Community-based care for healthy ageing: lessons from Japan

PROBLEM: The measures for long-term care prevention that the Japanese government had introduced in 2006 were unsuccessful because of the failures to identify high-risk individuals and to enrol enough participants in the community prevention programme. APPROACH: The Japanese government shifted its primary strategy from a high-risk strategy to a community-based population strategy in 2015, by reforming the Long-term Care Insurance Act. This act is focusing on community-based care and social determinants of health. The Act and the government’s plans for long-term care prevention are inspired by a social participation intervention called ikoino saron, that is gathering salons for people older than 65 years. These salons, managed by local volunteers, are held once or twice a month in communal spaces within walking distance of community members’ homes and have a low participation fee. At the gatherings, older people can meet and interact with others through enjoyable, relaxing and sometimes educational programmes. LOCAL SETTING: Japan has the world’s largest ageing population, with 27.7% (35.2 million/126.7 million) of people older than 65 years. RELEVANT CHANGES: Studies have shown that participation in the salons was associated with a halved incidence in long-term care needs and about one-third reduction in the risk of dementia onset. Evidence also suggests that financially vulnerable older adults were more likely to participate in such interventions. In 2017, 86.5% (1506/1741) of the Japanese municipalities had implemented the salons. LESSONS LEARNT: Integrated care for long-term care prevention should consider interventions targeting the whole community in addition to high-risk individuals.