{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:46:39Z","timestamp":1790610399159,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Geriatrics Gerontology Int"],"published-print":{"date-parts":[[2021,8]]},"abstract":"Background<\/jats:title>As Japan's population continues to age, it is estimated that the number of people aged \u226575\u2009years will exceed 20\u2009million by 2025. Furthermore, over the past 10\u2009years, we have not reduced the difference between life expectancy and healthy life expectancy. Therefore, the extension of healthy life expectancy and the development of a healthy society are the most urgent issues. In terms of medical care, the changing times have inevitably led to changes in disease structures and medical demands; therefore, the medical delivery system has had to be changed to meet these demands. As dementia rapidly increases, it is important to address \u201cfrailty,\u201d a condition in which people become more vulnerable to environmental factors as they age, and there is a need to provide services to older people, particularly the old\u2010old, that emphasize quality of life in addition to medical care. To realize a super\u2010aged society that will remain vigorous and vibrant for many years, we need to rethink the future of Japanese medicine and healthcare, and the state of society.<\/jats:p><\/jats:sec>Current situation and problems<\/jats:title>\nDisparity between healthy life expectancy and average life expectancy in the realization of a healthy society<\/jats:p>\nIt is a challenge to build a society with a long and healthy life expectancy through comprehensive prevention and management of lifestyle\u2010related diseases, as well as the elucidation of the factors that explain sex differences in healthy life expectancy, based on the recognition that lifestyle\u2010related diseases in midlife are risk factors for frailty and dementia in old age.<\/jats:p>\n<\/jats:list-item>\nChallenges in medical care for building a super\u2010aged and healthy society<\/jats:p>\nThe challenges include promoting clinical guidelines suitable for older people, including lifestyle\u2010related disease management, promoting comprehensive research on aging (basic research, clinical research and community collaboration research), and embodying a paradigm shift from \u201ccure\u2010seeking medical care\u201d to \u201ccure\u2010 and support\u2010seeking medical care.\u201d Furthermore, the key to the future of integrated community care is the development of a comprehensive medical care system for older people in each region and the development of the next generation of medical personnel.<\/jats:p>\n<\/jats:list-item>\nDissemination of frailty prevention measures in a super\u2010aged society<\/jats:p>\nThe concept of frailty encompasses the meaning of multifacetedness and reversibility; therefore, a comprehensive approach is required, including the renewal of conventional prevention activities in each region, such as the nutritional status of older people, physical activity including exercise, and various opportunities for social participation and participation conditions.<\/jats:p>\n<\/jats:list-item>\nChallenges of an unstable diet and undernutrition in older people<\/jats:p>\nAccording to the National Health and Nutrition Examination Survey of Japan, energy and protein intakes are low in Japanese people aged \u226575\u2009years; particularly in people aged \u226580\u2009years, low and insufficient intake of nutrients are prominent. Undernutrition in older people is increasing and is more pronounced in women. There are multiple factors behind this, including social factors, such as living alone, eating alone, poverty and other social factors, as well as problems with access to food security.<\/jats:p>\n<\/jats:list-item>\nPharmacotherapy for older people: measures against polypharmacy<\/jats:p>\nIn addition to the problems of adverse drug events, drug interactions, duplication of effects and the presence of drugs that \u201crequire particularly careful administration,\u201d it is also necessary to take measures against polypharmacy in older people, as well as medical economic issues, such as high drug costs and large amounts of remaining drugs. Barriers to this measure include multiple medical institution visits for each disease, lack of coordination between professions, and lack of understanding by patients and families.<\/jats:p>\n<\/jats:list-item>\nRole of local communities in a healthy society<\/jats:p>\nThe decline in the working\u2010age population is also a major challenge; however, we need to make a shift to use this declining birthrate and aging population as an opportunity rather than a crisis. As we look ahead to the coming of the 100\u2010year age of life, we rethink the creation of a comprehensive society and community, and aim to create an age\u2010free society where everyone can play an active role and live in peace, regardless of age.<\/jats:p>\n<\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>Contents of the proposal<\/jats:title>In this report, we have put together a vision for the future of an aging Japanese society from a broader perspective of how the environment and local communities should be, rather than simply from the perspective of individual health. We aim to convey this proposal to the Ministry of Health, Labor and Welfare, the Ministry of Education, Culture, Sports, Science and Technology, the Cabinet Office, and various professional organizations.\nThe paradigm shift from \u201ccure\u2010seeking medical care\u201d to \u201ccure\u2010 and support\u2010seeking medical care\u201d should be promoted for the development of a healthy society<\/jats:p>\nWhile further promoting pre\u2010emptive medical care in the medical care for older people, the development of multidisciplinary medical guidelines appropriate for older people should be promoted at the same time. In addition, we should promote basic aging research, clinical research (including the long\u2010term care field) and transitional research that cover regional areas. Furthermore, while promoting the paradigm shift from \u201ccure\u2010seeking medical care\u201d to \u201ccure\u2010 and support\u2010seeking medical care,\u201d the development of various comprehensive medical treatment systems for older people and the strengthening of integrated community care systems should be promoted.<\/jats:p>\n<\/jats:list-item>\nDevelopment of the next generation of medical personnel to comprehensively deal with geriatric care, including training geriatric specialists, should be promoted<\/jats:p>\nAs the number of older people with multimorbidities and frailty rapidly increases in the future, we should promote the development of the next generation of medical personnel who can comprehensively handle medical care for older people, including training leading geriatricians in cooperation with multiple professions in the integrated community care system to provide sufficient medical care.<\/jats:p><\/jats:list-item>\nCountermeasures for frailty in older people should be promoted from medical and community planning perspectives<\/jats:p>\nTo address frailty, which requires comprehensive evaluation and intervention, the three pillars of frailty prevention (nutrition, exercise and social participation) should be incorporated and addressed as part of community development within each municipality, taking into account local characteristics. In particular, it is necessary to revise the way of thinking about nutrition management in older people and the guidelines of the societies in the field. In addition, it is important to strengthen industry\u2013academia\u2013government\u2013private partnerships in each region, taking into account not only medical issues, but also social factors, and encourage the development of momentum in the entire region regarding measures against undernutrition in older people.<\/jats:p>\n<\/jats:list-item>\nPolypharmacy measures should be promoted in pharmacotherapy for older people<\/jats:p>\nIt is necessary to promote cooperation between physicians and pharmacists, establish other multiprofessional cooperation systems, and develop medical and long\u2010term care insurance systems to support this. It is also essential to change the public's mindset, and awareness\u2010raising activities at all levels are required, including the enhancement of educational materials for medical caregivers and the general public. In addition, the economic impact of healthcare using big data should be timely clarified.<\/jats:p>\n<\/jats:list-item>\nInnovation in medical and urban planning perspectives should be promoted<\/jats:p>\nIn the future, it will be necessary to modify and update multidisciplinary approaches such as social participation (e.g. participation in a salon) with a view to innovation in both medical care and community development, especially on the idea of a symbiotic community. In addition, industry\u2013academia\u2013government\u2013private partnership is necessary, including all aforementioned, such as places where people can play an active role in the rest of their lives (such as employment), promotion of human connections, promotion of technology to support older people and support for daily life. Geriatr Gerontol Int 2021; 21: 601\u2013613<\/jats:bold>.<\/jats:p>\n<\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>","DOI":"10.1111\/ggi.14201","type":"journal-article","created":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T09:01:41Z","timestamp":1625216501000},"page":"601-613","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":119,"title":["Toward the development of a vibrant, super\u2010aged society: The future of medicine and society in J<\/scp>apan"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1339-5681","authenticated-orcid":false,"given":"Katsuya","family":"Iijima","sequence":"first","affiliation":[{"name":"Institute of Gerontology The University of Tokyo Tokyo Japan"},{"name":"Institute for Future Initiatives The University of Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6747-8680","authenticated-orcid":false,"given":"Hidenori","family":"Arai","sequence":"additional","affiliation":[{"name":"National Center for Geriatrics and Gerontology Obu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Akishita","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Graduate School of Medicine The University of Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamao","family":"Endo","sequence":"additional","affiliation":[{"name":"Tokyo Metropolitan Institute of Gerontology Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kouetsu","family":"Ogasawara","sequence":"additional","affiliation":[{"name":"Institute of Development, Aging and Cancer Tohoku University Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Kashihara","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension Kawasaki Medical School Kurashiki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiko K","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology Tokyo Medical University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wako","family":"Yumura","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Endocrinology Tohoku Medical and Pharmaceutical University Hospital Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Yokode","sequence":"additional","affiliation":[{"name":"Kyoto University Graduate School of Medicine Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuyoshi","family":"Ouchi","sequence":"additional","affiliation":[{"name":"Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Ministry of Health Labor and Welfare White Paper 2016. 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