Page 25 - IJPS-8-2

International Journal of
Population Studies Japan’s death-laden society

increasing in the future due to anticipated growth of body is discovered by an unacquainted neighbor weeks
health-care needs associated with the continuous aging or months after his death (Kato, Shinfuku, Sartorius,
of the population over the coming decades. By 2040, the et al., 2017). Older people living alone in urban areas are
expenditures are projected to jump to 546.7 for medical likely to face a greater risk of lonely deaths than those in
care and 197.1 billion USD for long-term care (Figure 2). rural counterparts due mainly to a greater likelihood for

This projected public burden of disease is unsustainable the former to be childless and have weaker ties to the
and should the current framework to finance the communities in which they reside (Interview data, Tokyo,
expenditures be maintained in the era of a death-laden July 19, 2021).
society (Interview data, Tokyo, 6 July 2021). As discussed In the Tokyo area, for instance, incidents of “lonely
above, the majority of people in Japan die at hospitals, for deaths” have been rapidly surging in recent decades.
which significant financial resources are spent providing Figure 3 illustrates the trend from 2002 through 2021
medical care for patients suffering terminal health of the number of those aged 65 or older who died at
conditions. Over the next decade, the country may see home alone and were investigated by the Tokyo Medical
an increase in the number of people who die, or choose Examiner’s Office on the causes of death. One thousand
to die, at long-term care facilities as an alternative to the two hundred and seventy-four people allegedly died
conventional, hospital deaths (Interview data, Tokyo, July “lonely deaths” in 2002, and the number jumped to 5258
6, 2021). Whether dying at hospitals or long-term care by 2021, above a four-hold increase in two decades (Tokyo
facilities, however, the ballooning of deaths from old age Medical Examiner’s Office, 2022). To date, the data for
will only contribute to pushing the burden of disease to the whole country are not readily available. The case of
insolvency. Simultaneously, this challenge will be further Tokyo, nonetheless, may suggest that a similar trend has
exacerbated by a continuing decline in the working age been taking place in other major cities also, and that in the
population who primarily finance the public health-care coming decades, this grim phenomenon will likely prevail
budget. among a larger share of older people across the country
(Interview data, Tokyo, October 3, 2021).
3.3. Potential prevalence of “lonely deaths” among Dying in place with a sense of comfort and dignity
those in advanced age requires, in many cases, close care and quality support
The third area of challenge is a possible adverse effect of from informal caregivers – the dying person’s spouse,
promoting “dying in place” for those in advanced age in children, or siblings in particular – especially during the
Japan who wish to die at home rather than in hospitals. person’s last days (Brink, 2008). In Japan, however, over
Despite hospitals remaining the dominant place of death, the past several decades, the number of older people who
the majority of older people in the country would actually live alone has been steadily increasing due in part to a
prefer spending their final days at their homes. According combination of their prolonged longevity, loss of spouses
to an opinion survey conducted in 2020 with a nationally and siblings in later life, and living away from or not having
representative sample of those aged 75 to 84, above 64% children (Suzuki, Dolley, and Kortt, 2021). Moreover, due
of them expressed their desire to die at their own homes. to the rising number of unmarried or childless people
Moreover, over 85% of those preferring their homes in the country, in a death-laden, Japan, the size of the
reasoned that they considered that being at home would childless older population is also expected to grow at a rate
allow them to maintain a sense of self, comfort, and dignity unparalleled in the country’s history (Park, 2020).
up until the last moment of their lives (Nippon Foundation,
2021). Policymakers in the country might find it urgent
to follow other countries in promoting “dying in place”
both to accommodate such preference of today’s older
population and to help mitigate the prospective growth of
public health expenditures.
However, pursuing this policy direction may create
a potential adverse effect: A prevalence of what is often
referred to as “lonely deaths” among those in advanced
age. A “lonely death” refers to an incident when an older
person living alone spends his final years living alone and Figure 3. Number of those aged 65 or older who died at home alone and
then dying at home without care or attention from others, were investigated on the causes of deaths, Tokyo, Japan, 2002-2021.
including his own relatives, after which the deceased Source: Tokyo Medical Examiner’s Office (2022)

Volume 8 Issue 2 (2022) 19 https://doi.org/10.36922/ijps.v8i2.301