Health status of older adults living in the community in Japan: Recent changes and significance in the super-aged society.

As of 2017, the total Japanese population was 126.7 million, which included 35 million who were aged ≥65 years (27.6%) and 17.3 million aged ≥75 years (13.7%). From now, the old-old aged ≥75 years will increase rapidly in Japan compared with the young-old aged 65-74 years. The characteristics of the old-old include deterioration of activities of daily living (ADL) functions and an increase of chronic diseases, which are unavoidable consequences of advanced age. In the present review article, secular changes of the health status and functional capacity of older people living in communities are described based on representative longitudinal studies on aging in Japan. The author also discusses the importance and implication of two major strategies related to health promotion, and prevention of both lifestyle-related diseases and long-term care dependence in the super-aged society. Among the old-old people, prevention of long-term care dependence becomes a much higher priority than disease prevention. In regard to evidence-based prevention of long-term care dependence, various geriatric syndromes, such as undernutrition, falling, incontinence and decline of cognitive function, are the major targets for prevention. Many randomized controlled trials on the prevention of geriatric syndromes have been carried out in Japan, targeting high-risk older people living in the community, and have attained many excellent achievements so far. Finally, the author introduces a new index of competence for older people (the Japan Science and Technology Agency Index of Competence), which can accurately measure high-level competence and higher functioning needed to execute the activities of more sophisticated living of today and in the future. Geriatr Gerontol Int 2018; 18: 667-677.