Elderly Population In Japan Research Articles

Relationships between oral conditions and physical performance in a rural elderly population in Japan

To show relationships between oral conditions and physical performance in the elderly living independently. A total of 821 persons participated. Data on background factors and self-assessed masticatory ability were collected by means of questionnaires. An intraoral examination was performed to examine the pattern of occluding pairs of natural teeth. Handgrip strength and one-leg standing time with eyes open were measured. Step-wise linear regression models were conducted with muscle strength or one-leg standing time as the dependent variables; the pattern of occluding pairs and self-assessed masticatory ability as the principal independent variables. The self-assessed masticatory ability was retained in the final model of the step-wise regression for the handgrip strength, and significant relationships were established in the participants aged 65-74, but the pattern of occluding pairs was not retained. The pattern of occluding pairs, and the self-assessed masticatory ability were retained in the final models for the one-leg standing time, and significant relationships were shown here. The self-assessed masticatory ability may be significantly related to muscle strength and static balance function, and the pattern of occluding pairs may be significantly related to the static balance function, particularly in the elderly aged 65-74.

Trends in Hip Fracture Incidence in Japan: Estimates Based on Nationwide Hip Fracture Surveys From 1992 to 2017.

ABSTRACTAs of 2015, the aging population in Japan was the largest in the world. Although the National Database of Health Insurance Claims (NDB) was developed in 2012, long‐term trends regarding hip fracture incidence in Japan remain unclear. In order to clarify the trend in hip fracture incidence from 1992 to 2017, we estimated the number of new hip fractures in 2017, the seventh in a series of nationwide hip fracture surveys performed every 5 years since 1987. We also investigated regional differences in hip fracture incidence. We collected data through a nationwide mail‐in survey of orthopedic institutions in Japan and calculated hip fracture incidence by sex and age, as well as standardized incidence ratio (SIR) across 12 districts. The total number (95% confidence interval) of hip fractures in 2017 was estimated at 193,400 (187,300–199,500), occurring in 44,100 (42,700–45,500) males and 149,300 (144,500–154,100) females. Of all the hip fracture surveys from 1992 to 2017, the 5‐year hip fracture increase rates from 2012 to 2017 was the lowest among female patients. In males, the 5‐year rates from 2012 to 2017 were lower than those from 2007 to 2012. The age‐adjusted incidence rates for patients in both sexes did not show significant change in the 25‐year period. The estimated incidence rates in 2017 for patients aged 70 to 79 years in both sexes were lowest from 1992 to 2017, and declined significantly over the 25‐year period. SIRs differed between northeast and southwest regions. Our findings were similar to those from a previous study in Japan using the NDB from 2012 to 2015. Progress in the development of osteoporosis medication may contribute to the continuous decline in the 70‐year to 79‐year age group. © 2020 American Society for Bone and Mineral Research © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Analysis of the Surgical Outcome of Unruptured Intracranial Saccular Aneurysms in Octogenarians (80-89 Years).

Background:The prevalence of unruptured intracranial aneurysms is increasing in elderly population in Japan. Octogenarians (80–89 years) are more prone to complications due to increased age, comorbidities, increased risk of vasospasm, and treatment risks.Aim:The aim is to study the surgical outcome of unruptured intracranial saccular aneurysms in elderly patients aged between 80 and 89 years.Patients and Methods:A retrospective study was conducted involving all the cases of unruptured intracranial saccular aneurysms operated surgically in elderly patients aged between 80 and 89 years. All the cases operated between January 2017 and October 2019 were included in the study. The preoperative neurological status was assessed using the Glasgow Coma Scale (GCS). The comorbidities and risk factors involved were assessed. Postoperative neurological status was assessed by (1) postoperative GCS score and by the (2) presence or absence of the motor weakness of limbs.Results:Thirty-three aneurysms were operated in 27 patients. Two patients were operated two times at separate occasions for different aneurysms during the study period and hence making a total of 29 surgeries. The age range was 80–88 years, with a mean of 82.4 years ± 2.64 standard deviation (SD). There were 7 (24.1%) males and 22 (75.86%) females. All the patients had a preoperative GCS score of 15/15 without focal neurological deficit. The mean size (mm) of the aneurysms was 6.57 ± 4.04 SD. There were 31 (93.94%) aneurysms in the anterior circulation and 2 (6.06%) aneurysms in the posterior circulation. The comorbidities and risk factors were analyzed and found to be not influencing the outcome of the patients. Clipping was done in 32 aneurysms. One case of posterior inferior cerebellar artery (PICA) aneurysm underwent occipital artery to PICA bypass surgery. The postoperative complications include chronic subdural hematoma (CSDH) in 7 (24.13%) patients, extradural hematoma in 1 (3.4%), meningitis in 1 (3.4%), and lower cranial nerve palsy in 1 (3.4%) patient. All the patients were discharged with GCS score 15/15 without motor weakness of the limbs. The mean duration of stay was 16.62 days ± 9.98 SD.Conclusion:Surgery for unruptured saccular aneurysms in octogenarians has got a good result in the tertiary care facility. Advanced age alone should not be considered for preferring coiling over clipping. Octogenarians are more prone to developing postoperative CSDH.

Gaze-Based Vehicle Driving Evaluation of System with an Actual Vehicle at an Intersection with a Traffic Light

Due to the population aging in Japan, more elderly people are retaining their driver’s licenses and the increase in the number of car accidents by elderly drivers is a social problem. To address this problem, an objective data-based method to evaluate whether elderly drivers can continue driving is needed. In this paper, we propose a car driving evaluation system based on gaze as calculated by eye and head angles. We used an eye tracking device (TalkEye Lite) made by the Takei Scientific Instruments Cooperation. For our image processing technique, we propose a gaze fixation condition using deep learning (YOLOv2-tiny). By using an eye tracking device and the proposed gaze fixation condition, we built a system where drivers could be evaluated during actual car operation. We describe our system in this paper. In order to evaluate our proposed method, we conducted experiments from November 2017 to November 2018 where elderly people were evaluated by our system while driving an actual car. The subjects were 22 general drivers (two were 80–89 years old, four were 70–79 years old, six were 60–69 years old, three were 50–59 years old, five were 40–49 years old and two were 30–39 years old). We compared the subjects’ gaze information with the subjective evaluation by a professional driving instructor. As a result, we confirm that the subjects’ gaze information is related to the subjective evaluation by the instructor.

Kampo Medicine for Various Aging-Related Symptoms: A Review of Geriatric Syndrome.

With the continued growth of the aging population in Japan, geriatric syndrome (GS), which is associated with aging-related symptoms, has become a social problem. GS is caused by physiological and pathological aging and may manifest various symptoms. Physicians use multidisciplinary approaches to provide treatment for individual GS symptoms. Kampo medicine, a Japanese traditional medicine that uses multiple pharmacologically active substances, is useful for many syndromes, conditions, disorders, and diseases associated with GS. Evidence of the effectiveness of Kampo medicine for GS has accumulated in recent years. The effects of Kampo treatment for symptoms related to functional decline of the cardiovascular, respiratory, and digestive systems, cognitive impairment and related disorders, pain and other sensory issues, among others, support the use of Kampo medicine for the management of GS. The role of Kampo medicine for GS is summarized in this review.

Lifetime cumulative incidence of dementia in a community-dwelling elderly population in Japan.

ObjectiveTo estimate the lifetime cumulative incidence of dementia and its subtypes from a community-dwelling elderly population in Japan.MethodsA total of 1,193 community-dwelling Japanese individuals without dementia, aged 60 years or older, were followed up prospectively for 17 years. The cumulative incidence of dementia was estimated based on a death- and dementia-free survival function and the hazard functions of dementia at each year, which were computed by using a Weibull proportional hazards model. The lifetime risk of dementia was defined as the cumulative incidence of dementia at the point in time when the survival probability of the population was estimated to be less than 0.5%.ResultsDuring the follow-up, 350 participants experienced some type of dementia; among them, 191 participants developed Alzheimer disease (AD) and 117 developed vascular dementia (VaD). The lifetime risk of dementia was 55% (95% confidence interval, 49%–60%). Women had an approximately 1.5 times greater lifetime risk of dementia than men (65% [57%–72%] vs 41% [33%–49%]). The lifetime risks of developing AD and VaD were 42% (35%–50%) and 16% (12%–21%) in women vs 20% (7%–34%) and 18% (13%–23%) in men, respectively.ConclusionLifetime risk of all dementia for Japanese elderly was substantial at approximately 50% or higher. This study suggests that the lifetime burden attributable to dementia in contemporary Japanese communities is immense.

Association between visual status and social participation in older Japanese: The JAGES cross-sectional study.

Population aging in Japan has been accompanied by increases in those with visual impairment. No previous study has examined whether visual impairment is associated with reduced social participation in older people in Japan. In this cross-sectional study, questionnaires were mailed to older people living in 39 Japanese communities in 2016. Data from 24,313 respondents (70.3%, 74.0 ± 6.2 years) included information on visual status, social participation, socioeconomic status, and health. Visual status was measured by self-report (excellent, very good, good, or fair/poor). The prevalence of visual impairment (fair/poor) was 9.3%. After adjusting for individual covariates in multinominal logistic regression analysis with multiple imputations, visual status was significantly associated with reduced participation (once a week or more) in volunteer groups, sports groups, hobby groups, neighborhood associations, study/cultural groups, health promotion groups, and involvement in teaching skills/passing on experiences to others (p for trend <0.01). On the other hand, participation in senior citizen clubs was not associated with visual status (p for trend = 0.07). While excellent/very good vision was associated with increased volunteerism (e.g., involvement in teaching skills/passing on experiences to others: Odds ratios (OR) 1.78/1.21), poor vision disrupted participation in activities that require physical activity (e.g., sports groups: OR 0.64). These results suggest that vision status is an important determinant of social participation among older adults in Japan.

Association of Pedicle Sign Type with Clinical and Radiological Features in Patients with Symptomatic Spinal Metastases.

Because of population aging in Japan, the number of cancer diagnoses is increasing rapidly. The pedicle sign is a valuable radiographic indicator of metastases, as the pedicle is the most commonly affected vertebral structure in radiographic assessment. However, few studies have carefully examined the morphological features of pedicle signs. To improve the capacity of medical professionals to diagnose symptomatic spinal metastases, we retrospectively examined the morphological characteristics of pedicle signs and their associations with clinical and radiological features. 186 patients with symptomatic spinal metastases who visited our department during the period from January 1, 2011 through December 31, 2017 were enrolled. The pedicle sign was defined as a missing or obscured pedicle on an anteroposterior radiograph. Radiographs were evaluated for pedicles and other vertebrae structures. Clinical and other radiological features were compared in relation to the type of pedicle sign identified. Pedicle signs were classified as completely disappeared (complete, 26 patients), partially disappeared (partial, 40 patients), or obscured by the osteoblastic background (blastic, 28 patients). Disappearance of both the bone cortex and pedicle was observed in almost half of the patients with complete or partial pedicle signs. The complete pedicle sign was associated with significantly longer survival. Diagnosis of bone metastases requires understanding of pedicle sign types.

Changes in characteristics and outcomes in Japanese patients with heart failure from the 2000s to the 2010s: The HIJ-HF cohorts

BackgroundThe number of hospitalized patients with heart failure (HF) is increasing as a result of the increase in the elderly population in Japan. We evaluated changes in the characteristics and outcomes of HF patients hospitalized in the 2000s to the 2010s and discharged alive based on left ventricular ejection fraction (LVEF). MethodsPooled patient data were obtained from The Heart Institute of Japan Heart Failure studies (HIJ-HF I: 2001-2 and HIJ-HF II: 2013–4). We studied patients discharged alive from pooled data based on LVEF < 40% (HFrEF), 40–49% (HFmrEF), and ≥50% (HFpEF). The primary outcome was death from any cause, and the secondary outcomes were cardiac death and rehospitalization due to worsened HF. ResultsThe proportion of HFpEF increased (35%–43%, p < 0.01), and the median ages of patients with HFmrEF (72–76 years, p < 0.01) or HFpEF (72–80 years, p < 0.01) increased from HIJ-HF I to HIJ-HF II. The use of angiotensin II receptor blockers, beta-blockers, statins, amiodarone, and erythropoietin increased, but nitrate and digoxin usage decreased. The adjusted survival rate and cardiac death-free rate were not significantly different between the 2000s and 2010s in any LVEF group, and the incidence of rehospitalization due to worsened HF was reduced in patients discharged alive from HIJ-HF I to HIJ-HF II [HFrEF: hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.51–0.89; HFmrEF: HR 0.89, 95% CI 0.68–1.16; and HFpEF: HR 0.77, 95% CI 0.61–0.97] with no significant interaction by LVEF groups. ConclusionOur study demonstrated that age, the proportion of HFpEF, and guideline-recommended drug therapy use increased among hospitalized Japanese HF patients from the 2000s to the 2010s. The adjusted survival rate was not improved in any LVEF group, although the incidence of rehospitalization due to worsened HF was reduced.

Management following endoscopic resection in elderly patients with early-stage upper gastrointestinal neoplasia.

With the ongoing increase in the aging population in Japan, the number of elderly patients among the total population with upper gastrointestinal (GI) neoplasia has also been increasing. As elderly patients present unique age-related variations in their physical condition, the therapeutic approach for upper GI neoplasia should be differentiated between elderly and nonelderly patients. According to the existing guidelines, additional treatment is the standard therapy in patients who undergo endoscopic resection (ER) with a possible risk of lymph node metastasis (LNM) for upper GI neoplasia. However, due to the relatively low rate of LNM, applying additional treatment in all elderly patients may be excessive. Although additional treatment has the advantage of reducing cancer-specific mortality, its disadvantages include deteriorated quality of life, complications, and mortality in surgery. In patients with early gastric cancer, we propose treatment decisions be made using a risk-scoring system for LNM and upon considering the physical condition of the patient after ER with curability C-2. In those with superficial esophageal squamous cell carcinoma with a possible risk of LNM after ER, selective chemoradiotherapy may be a less-invasive treatment option, although the present standard treatment is esophagectomy. When considering the treatment decision, achieving a "cure" of the tumor has been regarded as critical. However, as the main cause of mortality in elderly patients with ER for upper GI neoplasia is noncancer-related death, both achieving a "cure" and also a good level of "care" is important in the management of elderly patients.

Changes in clinical features of multiple system atrophy in Japan

IntroductionMultiple system atrophy (MSA) is an adult-onset progressive neurodegenerative disease that causes parkinsonism, cerebellar ataxia, and/or autonomic failure. MSA is categorized as MSA with predominant cerebellar ataxia (MSA-C) or MSA with predominant parkinsonism (MSA-P) according to the cardinal symptom at diagnosis. MSA-C has been reported to be the predominant presentation in Japan to date. However, major epidemiological studies regarding MSA in Japan were carried out before 2006; thus, the recent advancement of various imaging studies remains unclear. This study aimed to investigate the clinical characteristics of the recent MSA patients in Japan. MethodsIn this retrospective study, we divided 80 probable MSA patients into group A and group B and examined them to reveal whether the clinical features of MSA were different depending on the time periods of diagnosis (1989–2003 and 2004–2018, respectively). ResultsThe age at onset was significantly higher in MSA-P patients than in MSA-C patients (p = 0.0039) and was also higher in group B than in group A (p = 0.013). Although MSA-C was the predominant type in both groups, MSA-P was significantly more frequent in group B than in group A (p = 0.039). Although not statistically significant, the early heart/mediastinum ratio in [123I]-meta-iodo benzylguanidine (MIBG) myocardial scintigraphy tended to be lower in patients with MSA-P than in those with MSA-C. ConclusionThe proportion of MSA-P was likely larger than previously recorded due to the aging population in Japan and the improvement of differential diagnosis between PD and MSA-P.

Physician Distribution by Specialty and Practice Setting: Findings in Japan in 2000, 2010 and 2016.

As the medical demand is projected to increase along with the population aging in Japan, the geographical distribution of physicians is a significant concern for society and policymakers. To implement effective measures on geographical physician distribution, this study aimed to describe and compare the distribution of physicians by specialty in 2000, 2010 and 2016 in Japan, and examine whether practice setting was associated with distribution. To quantify the geographical physician distribution by specialty, we calculated the Gini coefficients of physicians working at clinics or hospitals in 2000, 2010, and 2016. We used the basic geographic unit for medical care planning in Japan, a secondary medical area, as the study unit. To show the association between the geographical distribution of physicians in each specialty and their practice setting, we categorized specialties into two groups by the proportion of physicians in that specialty working in hospitals, and showed aggregated Lorenz curves for each category. The overall geographical distribution of physicians appeared to improve during the study period, but varied by specialty. Those in specialties, where at least 90% of physicians work in hospitals such as anesthesiologists and radiologists, were more clustered, as shown by the Lorenz curves and the Gini coefficients. Similar distributional differences were also found even when we excluded physicians working in clinics, meaning that the distributional variation could be explained by other factors than the distribution of hospitals. These results suggest that the nature of practice in each specialty strongly affects the geographical distribution of specialists.

Economic Burden of Neurological Disorders in an Aging Society, the Example of Japan: A Panel Data Analysis

Background: This research explored the burden of two neurological diseases, Alzheimer Disease (AD) and strokes on Japanese economy. While previous studies on the topic focused on accounting costs associated with the diseases, our research explored the loss of gross domestic product (GDP) due to the reduction of the labor force, which is attributed to increased prevalence and informal care of both diseases. Methods: Using time series panel data from Japanese prefectures between 2001 to 2012, we analyzed our study in two steps. First, we quantify the loss of GDP due to the reduction of labor force using the Cobb-Douglass production function to measure the relationship between the output (products) and labor. Next, we analyzed the total labor loss (LT) attributed to the increase prevalence and informal care of the two diseases. Finally, we plug the estimated value of LT in Cobb-Douglass-type of production function, in order to obtain the loss in output due to the shortage of labor. Findings: The difference between two GDPs (GDP with no labor loss and the actual GDP) is maximized in 2001, is 1.4%. However, it is interesting to note that, despite a steady increase of shortage of labor over the years, the gap between actual and predicted GDP is shrinking and in 2012 the gap is 1%. This evolution could be explained by higher values for capital and total factor productivity. Urban prefectures such as Tokyo or Osaka tended to suffer less from a loss of GDP than rural ones, such as Aomori, Niigata or Hokkaido for instance. In addition, empirical results show that, prefectures relying heavily on tourism such as Kyoto, Nara or, to a lesser extent, Kagawa, appeared to show reduced losses due to the shortage of labor, as a consequence of AD and strokes. Interpretation: Our study confirmed that economic costs as a result of labor loss are higher than accounting costs. The empirical analysis confirmed that the loss of labor due to AD and strokes has been increasing over the past decade. However, owing to increased investments in Research and Development (R&D) and higher private capital stock, the loss of GDP has been slightly reduced in the period of study. Nevertheless, given the trend of aging population in Japan and many other G20 economies, increasing R&D and private capital stock may not be sustainable in the future. Funding Statement: This research was supported by JSPS Kakenhi (2019-2020) Grant-in-Aid for Young Scientists No. 19K13742 and Grant in-Aid for Excellent Young Researcher of the Ministry of Education of Japan (MEXT). Declaration of Interests: Authors report no conflict of interest. Ethics Approval Statement: Not required.

Population aging in Japan: policy transformation, sustainable development goals, universal health coverage, and social determinates of health.

Japan is aging rapidly, and its society is changing. Population aging and social change are mutually linked and appear to form a vicious cycle. Post-war Japan started to invest intensively in infectious disease control by expanding health services and achieving universal medical insurance coverage in 1961. The high economic growth in the 1960s contributed to generate a thick middle class layer, but the lingering economic slump after the economic bubble crisis after 1991 and globalization weakened this segment of society. Health disparity has been acknowledged and social determinates of health have been focused. In this article, the author reviewed the response course to health challenges posed by population aging in Japan, and aims to offer lessons to learn for Asian nations that are also rapidly aging. The core viewpoints include: i) review health policy transformations until the super-aged society, ii) discuss how domestic issues in aging can be a global issue, iii) analyze its relationship with Japanese global health engagement, iv) debate the context of social determinates of health, and v) synthesize these issues and translate to future directions.

THE EFFECTS OF DEMOGRAPHIC CHANGES ON REGIONAL ECONOMIC GROWTH: EVIDENCE FROM JAPAN

Since the 1970s, due to the combination of the declining birthrate and rising longevity, the speed of population aging in Japan has been more dramatic than in any other developed country. Consequently, the growth of the working population, which had been faster than the growth of the total population, has gradually become slower in recent years than the latter in Japan. Moreover, similar rapid demographic changes are taking place at various speeds in all prefectures. By introducing demographic variables into empirical models of regional economic growth, which is based on prefecture-level panel data for the period 1980–2010, this paper shows that the recent demographic changes in Japan have had significant effects on its regional economic growth: the contribution of the growth rate difference between the working population and the total population to per capita Gross Regional Domestic Product (GRDP) growth rate, i.e., the demographic bonus, has disappeared. In addition, the growth rate of the aged population (65 years old and over) has had a very significant negative effect on per capita GRDP growth rate, while the growth rate of the young population aged 0–14 has had a significant positive effect. The findings of this study imply that Japan’s population aging and other ongoing demographic changes will continue to depress economic growth in all prefectures. Given the low probability of a significant rise in the birth rate and the rapid increase in the local labor supply, it is important for all prefectures in Japan to raise the quality of their labor-force and improve productivity. Meanwhile, effectively attracting young skilled workers to migrate from other regions/countries should be a key policy issue for both local and central governments in Japan.

2455-PUB: Number of Insulin Users May Explosively Increase with the Aging Population in Japan

Background: The impact of recent advances of oral antidiabetic agent on insulin users is unclear. Methods: A retrospective observational and comparative study using medical records of patients who were prescribed insulin at our facility between 2009 and 2017 for various parameters, excluding dialysis patients. Results: The number of insulin users was almost negligible (309-311 people). The age of the subjects was shifted to the old side on the frequency distribution polygon. The number of subjects who used ≥1 oral antidiabetic agents concurrently increased from 17.0% to 80.0%, especially among those aged &amp;gt;80 years (about 8 times). HbA1c value remained negligible from 8.1% to 8.1%. Conclusion: Our findings suggest an increasing number of patients with insulin secretory dysfunction masked using of oral antidiabetic agents. Disclosure A. Kokita: None. M. Araki: None.

Abstract P331: Unfavorable Social Factors Increased the Risk of Future Disability Subsequent to Heart Failure in Elderly Japanese Community Dwellers: The Iwate KENCO Study Group

Introduction: The risk factors that contribute to future disability after heart failure (HF) are poorly understood. The aim of this study was to determine the risk factors of future disability subsequent to HF in the general elderly population in Japan. Hypothesis: We assessed the hypothesis that unfavorable social factors after than traditional cardiovascular risk factors contribute to an increased risk for disability after HF. Methods: The subjects were community-dwelling elderly individuals aged 65 years or older without a history of cardiovascular diseases. We defined disabled subjects as individuals who had been newly certified by the long-term care insurance (LTCI) system during the observation period. HF was diagnosed according to the Framingham diagnostic criteria. After excluding subjects who received LTCI without HF (n= 2,305) and subjects who had already received LTCI prior to HF onset (n=33), we classified the remaining subjects (n= 4,644) into 3 groups: event-free (no LTCI and no HF; n= 4,548, mean age = 70.1 years at the baseline survey), no LTCI after HF (n= 52, mean age = 72.3 years) and LTCI after HF (n= 44, mean age =74.6 years). We determined the multivariate-adjusted odds ratio (OR) for having each risk factor (male gender, age (increment of years), unmarried status, less educational years (&lt;7 years), no job status, smoking, drinking, hypertension, diabetes mellitus and dyslipidemia) in the latter two groups (reference: event-free) using polytomous logistic regression analysis. Results: The median follow-up period was 10.6 years (49,133 person-years), and the median period [interquartile range] from the incidence of HF to the certification for LTCI was 1.3 [0.3- 4.7] years. Significantly associated risk factors were more advanced age (OR [95% confidence intervals]:1.18 [1.10-1.25]), unmarried status (2.29 [1.14- 4.63]), less educational years (3.36 [1.72-6.55]) and regular drinking (2.58 [1.13- 5.88]) in the group of LTC after HF, while the risk factor was more advanced age (1.08 [1.02-1.15]) in the group of no LTCI after HF. Conclusion: The results suggested that unfavorable social risk factors such as unmarried status, shorter education period and regular drinking strongly contributed to the higher risk of disability subsequent to HF, while those unfavorable risk factors did not contribute to the risk of incident HF without LTCI. Preventive measures must be taken to protect elderly individuals with unfavorable social factors from disability after HF via a multidisciplinary approach.

Measuring the Impact of Population Aging on Tax Revenue: Evidence from Japan and Korea

This paper assesses empirically the tax implications of population aging in Japan and Korea. We achieve the research objectives by taking two approaches: (1) a vector autoregression (VAR) analysis; and (2) an estimated dynamic stochastic general equilibrium (DSGE) framework. Based on data from 1973 to 2015, the VAR results for both countries reveal that an aging shock decreases GDP, hours, consumption, and investment. As the tax bases fall, so do tax revenues. Conditioned on estimated DSGE models, the second approach is to characterize Laffer curves at two steady states: the current (as of 2015) and aged (as of 2060) states. We find that the adverse effect of population aging on tax revenues is more serious for Korea than for Japan. Even in the aged state, Japan has room to generate tax revenues comparable to the current state, whereas combinations of tax rates satisfying this property do not exist for Korea.

Socioeconomic factors and the risk of cognitive decline among the elderly population in Japan.

In Japan, with the largest percentage of population aged 65years or over, a dementia strategy is needed not only from a medical perspective, but also from a social policy viewpoint. This study aimed to verify the association between socioeconomic factors and cognitive decline among Japanese elderly people. Cognitive decline was assessed over a 15-year follow-up period using memory tests or through identifying missing/proxy responses to survey questions due to cognitive dysfunction. I analysed 1886 men and 2102 women in Japan, using competing risk models for cognitive decline, to consider survival effects. Survival effects have not been considered so far although those who live longer may be more likely to experience cognitive decline. Men with higher income had a lower risk of cognitive decline (sub-hazard ratio [SHR]: 0.997, 95% confidence interval (CI): 0.995-0.999). Women with higher education had a lower risk of cognitive decline: 8 to 9years (SHR: 0.646, 95% CI: 0.457-0.914) and ≥12years (SHR: 0.360, 95% CI: 0.164-0.794) than women with 0 to 7years of education. This study suggests that cognitive decline among the elderly Japanese population is associated with socioeconomic factors, such as income and education, even after taking survival effects into account.

Musical Hallucinosis

Musical hallucination is one of the most complex forms of auditory hallucinations, where subjects perceive complex sound in the form of music, in the absence of an acoustic stimulus. It has been reported in patients with diseases such as psychiatric disorders, organic brain diseases, and epilepsy. However, the most common of these are idiopathic musical hallucinations that occur alongside deafness in the elderly. In recent years, there have been many reports of musical hallucination occurring as a result of mild cognitive impairment and dementia. Musical hallucinations accompanying hearing loss may reflect deterioration of cerebral function. It has been suggested that auditory Charles Bonnet syndrome is a pathophysiological mechanism of musical hallucination. The decrease in auditory stimulation and activation of the auditory network may activate the cerebral network in relation to music. It is also thought that musical hallucination appears from disintegration of the complementary relationship between sensation and memory. Treatment is still the focus of extensive investigation. Some authors have reported that hearing aids, antiepileptic drugs, anticholinergics, and antipsychotics can relieve musical hallucination. It is possible that such treatment may lead to relief of musical hallucination in patients with various background diseases. Population aging in Japan has exceeded 20%, which is the highest in the world; therefore, there may be many undiagnosed patients throughout the country.