Healthcare challenges for elderly people in Japan during COVID-19 pandemic

Healthcare challenges for elderly people in Japan during the COVID-19 pandemic

The COVID-19 pandemic is strongly influencing the global population in many countries around the world. The elderly are especially vulnerable and face the most challenges, although all age groups are at risk of contracting COVID-19 [1]. It is said that older people are more susceptible because of any underlying chronic health conditions they may already have. The impact of COVID-19 on elderly people in Japan, the country with the highest aging population in the world, will be discussed in this short note.

1) The situation of COVID-19 among elderly people in Japan

Using data from the Ministry of Health, Labour, and Welfare (MHLW) in Japan, as of 18:00, May 20, 16,280 cases were confirmed as COVID-19 positive through PCR testing, including 542 deaths [2]. Looking at the number of confirmed cases by age, the number of infected people aged 70 and over accounted for 20.2%, but the number of deaths in this age group (70 and over) occupied 83% of total deaths (450/542 cases). The crude average mortality rate among PCR-tested COVID-19 cases in Japan was 2.9%. This crude average mortality rate grew with age, with the highest mortality rate, 17.9%, in those aged 80 or older.

2)  Accessibility of online medical services for elderly people in Japan

Due to the impact of COVID-19, widespread use of online medical services was approved by the MHLW in Japan on April 10, 2020 as a temporary countermeasure. The utilization of online medical services carries significant meaning in that it avoids having to go to crowded hospitals, and this is especially true for elderly people, who have a high risk of developing severe symptoms when infected with COVID-19 while juggling several chronic diseases at the same time.
However, there are challenges in getting the elderly to accept online medical services. According to research about Internet usage in Japan by the Ministry of Internal Affairs and communications, less than half of the Japanese population aged 70 and over used the internet in 2017, compared to over 90% for people aged 13 to 59 years old. Online medical services include providing medical services through any kind of communications equipment such as telephones, personal computers, and mobile phones. Increasing the accessibility of online medical services for elderly people would require efforts to bridge the gap in digital literacy and/or promote a simple approach to consult their doctors and delivering their medicine.

3)  The impact on long-term care facilities in Japan

A survey about the impact of COVID-19 on the financial status of long-term care facilities was collected from 1,789 facilities across Japan by the Japan Federation of Kaigo Business Providers [3]. The data revealed that nearly half of the surveyed long-term care facilities had already experienced a deterioration of their financial condition as of the end of March, before the COVID-19 state of emergency was declared in Japan. Among the various kinds of long-term care facilities, day-care services facilities including day-care, day-rehabilitation, day-support/rehabilitation for long-term care prevention, day-care/support for dementia, were most affected. Of all day-care facilities surveyed, 663 out of 772 (82%) faced some form of financial deterioration. The situation in March predicted that not only will there be a noticeable downward trend in the financial status of long-term care facilities, especially day-care services facilities, but there would also be a deterioration in the condition of elderly people's health and an increase in the burden to take care of these people.
Long-term care facilities will have some difficulties in keeping social distance based on the nature of their services, as it threatens the health of the care worker. Moreover, there is a chronic shortage of care workers in Japan. The standard required staffing level of care workers in each long-term care facility is determined by the government, but a notification was issued to temporarily allow low staffing levels due to the impact of COVID-19 [4].

Japan has some healthcare challenges related to the protection of elderly people, who account for nearly 30% of Japan's total population, during the COVID-19 pandemic and the various impacts it will have in the long term. MHLW has created a webpage targeting the elderly, with announcements on staying safe from COVID-19, with content such as guidelines for long-term care facilities and original exercise videos or leaflets collected from each prefecture [5]. As a result of implementing new online services,　it is expected the elderly people have easier access to both medical treatment and care, but there are still many challenges we need to tackle to close the gap in digital literacy. Analyzing the impact on long-term care facilities will provide us various measures for taking care of the elderly during/after this pandemic.

1. WHO. (2020) Health care consideration for older people during COVID-19 pandemic. (Accsessed, May 14, 2020.)
http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/health-care-considerations-for-older-people-during-covid-19-pandemic.

2. Ministry of Health, Labour, and Welfare (2020) Situation report of COVID-19 as of May 5, 2020. (written in Japanese) 厚生労働省. 新型コロナウイルス感染症の国内発生動向. (Accsessed, May 27, 2020.)
https://www.mhlw.go.jp/content/10906000/000633363.pdf

3. Japan Federation of Kaigo Business Providers. (2020). Survey results about the changingfinancial status under COVID-19 as of the end of March. (written in Japanese) 全国介護事業者連盟. 新型コロナウイルス感染症に係る 経営状況への影響について『緊急調査』 集計結果.(Accsessed, May 14, 2020.)
http://kaiziren.or.jp/wp/wp-content/uploads/2020/04/kinkyuutyousa20200422.pdf.

4. Ministry of Health, Labour, and Welfare (2020). The notification of the temporary measurements for staffing level in long-term care facilities under the COVID-19. (Written in Japanese). 厚生労働省. 新型コロナウイルス感染症に係る介護サービス事業所の人員基準等の臨時的な取扱いについて. (Accsessed, May 14, 2020.)
https://www.mhlw.go.jp/content/000601694.pdf.

5. Ministry of Health, Labour, and Welfare (2020) .The information for elderly people how to deal with COVID-19. (Written in Japanese).
厚生労働省. 新型コロナウイルス感染症への対応について（高齢者の皆様へ）
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/kaigo_koureisha/yobou/index_00013.html
 

Masashi Suzuki Healthcare Global Unit Manager
Mitsuyo Morikawa Healthcare Global Unit Senior Staff
Mami Wakabayashi Healthcare Global Unit Staff