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The Care for the Elderly in Sweden and in Japan


 3. Background The Basic Difference of the Two Countries 


3.4 The Problems In Japan 
3 4 1  700,000 "Bedridden Elderly" ~"Netakiri Shock!"~  

  One of the biggest problems among the elderly care In Japan Is the " Bedridden Elderly " ( Säng-liggande äldre )."  Bedridden Elderly" is called "Netakiri" in Japanese. This is a very unique problem in Japan.  In 1990 the number of elderly aged 65 and over is about 14,000,000 and the aging rate is 12%.  The Japanese Ministry of Health and Welfare estimates that about 700,000 bedridden elderly exist in Japan in 1990.  It means that about 5% of the elderly aged 65 and over is bed ridden in Japan nowadays.  The definition of "Bedridden Elderly" is not so exact, because different municipalities use a little different definitions about the "Bedridden Elderly".  But the general definition is that "Bedridden Elderly" means the elderly who spend the most of their daily time on the beds.

  Table.6 show the location of the "Bedridden Elderly" in 1986.  

Table.6  The Location of the Bedridden Elderly  
Location Estimated Number Ratio
At Home  220,000   37.1%
Nursing Home   130.000  21.l% 
Hospital *  250,000 41.8%
Total 600,000 100.0%
(Source:  Japanese Ministry of Health and Welfare 1986) 
*Elderly patients who stays at the hospitals for over six months.  


  There were about 600,000 "Bedridden Elderly" in Japan in 1986 and about 250,000(41.8%) stayed at the hospitals for over six months! And about 130,000 (21.l%) stayed at the nursing home and about 220,000 (37.1%) stayed at their own homes.  There is no public sheltered housing (service house) in Japan. 

There are some reasons why so many "Bedridden Elderly" exist in Japan. The following four reasons are supposed to be very important . 

<1> Care-givers are usually their own Families
<2>
Japanese "TATAMI" Culture -Elderly Prefer to Lie on the Bed to Sit on the Chair-
<3> Rehabilitation Function is very Weak at the Long Term Care Facilities
<4> The Numbers of Stuffs and Nurses at the Hospitals and at the Nursing Homes are Very Low

  Families have the responsibility to take care of the elderly in Japan, but the family care-givers do not have knowledge how to rehabilitate and activate the sick or handicapped elderly.  As a result, families let elderly lie on the bed every day.

  And elderly themselves prefer to lie on the bed.  Because Japanese elderly are get used to sit and lie on the "TATAMI" -special Japanese matt- not to sit on the chairs.

  So elderly prefer to lie on the floor when they feel tired.  "To lie on the bed and to take a rest is the best way to recover your health!" This is a traditional Japanese saying.  And the importance of the rehabilitation for the elderly is not so realized in Japan.  And at Japanese hospitals and institutions rehabilitation has not been so emphasized neither.  The numbers of stuffs and nurses at the Japanese hospitals and the nursing homes are much lower than Swedish standard(1 will explain about this point more in detail later).

3 4 2 One Million Senile Dementia Patients in Japan  

 Another Japanese problem is the rapid increase of the number of senile dementia elderly.  The Swedish society faces the same problem also.  In 1991 about one million elderly are suffered from dementia disease in Japan. Table.7 shows the location of the dementia elderly.  

Table.7 Location of the Senile Dementia Elderly in Japan and Sweden 

 (in 1991)  

Location JAPAN SWEDEN 
Hospital * * * 60,000
 (6.0%) 
-
(-)
Nursing Home 
( Sjukhem ) 
83,000 
( 8.3% )   
 
Geriatric Hospital (LångvårdkIinik)  54,000
 (5.4%) 
20,000
( 25.
0% ) 
Mental Hospital  33.000  
( 3.3% ) 
 
Old Age Home** (Ålderdomshern och Servicehus )  13.000
 (1.3%)
 16.000 
( 20.
0% ) 
Facilities for Health**** Services for the Elderly   12,000  
(1.2%) 
 -
(-) 
Group Living   -
(-) 
4,000
 ( 5.
0% ) 
At Home  740, 000 
( 74.
0% )
 40.000
 ( 50.0%) 
Total  990.000 
( 100% )
80,000 
( 100% ) 
Source :


The Research of the Health Science by the Japanese Ministry of Health and Welfare in 1991) 
The rough estimation by the "demens forbundet" in Sweden in 1992
(Demensforum NR2 1992 MAJ sidan 3)  
*
About 20.000 senile dementia patients stay at the long term institutions (långvårdklinik and sjukhem and mental sjukhes)
**




Old Age Home in Japan is an institution for the 'healthy and poor elderly. So there are only few senile dementia elderly Nursing home in Japan is similar to the old age home ( ålderdomshem ) in Sweden. And geriatric hospital in Japan is similar to the nursing home ( sjukhem ) in Sweden. More in detail is explained in chapter.5.
***

In Sweden patients do not stay at the general hospitals for a long time. But in Japan patients can stay at the general hospital within three months easily.
****

 

Facilities f or the e elderly who do not need to be hospitalized for treatment, but who need functional training, nursing and care for rehabilitation. In general patients can 
stay here maximum three months. But Actually patients can not move back home so easily. 

 

   One of the difference in the two countries is that the support by the home help service and the day care center. In Japan the number of home helpers and day care centers are much less than those in Sweden. So the burden of Japanese families who take care of senile dementia elderly is much heavier.

And recently in Sweden the group living ( gruppboende ) has become popular for the senile dementia elderly. But there is no group living in Japan.

The location of the senile dementia elderly in both countries are very different. The biggest reason is that the function of the various facilities in the two countries are much different. Later I will explain the difference of the facilities in both countries .

74% of them stay at home. And they can get only the little home help service. The statistics shows almost the same trend of that of "Bedridden Elderly - most of the elderly are cared by the family at home without the support of home helpers -".

Table . 8 The Forecast of the Number of Senile Dementia Patients in Japan
Year  Number  Ratio(%)per Aged 
Population ( > 6 5 )
1990 990,000 6.7%
1995 l,230,000 6.8%
2000 l,500,000 7.0%
2005 l,790,000 7.4%
2010 2,130,000 7.9%
2015 2,470,000 8.l%
2020 2,740,000 8.6%

(Source 

the same source as Table.7)  


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