Teaching the world a better way to age

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This article was published 23/08/2023 (768 days ago), so information in it may no longer be current.

KYOTO, Japan — If you want a glimpse of the future, go to Japan. Forget the Shinkansen, the high-speed bullet trains that have been around since 1964. And don’t get distracted by the cat cafes or the caregiving robots — solutions to loneliness and labor shortages, respectively, that could have far easier remedies if people were willing to, say, rescue stray animals or open the borders to immigrants.

Where you will see what lies ahead for many other countries, including the United States, is in rural areas and regional cities outside greater Tokyo: lots of people aging and dying, and relatively few giving birth and raising kids. In small urban centers such as Katori, this means the playgrounds are empty and elementary school classrooms have only a fraction of the students they had a generation ago. In rural areas of the Tohoku region, where the March 2011 earthquake displaced entire communities, this means a dearth of well-trained doctors and nurses who can treat the elderly as they near the end of life. In today’s Japan, the young and middle-aged are consumed by caring for the old, and small-town resources are overstretched. In some places, family gravesites lack descendants to tend them, and sacred festivals carried on for generations are in danger of dying out.

Some of the drivers of demographic change in Japan are, of course, particular to that country. Immigration policies remain some of the world’s most restrictive, and xenophobia persists. Japan ranks abysmally low in gender equality; women often have to choose between career advancement and child-rearing. Economic stagnation has made it unaffordable for most couples to have big families. But when it comes to the numbers on aging, the United States is not far behind Japan. Almost one-third of the Japanese population is over 65, an age bracket that makes up about 17 percent of the U.S. population but whose share is steadily growing — most dramatically outside of cities. Maternity wards are already closing in rural U.S. hospitals as birthrates fall. South Korea, Europe and China face similar trends of population aging and decline.

Japan can also offer a glimpse of a more hopeful future, however, in that it’s further along in fostering inventive ways to meet the demands of an aging population. Japanese innovators are already demonstrating what’s possible — and, in many cases, not with high-tech fixes but by showcasing design thinking, dignity and respect.

Satoko Fujioka, the co-founder of a home health-care clinic and community center in Karuizawa, is one of them. At Hotch No Lodge, which has hosted elderly residents since 2020, she decided that elderly people would not be treated as frail, weak and useless. Instead, they would be invited to share their wisdom and skills to help them stay active, sharp and socially engaged. Old people at the center cook for one another and teach young people how to grow vegetables and make art. Fujioka considers them not “care receivers” but contributors of care to the wider community.

In the city of Toyama, a farsighted plan reversed the trend of outward migration and car dependency that had discouraged older people from continuing to work and had left many far from medical care and other urban amenities. The city repurposed old train and tram lines into a sleek light-rail system, with platforms placed at the level of the train cars so that people would not need to climb or descend stairs. Public transit ridership among people in their 60s and 70s has since more than tripled, and this has helped seniors maintain active and social lifestyles.

“What Toyama’s doing specifically is working well because they are making public transit easier to navigate, and having an efficient working system helps older people participate in the economy,” said Tom Le, a professor at Pomona College in California who researches the politics and economics of aging in Japan.

Hana Hayashi, a public health professional who studied at Harvard University, decided a few years ago to return to her hometown of Katori, where her three-year-old son is often the only kid on the playground. Since moving back, she has lost all four of her grandparents and has witnessed how difficult it is for elderly people who live outside Japan’s major cities to access high-quality medical care. Hayashi is now collaborating with Yusuke Tanoue, a surgeon who a decade ago dedicated his career to bringing in-home health care to rural areas and regional cities that struggle to recruit doctors — given that most young professionals want to live in Tokyo or other large cities. With his company, Yamato, Tanoue created a model that allows doctors to circulate among clinic sites, so they can continue to live and raise their families in cities but spend part of the week in rural areas, particularly in the Tohoku region, which is lacking in medical personnel but rife with elderly people who can benefit from in-home care. Tanoue and Hayashi aim to bring the same model to Katori.

Other social entrepreneurs in Japan have focused on food — for instance, bringing children and the elderly together in cafeterias that serve traditional dishes. In some, the older folks get health checkups. One Tokyo pop-up eatery, dubbed the Restaurant of Mistaken Orders, has employed people with dementia as its waitstaff.

A common feature of these innovations is that they meet older people where they are, metaphorically and physically, rather than demand that they either conform to the lifestyles of the young or live in neglect. It helps that Japan has a national health-care system that financially supports new models for medical care such as Tanoue’s, and that the government invests in activities beyond medicine that can help prevent aging-related illness, in part because of the savings.

The U.S. government, too, could save money by supporting healthy, active lifestyles for the aging. “Providing Medicare at 65 makes no sense if people are so beat up from being unhealthy till age 65,” said Le. “It’s going to be more expensive, and they are going to be sicker. The preventive care keeps the elderly population healthier in Japan so that they can work longer — that’s where the U.S. can do much better.”

I met Le and several Japanese aging innovators recently while taking part in the U.S.-Japan Leadership Program, which brings together American and Japanese delegates under age 45 to learn from one another. What struck me was the thoughtfulness with which the Japanese delegates spoke about not just their elders but also the aging process and the possibility that it could involve greater dignity. That culture of reverence, combined with the human-centered design that characterizes so many Japanese products and systems – from the packaging of gifts to the presentation of food in bento boxes and the organization of train stations – has yielded ideas that prioritize helping old people flourish, not just managing their illnesses, disabilities and deaths.

And although technology features in some of these efforts, such as automated systems for organizing doctors’ locations and schedules, their approach to the aging problem – counter to Western stereotypes of Japan – is surprisingly low-tech. These young leaders aren’t looking for robots to care for the elderly.

It’s a gift to receive wisdom from the old, but a rarer gift still to receive a missive from the future. Following some Japanese exemplars could make life better for people living longer in all parts of the world — and for all the caregivers and societies that face the steep costs and stark realities of aging populations.

Bina Venkataraman is an American journalist, author, and science & technology policy expert. She is currently a columnist at The Washington Post writing on the future.