Key changes in situation of older persons
3711575-248285005876925-252095 The impact of COVID-19 on older personsJapan country analytical brief July 2020FUJINAMI Yuma1), KOGA Chie2), TAJIKA Atsuko3), AIDA Jun4), SHOBUGAWA Yugo5), KONDO Naoki6), KONDO Katsunori7)1) Japan Agency for Gerontological Evaluation Study (JAGES), Tokyo, Japan; 2) Center for Preventive Medical Sciences, Chiba University, Chiba, Japan; 3) Division of Advanced Preventive Medicine, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; 4) Japan Agency for Gerontological Evaluation Study (JAGES), Tokyo, Japan/Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Miyagi; 5) Department of Active Ageing (donated by Tokamachi city, Niigata Japan) International Health, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; 6) Japan Agency for Gerontological Evaluation Study (JAGES), Tokyo, Japan/Department of Health Education and Health Sociology, The University of Tokyo, Miyagi, Japan; 7) Japan Agency for Gerontological Evaluation Study (JAGES), Tokyo, Japan/Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.Key changes in situation of older persons Health and careAs of July 20, 2020, the total deaths caused by COVID-19 has exceeded 1,000, and >80% deaths have occurred in individuals aged ≥70 years. The number of positive cases has also been increasing since the state of emergency was lifted. On July 18, 2020, the highest number of new cases (664) was reported.Evidence shows a positive correlation between the rate of aging (percentage of the total population aged 65 and over) and number of deaths due to COVID-19, according to a report from the Japan Agency for International Cooperation (JICA), though the number of deaths is lower than the estimated number from the model presented in the JICA report. The ratio of elderly facility resident deaths due to COVID-19 to all deaths caused by COVID-19 is approximately 14%, which is lower than the ratio in other countries, such as Germany and France (about 40%).Nursing homes in Japan have become clusters of COVID-19. For example, in Hokkaido, in northern Japan, around 70% of the residents of a nursing home became infected with the virus. Another cluster was found in Nagoya. An article published on March 17, 2020 reported that 14 people died of COVID-19 in Nagoya, and at least 12 of them belonged to a cluster at a day care facility for older persons. As older persons are at an increased risk for COVID-19, nursing home/care facilities are struggling to prevent the spread of infection. Many day care and short-stay facilities have shut since the declaration of emergency. According to an article published on April 25, 2020, 858 facilities closed during the week starting from the previous Sunday (April 19), accounting for 1.13% of all day care and short-stay facilities across Japan. 503 facilities that were shut a week before the article came out, indicating an increase in the closure of facilities. Cluster infections were also reported from hospitals and service care centers for the elderly in Kyoto, Toyama, and Hiroshima.Income securityAccording to a report issued by Japan’s Cabinet Office, the employment rates in 2018 for age groups 60-64, 65-69, 70-74, and 75 years and older reached 68.8%, 46.6%, 30.2%, and 9.8%, respectively. The employment rate of older persons is increasing every year, thus raising the presence of older persons in Japan’s labor market. However, because of the unprecedented situation created by the spread of COVID-19, older persons in Japan seem to be losing their jobs. The reason for this can be attributed to the following two factors: fear of being infected by COVID-19 and a worsening business situation in the wake of COVID-19.As older persons are at an increased risk of getting sick with COVID-19, they quit their jobs to stay safe. Furthermore, older persons tend to work as non-regular workers and tend to be the subject of employment adjustment. Referring to the data released by the government, this article shows that the number of people employed in April registered a decline compared that in the previous month. The greatest drop was seen among those aged 65 and older, with the figure falling by 330,000 to 8.77 million. When these individuals lost their jobs, they became dependent on the public pension or public assistance. Another report showed that the average income of aged households in 2015 was 3,081,000 yen (29,500 dollars), and 54.2% of aged households depended on the public pension for their income. The number of older persons receiving public assistance is also increasing, with the number of recipients aged 65 and older reaching 970,000 in 2015. Regarding the impact to the labor market in older persons, according to the Statistics Bureau of Japan, between October and December 2019, 911,000 older persons (65 years and above) engaged in paid work. Among older persons, 403,000 were non-regular employees (employees with a fixed term) and 210,000 were self-employed, including those doing piecework at home. Of those who were working during October to December 2019 (total: 911,000), 129,000 worked in the wholesale and retail trade sector; followed by 106,000 in the services, Not Elsewhere Classified (N.E.C) sector; 97,000 in the manufacturing sector; and 94,000 in the medical, health care, and welfare sector. Comparing the employment status of older persons between October to December 2019 and January to March 2020, the number of older persons who are self-employed or are non-regular employees has decreased, while the number of those working as executives and regular workers seems to be stable. Therefore, no drastic change in the employment status of older persons has been found yet.Employment status of persons aged 65 years and above(thousand persons)Oct-Dec 19Jan-Mar 20Self-employed worker including those doing piecework at home210202Family worker6457EmployeeExecutive of company or corporation106112Regular employee120118Part-time worker203199Arbeit (temporary worker)7569Dispatched worker from temporary labour agency1516Contract employee4545Entrusted employee3938Others2523Source: Statistics Bureau of Japan, addition, declining numbers of older employees were found during February, March, and April in previous years. Therefore, the present data does not show any drastic change in the employment status of older adults after the COVID-19 pandemic. However, there is a possibility that the effects of COVID-19 on employment of older persons will appear in the future; it is necessary to keep a close watch on the trend.left2840355Source: Labour force survey. Statistics Bureau of Japamhttps//stat.go.jp/English/data/roudou/index.html020000Source: Labour force survey. Statistics Bureau of Japamhttps//stat.go.jp/English/data/roudou/index.html194142248200Concerning the public pension in Japan, there are two types of old-age pensions in the national pension system: “Employees’ Old-Age Pension” and “Basic Old-Age Pension.” If an individual is enrolled in the Employees’ Old-Age Pension Insurance program, they will receive the Employees’ Old-Age Pension in addition to their Basic Old-Age Pension. The amount received depends on the length of enrollment and salary. An individual must pay the premium for at least 10 years to receive the pension benefit and can receive the full benefit amount after paying the premium for 40 years. The full benefit amount of the Basic Old-Age Pension at 65 years of age is ?781,700/year (if an individual starts receiving the pension between 60 and 65 years of age, the amount will decrease), and in the case an individual paid the premium for only 10 years, the amount becomes 1/4 of the total. If an individual cannot afford to pay the premium, they can be exempted. This exemption period is also cumulated as a period of premium payment, but the benefit amount will decrease. According to a report by the Ministry of Health, Labour and Welfare (in Japanese), in 2017, 51.1% of households that received pension benefits had only the national pension system as an income source. Another report by the Ministry of Health, Labour and Welfare (in Japanese) shows that in 2017, 34.84 million people received the pension benefit from the national pension system, with 920,000 contributing toward the premium for less than 25 years. The average amount of pension benefit for such persons was ?19,091/month (?55,615/month for those who paid the premium for more than 25 years). However, the average amount of Employees’ Old-Age Pension benefit in 2017 was ?174,535/month (for those aged 65 years and above).There are thus different types of pensions in Japan, and even within the same pension type, the benefit amount is different depending on the period of payment of the premium. An article reported that older individuals feel anxious about facing challenges in their lives due to losing their jobs, and that the amount of benefit from the public pension is not enough. Additionally, this causes mental and physical health issues. For example, a study indicated the association between types of pension and happiness in Japanese older persons after adjustment for equivalent income; studies have shown that older persons who retired from paid work reported a significant increase in depressive symptoms compared to those who kept working. However, encouraging recreational social participation may mitigate the adverse effects of retirement on the mental health of Japanese older men. Social issuesDue to the government’s stay-at-home measures and the anxiety about infection among older persons, many people are staying at home, and isolation, loneliness, and the potentially increased risks for disuse syndrome and frailty of older persons are concerning social and health issues. The government, municipalities and the private sector are taking measures to mitigate this issue, including actions based on public-private partnerships. For example, many municipal governments and private long-term care service providers have created videos of their original exercise programmes and posted them on the internet (e.g. YouTube). As of July 17, 2020, the Japan Agency for Gerontological Evaluation Study (JAGES) has introduced 10 cases of municipalities’ efforts, including introducing exercise video, through its website. Eight of the 10 municipalities created do-at-home exercise videos and distributed them through DVD (via post) (Kobe City, Tenri City), web (Matsudo City, Ichihara City, Machida City), or multimedia devices (Chizu Town). Ikoma City conducted open-air classes to facilitate interaction among participants while avoiding close contact. Mifune and Oarai towns conducted home visits to confirm the health condition of older persons. The cities of Kobe and Ichihara utilized local TV broadcasting and cable channels to distribute exercise videos, while Machida city collaborated with a professional football team to promote exercise at home. According to the Cabinet Office report, the number of older persons who use the internet is increasing. From 2010 – 2017, the internet usage rate of people aged 60-69 and 70-79 years increased by 9.5 and 7.5 points, reaching 73.9% and 46.7%, respectively. In the case of people aged 80 years and above, the rate in 2010 and 2017 was almost the same at 20.1%.1 As the number of older persons who can use the internet is increasing, online solutions would be considered to resolve any issues arising from stay-at-home-measures.Although stay-at home is important to prevent infection, maintenance of physically and socially active daily livings, including exercising, eating, and interacting with others is also essential for older persons’ health. Research claims that promoting social participation may reduce the prevalence of hypertension in older people and living in an area with a higher community-level social participation may lead to a lower incidence of Instrumental Activities of Daily Living (IADL) disability. Men who go on fewer outings had 2.14 times greater odds of being persistently disabled.Responses Japan’s central and local governments have recommended the people to avoid the “3Cs”: closed spaces with poor ventilation, crowded spaces and close-contact settings. This concept has been well understood and accepted nationwide. After terminating Japan’s state of emergency on 25th May 2020, the central government introduced several measures to promote the economy, such as the “Go To Travel campaign”, a campaign subsidizing domestic leisure trips. However, as older individuals are at a higher threat of contracting COVID-19, the tourism minister has asked them not to participate in this campaign.Japan’s current challenge lies in maintaining economic activities and restarting formal and informal services to provide physical and social activity opportunities for older adults, while ensuring avoidance of the 3Cs. The prevention of heat stroke among older adults staying at home is an additional goal of public health measures in the country: since the rains ended in early August 2020, the climate has become hot and humid. In Japan, more than 80% of medical care providers were in the private sector in 2017. Due to reduced visits for hospitals and clinics, many hospitals and health facilities are facing financial difficulties. A survey found that the average profitability of 1,049 hospitals in Japan was at -9.0%, down 10 percentage points from the previous year. The profitability rate of hospitals which accepted COVID-19 patients fell below -10.0%. If an outbreak is reported within the facility, the hospital has to shut down, which makes the financing of medical care facilities difficult further. Consequently, about a third of health facilities are cutting summer bonuses for medical staff. To amend this, the central government has provided financial support for medical care providers. The Japanese government decided to double the reimbursement paid to hospitals for the treatment of severe COVID-19 patients. Hospitals will now be paid 160,000 yen to 280,000 yen (1,480 dollars to 2,560 dollars) for each day a COVID-19 patient stays in an intensive care unit. In addition, the government will provide up to 200,000 yen (1,900 dollars) for each medical worker in hospitals and staff in nursing homes treating COVID-19 patients. Furthermore, 200,000 yen (1,900 dollars) will be paid to each frontline worker who admits COVID-19 patients, and 100,000 yen (950 dollars) to each staff member at medical institutions who have secured beds and are prepared to accept COVID-19 patients.,Considerable flooding occurred nationwide during the rainy season in June and July, which caused additional challenges in coronavirus control at evacuation centers. In early July 2020, rivers overflowed due to heavy rain in Southern Kumamoto prefecture in Southwestern Japan. This might have been the first time that evacuation due to a natural disaster was dealt with in tandem with preventing the spread of an infectious disease. While social distancing or avoiding the 3Cs is a necessity during the pandemic, the evacuation centers in the city are not spacious enough to facilitate this safely. The evacuation centers are trying to maintain distance between the living spaces provided to families by using partitions. However, in the immediate aftermath of the disaster, some evacuation centers found it difficult to take appropriate steps to respond to the natural disaster amid the risk of COVID-19 infection. Given Japan’s accumulated evidence on the importance of maintaining social relationships among older adults during the previous natural disasters, providing opportunities for social interaction has been a priority in Japan’s public health measures in the time of emergencies such as flooding. ,, A further challenge for older people whose homes have been severely damaged (283 houses totally damaged, 658 partially damaged, 7,916 with inundated floors) is the associated risk to their health; housing damage is a known strong risk for older adults’ health., The Japanese Government has made it a priority to develop a vaccine. Japan’s first vaccine trial has begun. The Japanese government is holding discussions with domestic and international companies to secure a vaccine for COVID-19. Prime Minister Shinzo Abe has announced that a COVID-19 vaccine manufactured outside of Japan is expected to be distributed around the end of this year. The government is also planning to give first priority to health care workers and older persons.Endnotes 1143006343650Contact informationYuma FUJINAMI, Director General, y.fujinami@Japan Agency for Gerontological Evaluation Study (JAGES), HQ00Contact informationYuma FUJINAMI, Director General, y.fujinami@Japan Agency for Gerontological Evaluation Study (JAGES), HQ ................
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