Care Preferences of Elderly People Living Alone in Japan

Introduction There is strong evidence that social isolation is a risk factor for poor mental and physical health [1], and is associated with increased mortality [2,3]. The most commonly studied outcomes of social isolation or loneliness are depression and cardiovascular health [1]. The risks of social isolation depend not only on who you are, but also on where you live [4], especially in urban areas, where there tends to be more elderly people with a higher degree of social isolation. Therefore, care problems arising from social isolation have emerged as a major concern for health policy. In Japan, the number of elderly people living alone has grown. In 2015, the proportion among those aged ≥65 years was 13.3% in males, and 21.1% in females. The proportion of elderly people living alone increased from 9.6% in 2000 to 15.5% in 2015. Most elderly living alone are likely to be socially isolated and to die alone if unable to receive long-term care insurance (LTCI) services when needing care. Demand for the LTCI service exceeds supply in urban areas. Staff shortage in the care sector has been found to be related to both the shortage of human resources and high land prices [5]. Moreover, excess demand for labor in the care sector depends on delayed adjustment of nursing care costs set by the Japanese government [6]. Thus, overcoming supply constraints in the care sector is considered difficult. Social isolation exacerbates the health issues of elderly persons who live alone, resulting in longer waiting times for LTCI services in Japan.1 Previous studies have found care preferences relating to individual healthcare or nursing care needs. Residents of a country with a strong national healthcare infrastructure are less likely to prefer family-based care [7]. In a previous study, nursing home care was most preferred for dementia care [8]. Another study pointed out that old, frail, and reclusive people who live alone may require home care [4].