimation, a total of nine patterns of births and deaths (low, medium, and high), each of which is assumed in the projection, are considered. Although there are differences in the time of arrival, the results indicate that the aging rate will reach a flat level in the long term in all patterns.
3. Situation of the elderly (employment and economic life)
The White Paper also discusses trends in the lives of the elderly. The employment rate in 2020 was approximately 50% for the 65-69 age group and more than 30% for the 70-74 age group, up 13.2% and 10.5%, respectively, from 2010. On the other hand, the employment rate for those aged 75 and older was about 10%, with a marginal growth of 2.1% over the 10-year period (Figure 3). (Figure 3)
In response to the question "Until what age do you want to work with income?" in the survey on the economic life of the elderly6), the total number of respondents who answered "70," "75," "80," or "As long as I can work" was approximately 60%. The results show that about 90% of those who are currently in income-earning jobs have high motivation to work even in old age. (Figure 4) The results by age group were almost the same for the 65-79 age group. (Figure 5)
The reasons for this high willingness to work are compared with those of three Western countries in the White Paper. The results of the question to those aged 60 and older who responded that they "want to work (or continue to work) with income" showed that the most common reason given in Japan, at over 50%, was "because I want an income," which is different from the three Western countries where "work itself is interesting and energizing for me" was the most common reason given. (Figure 6)
The economic life of the elderly, which can be the basis of employment awareness, was compared with that of the three Western countries in the International Comparative Study on the Lives and Attitudes of the Elderly7) (hereafter referred to as the "International Comparative Study"). Looking at the results of the survey (Figure 7) on whether or not they "have problems with their daily lives" in an economic sense, the total of "have problems" and "have some problems" in Japan exceeded 30% (33.8%), while only about 10% to 20% (13.6% to 22.1%) in the three Western countries, a difference that can be clearly seen.
In addition, in the survey on the "degree of sufficiency of current savings and assets to prepare for retirement" (Figure 8), the total of "somewhat insufficient" and "not sufficient at all" exceeded 50% in Japan at 55.5%, while it was approximately 10% to 20% (16.1% to 20.0%) in the three European countries and the United States, A large difference could be seen.
Furthermore, the "average income per month (including tax)" was also surveyed. (Figure 9) Although there are differences in price levels among countries, and the non-response rate in the U.S. accounts for 24.6%, making it difficult to simply compare the figures, it was considered characteristic that the percentage of respondents with a monthly income of less than 100,000 yen was 12.2% in Japan, higher than in the three Western countries (4.4% to 6.8%).
4. Situation of the elderly (health and welfare)
In the White Paper, the status of health and welfare is also mentioned. In a survey asking people aged 60 and over in each country about their current health status, the total percentage of respondents who answered "healthy" or "not very healthy but not sick" was relatively good, exceeding 90% in all four countries including Japan. (Figure 10)
Furthermore, in the "Need for assistance or nursing care in daily life" survey conducted in the International Comparison Survey7), the percentage of respondents who answered "I have no difficulty at all" or "I have some difficulty but can manage to do it by myself" exceeded 90% in all four countries, indicating a high level of independence among the elderly. (Figure 11)
As mentioned earlier, there was no marked difference between countries in the survey on health status and the need for assistance and nursing care in daily life, but there was a difference between Japan and the three Western countries in the survey on "use of medical services" in the International Comparative Survey7) (Figure 12). (Fig. 12) This survey was conducted in Japan in January 2011, and in the three Western countries from December 2020 to January 2021, when a new type of coronavirus infection was prevalent. The percentage of respondents who used medical services from "almost every day" to "about once a month" was 59.2% in Japan, compared to 20.3% in the U.S., 30.3% in Germany, and 8.2% in Sweden, indicating a high frequency of use in Japan. Whether this difference affects Japan's high average life expectancy and healthy life expectancy was not mentioned and is unclear.
The International Comparative Study7) also examined the "level and burden of social security systems" that support medical care and long-term care. In Japan, the highest response rate, over 40%, was "maintain the level even if the burden is increased," followed by "improve the level even if the burden is increased. In all four countries, more than 70% of respondents accepted an increase in the burden. (Figure 13)
5. Revision of the definition of the elderly
In March 2017, the Japan Geriatrics Society and the Japan Geriatrics Society jointly released a report8) of the Working Group on Definitions Concerning the Elderly, which recommended a revision of the definition of the elderly, which had previously been defined as calendar age 65 years and older. The report noted that the appearance of age-related changes in physical and psychological functions among the elderly today is delayed by 5 to 10 years compared to 10 to 20 years ago, indicating a "rejuvenation" phenomenon. In particular, the majority of the "early elderly" aged 65-74 years have maintained their physical and mental health and are able to engage in active social activities. The committee proposed the definition of "elderly" as those aged 75 years or older, "associate elderly" as those aged 65-74 years, and "super elderly" as those aged 90 years or older when classifying the elderly (hereafter, the new definition). (Figure 14)
The report states that the significance of the reexamination of the definition is to "change the negative image of the elderly as a person to be supported to a positive one as a person who supports and motivates society, and as a result, to make the looming super-aging society a brighter and more vibrant one. On the other hand, as a point to keep in mind, the report mentions that the elderly are a diverse group in terms of physical and mental health and social activity, and that it is unclear whether the delay in the physical and mental aging process will continue, which is a challenge for future medical science and healthcare.
Regarding the diversity of the elderly, in a previous study, Professor Hiroko Akiyama of the Institute of Gerontology, University of Tokyo, reported a pattern of changes in the level of independence among the elderly: approximately 10% of the elderly can maintain their independence until age 89, approximately 70% have a gradual decline in independence after age 75, when they are classified as elderly according to the new definition of "elderly," and approximately 70% are in the group of associate About 20% of the elderly need assistance from their old age. (Figure 15) The diversity in the level of independence (≒health status) of the elderly should be kept in mind when considering the problems of the elderly.
6. Consideration of healthy life expectancy
The following is a summary of the aforementioned statements in the White Paper and other sources.
- Although the total population will continue to decline, the aging rate will remain steady in the long term.
- The employment rate is continuously growing at 50% for those aged 65-69 and 30% for those aged 70-74, while the rate for those aged 75 and over is slowing at 10%.
- Sixty percent of the respondents retained the desire to work in old age. Those who were already working had an even higher percentage at 90%. The most common reason for employment was the need for income.
- 30% of the respondents were aware of financial difficulties, 50% were aware of lack of savings/assets, and more than 10% had low income (monthly income of less than 100,000 yen).
- The health status of 90% of the respondents were healthy or unwell, and a high 90% of the respondents were independent from nursing care. （The percentage of those who use medical services (once a month or more) was 60%, more than double the percentage in the U.S. and Europe.
- As for social security, 70% of the respondents were willing to accept an increase in the burden.
In Japan, where the population will continue to age until the 2050s, it is necessary for the Japanese people to be able to enjoy a healthy and fulfilling life, to feel secure in the knowledge that they will receive the necessary support when they need assistance or nursing care, and to maintain and grow the Japanese economy through the active participation of the Japanese people in society, As indicated in the report of the Working Group for Definitional Studies on the Elderly8), one of the prescriptions is to "change the negative image of the elderly as a person to be supported to a positive one as a person who is a supporter and motivator of society. While healthy life expectancy has an aspect of fulfillment of personal life, it is also thought to have a strong aspect of social activity. In this sense, healthy life expectancy can be viewed as "socially active life expectancy. Fortunately, the White Paper shows that healthy life expectancy is continuously increasing (Figure 16). (Figure 16)
The employment rate for the 65-69 age group is approaching 50%, but the rate for the 70-74 age group is only 30%, which is a gap from the 60% willingness to work. In the case of men, further extension of healthy life expectancy, which is currently in the 72-year age range, will also be necessary.
If it becomes possible to expect associate elderly persons to play an active role in society, the structure of social support, which is the basis for a sense of security in assisting and caring for the elderly, will move in the right direction. In the White Paper, the "support ratio" is considered to be "the ratio of those aged 15-64 supporting those aged 65 and over," and the figure of 2.3 (in 2015) is expected to decline to 1.3 in the long term. If this can be converted to "the proportion of those aged 15-74 supporting those aged 75 and over," a significant structural improvement can be expected. Adjusted for actual willingness to work (59%), it would be possible to maintain roughly 2015 levels. (Figure 17)
The Revised Law Concerning Stabilization of Employment of Older Persons10) came into effect on April 1, 2021, and in addition to ensuring employment up to age 65 (mandatory), it newly made it an obligation to make efforts to ensure employment opportunities up to age 70. In addition, the Pension System Amendment Law went into effect on April 1, 2022, and the age range of pension benefits will be expanded from 60-70 to 60-75. 11) Thus, the social activities of associate elderly persons have been legally established, and measures are being taken on the assumption that they will play an active role in society. If associate elderly people's active participation in society becomes the norm, there is a possibility that their sense of economic deprivation and lack of savings and assets will be alleviated.
On the other hand, there is a large possibility that issues remain from the perspective of fulfilling a personal life full of purpose in life. The most common reason for the intention to work among the elderly (Figure 6), at more than 50%, was "because I want an income," a marked difference from the three Western countries, where the most common reason was "because the work itself is interesting and energizes me" (32.6%-43.3%). If the elderly are "forced to continue working" due to a high awareness of the insufficiency of their current savings and assets (Figure 8), this may be a problem in terms of fulfillment of personal life and purpose in life. The White Paper presents the results of a survey on overall satisfaction with life in old age (Figure 18), and it is desirable to further improve the current situation in Japan, where the percentage of those who are "satisfied" is only in the 20% range, compared to the 50-70% range in the three Western countries.
The White Paper's description of the health status of the elderly could be interpreted as "healthy" and "not sick," and the elderly were able to maintain a high level of independence with regard to the need for assistance and nursing care, indicating that overall the situation of the elderly is good. On the other hand, it must be fully taken into account that the elderly show diverse patterns. While the 70% of the elderly whose level of independence gradually declines should be slowed down as much as possible, it is necessary to consider how to rescue the 20% whose level of independence declines relatively early, and how to improve the ratio between the 70% and the 20%. In addition, we believe that the pharmaceutical industry has potential to contribute here.
7. Summary
In this paper, we first examined the situation of the aging and elderly population at present in order to promote the study of "pre-disease/prevention" in next-generation healthcare. What became clear during the study was that the elderly in recent years generally embody "rejuvenation," have a high motivation to work, and are in relatively good health. On the other hand, it was also understood that the elderly show diverse patterns of independence, and that it is not desirable to consider them as a single group. In particular, the pharmaceutical industry, which is expected to contribute to extending healthy life expectancy in terms of health, should continue to consider what kind of contribution it should make to the elderly and what kind of contribution it should make to the elderly in the future.
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1) Number of reports and countries from which data was obtained
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2)Pharmaceutical and Industrial Policy Research Institute, "Living with Disease among Cancer Survivors," Policy Research Institute News No. 62 (March 2021)
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3)Institute of Pharmaceutical Industry and Policy Studies, "Conviviality with Diseases in Dementia," Policy Research Institute News No. 63 (July 2021) (in Japanese)
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