In the 2030s, Japan’s working population will decrease by more than 8.6 million. With the further ageing of the population, we expect a sharp increase in demand for medical and nursing care services. The problems of population ageing should be solved with short-, medium-, and long-term approaches, but in Japan, we do not have enough time for that. To enable Japan to continue to play its role in the international community, we need to solve all the problems holistically and create a basic institutional design by 2030. The problems of the ageing society span many domains and thus require an interdisciplinary approach. Also, we should focus our efforts on establishing a medical and nursing care system that takes into account international perspectives, such as embracing care workers from overseas to help fill the staffing shortage in nursing care and reviewing the number of hospital beds in view of an expected increase in demand for inpatient therapy in Japan by medical stay visa holders.

The Japanese government is working to create a social security system that can cater to the needs of all generations. We will alleviate the burden of the working generation and encourage motivated elderly individuals, women, and people with disabilities to remain in or enter the workforce. We will work to activate local initiatives and activities in which elderly people can play an active role and feel a sense of fulfillment. In January 2024, the Basic Act on Dementia to Promote an Inclusive Society was brought into force in Japan. With this law, we aim to realize an inclusive society where people support each other and they can live with hope even if they suffer from dementia. Revitalizing rural regions is essential to addressing the problems of the super-ageing society. We will make every effort to reinvigorate rural communities.

Populations are ageing at a higher pace in low- and middle-income countries than in high-income countries. To promote comprehensive initiatives for healthy longevity, it is vital to provide economic assistance to help them avoid catastrophic health expenditure, for example by expanding non-contributory or subsidized pensions. This would reduce the number of deaths by 100 million by 2050. Exercising taxation on tobacco, alcohol, and sugared drink can mobilize additional revenues and encourage more healthy behaviors. At the World Bank, we have proposed building integrated services for the elderly around primary health care. We help countries to implement longevity programs and strengthen their health insurance systems; we have provided financial assistance, knowledge, and technologies to more than 100 countries across the world.

Factors behind increasing average life and healthy life expectancies in Japan include the presence of public health checkups and universal health insurance programs as well as advancements in treatment for various diseases. Elderly Japanese people are becoming rejuvenated, with their physical functioning improving year by year and the risk of dementia lowering. The healthy life expectancy of the elderly is influenced by personal factors and environmental factors. Going forward, we need to bring about societal transformation using artificial intelligence (AI) and information and communication technology (ICT). We will collect biometric data to build a database, and seek to increase healthy life expectancy and improve the quality of life (QOL) through AI-assisted disease predictions and health advice. This will shape the image of the rejuvenated and actively engaged elderly in the 2040s.

Speaking of the significance and purpose of the Conference, Mr. Seike said, “Investment for extending healthy life expectancy will promote workforce participation among the elderly and enhance the sustainability of society as a whole. Extending healthy life expectancy is important for not only extending working-life expectancy but also increasing the number of years engaged as a consumer, investor, and member of a local community.”

Ms. Fried said that healthy longevity is the “state in which years in good health approach the biological life span, with physical, cognitive and social functioning, enabling well-being across populations,” referring to the definition by the U.S. National Academy of Medicine. She noted that preventing risks associated with ageing, investing in education, and enhancing engagement with society will lead to greater healthy longevity.

Mr. Sawa introduced smart operations to be implemented at a new hospital set to open in 2025. “Patients directly go to the examination room without visiting the reception, just like when you drive through an ETC gate on a highway. They can check their biometric data and therapeutic information on their smartphone. The doctors, nurses, and hospital staff can view patients’ electronic medical records wherever they are in the hospital, leading to improvements in working practices of hospital staff,” he said, presenting a vision of a new hospital in a super-ageing society.

Mr. Piggott discussed how pension systems should be. Taking the 2011 pension reform of Norway as an example, he said that the reform, which has set 62 as a uniform access age for all types of pensions, created a new option to allow elderly individuals to continue to work while receiving pension benefits, by reducing their work hours according to their capacity. He also noted that promoting work flexibility has important implications in extending the working-life span.

Ms. Yamamoto focused on the problem of loneliness and isolation. “The problem is not being alone in and of itself, but that worries and struggles grow more and more complicated and serious when people try to deal with them alone,” she said, pointing to the need to promote cross-sectoral coordination and establish a platform for public-private coordination to enhance synergies in implementing measures to create connections among people from a preventive point of view. She said that the goal should be a “community-based inclusive society,” which is more than just the relationship between those supporting and those supported, transcending generations and sectors.

Panel Session 1 was focused on the issue of dementia. Mr. Mimura said, “Treatment of dementia has a significant meaning in the stage of mild cognitive impairment (MCI) or even in the preceding preclinical stage. It is believed that 40 percent of dementia patients can make a recovery if they receive education and alleviate problems concerning social isolation and lifestyle. The two-pillar approach of treatment and prevention is essential in addressing dementia,” he said, describing the current situation of dementia care.

Mr. Iwatsubo said, “To raise the effectiveness of dementia treatment, it is necessary to increase symptom assessments in the preclinical stage, where patients show no symptoms but have amyloid beta (a substance that causes Alzheimer’s disease) accumulated in their body. He talked about J-TRC’s activities to create a cohort of people in the preclinical stage without symptoms of dementia, in which 14,500 people have participated through the Internet.

Mr. Ninomiya reported the results of an ongoing epidemiological study in Hisayama Town, Fukuoka Prefecture. According to the study, the dementia morbidity rate has been on the decline since 2012. The onset of dementia has been delayed, and the survival rate after the onset has also improved. Mr. Ninomiya asserted that a mixture of multiple risk factors could cause a jump in the incidence of dementia, and that the disease was epidemiologically preventable.

Ms. Hotta has held interviews with more than 100 people with dementia at the Designing for Dementia Hub since 2018 and archived the interviews in the hub’s library database. “Ordinary people might imagine that people with dementia are living in fear and sorrow, but the emotion shown most strongly by dementia patients was ‘happiness,’” said Ms. Hotta. “In particular, communication and interaction arouse a feeling of happiness. This ‘micro happiness’ will hopefully provide a clue to our search for activities to create a comfortable and livable community.”

Mr. Dey brought up the issue of dementia care programs in low- and middle-income countries. He said that the importance of assessment and care for dementia patients was not fully acknowledged in these countries, and that introducing high-income countries’ programs would not necessarily be successful in the same way. Mr. Dey outlined a cross-sectional study called LASI-DAD, which began in India in 2014. “The dementia morbidity rate among people aged 60 or over is estimated at 7.4%, suggesting the possibility that 8.8 million Indians may be living with dementia,” he said. “This figure is expected to increase twofold over the next 15 years, so this situation calls for urgent attention.”

Novartis Pharma is a research and development (R&D)-oriented company with 25% of its sales reinvested in research. In Japan, we have developed a number of new drugs, with quite a few drugs for rare diseases and those for pediatric patients approved by the Japanese government. In 2023, we announced a plan to invest 100 million dollars in our plant in Tanbasasayama, Hyogo Prefecture, to establish radioligand therapy (RLT) manufacturing capabilities in Japan. However, due to the influence of the weak Japanese yen and market entry barriers such as government regulations, it has been difficult to deliver to the Japanese market some of our products that can be administered elsewhere in the world. We will work to create an environment that would enable us to continue to deliver innovation to Japan by forming social consensus, continuing to create jobs, and building necessary ecosystems.

Ms. Sato said, “By the mid-2040s, more than 30 percent of Japan’s labor population will consist of people aged 60 or over. Financial asset owners have grown older, and people aged 75 or over are expected to account for 31% of the overall financial asset owners in 2030. These issues cannot be resolved by thinking in a traditional way. What should we do?”

Mr. Ouchi took up the issue facing financial institutions concerning the cognitive ability of ohitorisama (elderly people living alone). “Currently, cognitive ability is judged by each salesperson based on their experience. The judgements made this way may be different from the actual conditions of elderly patients, which poses a big challenge,” he said. “To address this challenge, we should start by using unbiased digital judgements as reference information.”

There are other worries for elderly people living alone, such as personal reference by a third person, which is required for hospitalization and nursing home admission, and delegation of authority for posthumous affairs, which is required for funeral, burial and other administrative procedures after death.

Mr. Ogawa criticized the guidelines on lifetime support service released by the Ministry of Justice in June, saying that it “is a big step backward from the previous state policy of not requiring personal reference.” He went on to say, “What healthcare providers actually want is emergency contact information and the collection of the deceased’s body and the personal belongings left behind. Therefore, personal reference should be prohibited because it could be mistaken for joint and several liability,” Mr. Ogawa insisted. He also mentioned the limits to the delegation of authority for procedures after death, and suggested the “need to create a service for watching over elderly people living alone while satisfying the needs of healthcare providers.”

In the discussions on the employment of elderly people, Ms. Takayama pointed out that cognitive decline would come much later than previously thought. “Crystallized intelligence that involves experience, such as comprehension and discernment, is retained until one’s mid-eighties. Fluid intelligence, such as processing speed and intuition, begins to decline in one’s sixties but can be retained and recovered through training, according to some reports,” she said, and indicated the importance of offering proper support to elderly people to improve their functional ability.

Mr. Tsutsumi talked about YKK’s decision to abolish mandatory retirement in 2021. “Mandatory requirement (a system that allows the company to decide the timing of retirement) did not align with YKK’s standard of value which emphasizes ‘autonomy’ and ‘fairness.’ Prior to the abolishment of the mandatory requirement system, YKK introduced a merit system in 2000 and a reemployment system in 2005. In 2015, we adopted a dual-ladder course system that allows employees to choose whether they want to work globally or within specific regions,” he said. Looking back at the company’s reforms, he said, YKK “could abolish the mandatory requirement system without confusion thanks to these foundations.”

Relive Co. Ltd. is the developer and manufacturer of the Relive wear clothing designed for better health. The clothes are made by mixing several kinds of minerals into paint that is printed on the surface. The minerals included are effective on acupoints across the body, easing muscle tension and stiffness, facilitating recovery from fatigue and improving blood circulation. A study by a third-party organization shows a significant difference in improvement effect for all six items, which include blood flow, back strength, fatigue, muscle rigidity around the waist and forward bending. Verification tests are still continuing at universities, local governments and other institutions. Relive’s clothing is reasonably priced compared to nursing-care robots and has almost no side effects. This is why the clothing is expected to contribute greatly to preventing frailty and enhancing the quality of life (QOL) for elderly people.

How can ICT contribute to social participation by elderly people? Mr. Hirose compared ICT to complex numbers. “Introducing a new concept can resolve problems that otherwise could not be solved,” he said. “Metaverse creates a new communication space and VR creates new forms of entertainment that transcend time and space. Likewise, ICT will hopefully create new possibilities for the elderly’s social participation.”

Ms. Ueoka cited an example of social participation by elderly people using ICT. She talked about initiatives based on the “telepresence chat” system, which can be used on the smartphone immediately without installing an app, and with which an object shown on the screen can be indicated by using an icon. “If elderly people in local communities become players distributing interesting content, they can form connections with society beyond the bounds of distance,” she said.

Mr. Mizuno reported the results of a survey intended to “clarify how ICT can make contributions.” “Ninety percent of senior people use information technology equipment, and 80 percent of them search information. Elderly people who use the Internet for social participation can find opportunities more frequently and enjoy a higher quality of life,” he said, describing how deeply the use of the Internet has permeated into the elderly’s lifestyle.

Mr. Su talked about a Taiwanese precision personal healthcare platform that is based on big data and AI technology. “The platform uses measurement data on the elderly’s physical strength and capabilities to give them advice on proper exercise. The results are also accumulated in the database and used for the prevention of frailty and rehabilitation therapy for elderly people. The important thing is to connect the hospital and homecare, and this is where cutting-edge ICT can contribute,” he said, noting the importance of the use of ICT.

Mr. Hirose talked about unique activities of a gerontology study group organized by junior high school students. “Since they were born, they have seen an inverted triangle demographic pyramid, so they don’t think anageing society is an issue. That is why they have positive thoughts about gerontology. At the group’s session, a lot of unique ideas popped up, such as a VR-based reunion for 100-year-olds,” Mr. Hirose said, adding that junior high school students’ flexible ideas could drive the creation of a new ageing society.

Mr. Chung said, “What is social innovation? What is happiness? How can the diverse perspectives of multiple generations be included? Let’s think about how to implement social innovation ecosystems.” Raising these questions, he directed the direction of discussions.

Ms. Shimaoka defined social innovation as “creating ideas, products and services contributing to the public good and at the same time, new social relationships and collaborations.” She then referred to entrepreneurship education provided by health innovation schools. “Resolving actual healthcare issues may lead to innovation. However, the question is how to create a complex model that will work both as a business model and a mission mode,” she said.

Mr. Maeno presented the results of a study on subjective well-being. “Happy people are healthy and live long. Elderly people have a higher level of happiness, and happy people are altruistic, broad-minded and highly creative. So they can play a part in social innovation. In the coming age, subjective happiness will lead social innovation,” he stated.

Ms. Sagara explained BAOBAB’s annotation service, namely, the action of adding tags to datasets for AI learning. “Currently, we have 1,200 annotators working online in 22 countries worldwide. We also outsource annotation work to support facilities for people with disabilities. What is noteworthy is that autistic people feel proud of themselves doing leading-edge work and have begun to interact and shown other big changes. Creating a working environment for minorities to work as they actually are, will lead to inclusion of diverse perspectives,” she stated.

Mr. Wong talked about an initiative in Singapore. “Eighty percent of people live in public housing in Singapore, where platforms (to extend healthy life expectancy) are formed on a location basis. Ministries and agencies work together with the private sector, with each player taking on such roles as preventive health, environmental architecture, and technology. While doing so, they design things based on the Japanese concept of Ibasho (note: used to mean a place where all the people there can play a certain role).