Running head: GROWING OLD IN JAPAN 1

Growing Old in Japan:

Familial Responsibilities

Lacey Ruby

Western Washington University

Hilary Schwandt, PhD MHS

July 24, 2017

GROWING OLD IN JAPAN 2

Growing Old in Japan: Familial Responsibilities

Japan has the highest level of proportion of elderly people in the world and has been

rapidly growing since 1970; however while life expectancy is long, healthy old age has been

declining (Ishii, Ogawa, & Akishita, 2015; Kikuzawa, 2015). Geriatric care in Japan has fallen

mostly to the family because traditional norms typically stress filial piety and paternal

hierarchical family relationships (Okabayashi & Hougham, 2014). Traditionally, the care of the

elder generation fell to the oldest son, elders were considered wise and an important part of the

family, and ancestor worship a common practice (Kikuzawa, 2015). However, after World War

II, the family dynamic in Japan changed towards a more Western structure, holding to less

intergenerational households. Where before there were three generation households, now first

born sons were leaving the home and second born sons would sometimes fill in taking care of

their parents (Traphagan, 2010).

Familial responsibility of elders in Japan can lead to an increase in perceived well-being

for the older adult, but caregiver strain for the family and an increasing rate of elder suicide may

also be outcomes.

Increased Perception of Well-Being

Japanese society has historically been characterized by high levels of social cohesion

(Sachiko, Yorifuji, Takao, Doi, & Kawachi, 2013). Social cohesion involves strong relationships

built with trust and a willingness to help each other; community cohesion is similar except the

relationship is to a community, as a whole, instead of individuals. Research suggests there is

evidence of a connection between social or community cohesion and mortality; though it has

been found that social cohesion and not community cohesion in Japan has an increased

perception of well-being (Sachiko et al., 2013). This suggests that the Japanese older adult does
GROWING OLD IN JAPAN 3

not feel connected to their community but instead to their families, friends, and societal roles;

and these connections influence their idea of self-worth, their emotional balance, and therefore

there perceived well-being.

Healthy relationships with spouses and adult children have beneficial effects on mental

well-being; and when in intergenerational households, elder adults perceived better well-being

spending time with grandchildren than when not in an intergenerational house (Okabayashi &

Hougham, 2014). There were higher perceived benefits from the connection of the whole family

together then there was with grandparents taking on caregiver roles for the grandchildren or with

limited contact from visiting with the children. This suggests that when in an intergenerational

household, the perceived well-being is improved because that fulfills certain life and role

expectancies for the older generation; while being in a nuclear, Western-style family structure

leaves the Japanese older adult feeling displaced, isolated, and depressed decreasing their

perceived well-being.

Another interaction that is useful for perceived well-being in Japan is community

socializations and friendships outside of the home. Because most Japanese companies have an

enforced retirement age, most older adults are not working full time, however, working part time

for money or volunteer work can give a sense of purpose and allow for socializations and

friendships outside of the family. The perceived well-being benefits from a part-time job are

negated if the older adult is working due to financial need (Okabayashi & Hougham, 2014). So

having social interactions and a purpose can increase well-being, but once work is a requirement,

the money can relieve financial strain but causes stress and decreased well-being overall. Stress

and depression can lead to poorer health outcomes and increased problems in the family dynamic

or structure.
GROWING OLD IN JAPAN 4

Caregiver Strain and Elder Mistreatment

Caregiver strain, or mental and physical fatigue related to the continual stress of taking

care of an impaired dependent, can lead to depression, frustration, and abuse or neglect. Research

found that while Japan and Western caregivers utilize the same coping mechanisms such as:

distancing, distraction, complaining, asking advice, or resignation that the Japanese coping

mechanisms had more of an effect on alleviating some depression and strain on the caregiver

(Abe, Kashiwagi, & Tsuneto, 2003).

Caregivers are getting older and having their own health concerns and financial concerns,

and this can cause strain and frustration at the situation. As people in Japan start reaching

expectancies over 75 and higher, their adult children being their caregivers can become complex.

The adult children themselves could be at a retirement age and at an age they might have

expected the next generation to start taking care of them however financial needs and longer-

lived parents cause a disruption in that routine. When the caregivers themselves become ill or

aged, relationships can become strained or neglect can occur. Neglect could be purposeful or

accidental; a misunderstanding of the elder adults changing needs, or the caregiver being too

sick to care for the older adult (Shibusawa, Iwano, Kaizu, & Kawamuro, 2014).

Another change in alleviating caregiver stress is the growing trend of in-home health

services which allows the family caregiver to get a job or to find respite outside of the stress of

familial obligations (Shibusawa et al., 2014). There is a rise in comorbidities in Japans elderly

and with the longer life expectancy, their familial caregivers are also aging and dealing with

more acute or difficult care. While the Specific Health Checkup, introduced in 2008, did begin a

decline in mortality by early screening, diagnosis, and treatments, this left an increasing rate of

older Japanese adults living with complex comorbidities to manage (Ishii et al., 2015). Having
GROWING OLD IN JAPAN 5

in-home healthcare or visiting nurses allows the family to avoid the strain of caregiving or limit

the strain.

Another benefit of healthcare professionals being involved in care of the elderly is the

ability to monitor for older adults at risk for neglect, mistreatment, or abuse. In 2006 Japan

acknowledged an alarming trend of elder mistreatment and took steps to create a law requiring

local municipalities or governments to create and maintain elder abuse prevention and

intervention programs, as well as caregiver support (Shibusawa et al., 2014). With healthcare

professionals entering the home, at risk older adults could be monitored and neglect,

mistreatment, or abuse could be reported with interventions in place. Though this only would

alleviate family mistreatment of the older adult and not medical healthcare professional

mistreatment of their patient. Studies do suggest that caregiver strain is not the only reason for

mistreatment or neglect nor does caregiver strain necessarily mean that the caregiver will

mistreat or abuse the older adult (Shibusawa et al., 2014).

The majority of elder mistreatment was found to be psychological mistreatment or

neglect, there was also some significant amount of financial mistreatment and the lowest statistic

found was physical abuse. The studies also found that behavioral problems on the elders part

such as from dementia or health difficulties on the caregivers part increased the risk of

mistreatment; mistreatment due to lack of understanding of comorbidities or illnesses of the

older adult was also found (Shibusawa et al., 2014).

Elder Suicide

Adults over sixty-five years of age are not only 23% of Japans population, but also a

majority in the statistics of suicides in Japan. While Western ideas suggest a social acceptance in

Japanese culture for suicide, a better understanding of cultural changes in life or role
GROWING OLD IN JAPAN 6

expectations shows that there is more complexity than acceptance of the realities of suicide

(Traphagan, 2010). Many Japanese elders suggest that suicide is multifaceted but can be

described as intergenerational stress where their expectations of familial roles and

responsibilities conflict with the newer generations perspective.

With the change to single generational households and oldest sons moving away from

home, Japanese older adults are dealing with a role reversal of no longer overseeing the

household and losing control to the younger generation. Some find this change in family

dynamics to leave them feeling powerless and as if they have no say in how the family is

managed (Traphagan, 2010). The combination of the older son not taking on expected roles nor

filial piety, with the elders perceived lack of power, leaves the older adult feeling as if they are a

burden instead of a respected member of the household. This feeling of burdening their family

and powerlessness can lead to isolation, depression, and death.

With increased morbidities; instances of neglect, mistreatment, or abuse; or dysfunctional

family dynamic, there are times the Japanese older adult is unable to stay in their home and must

go to a medical facility instead. This situation increases depression and nostalgia for the past;

they can feel out of place and that they do not fit in current culture which can make them

feel that there is no point in living (Traphagan, 2010). When the older adult feels isolated,

without a purpose or place, and depressed, mortality rates increase and self-harm or suicide

becomes a higher risk.

It is not a cultural acceptance of suicide, but an understanding that when life expectations

are not met, depression and suffering follow. The change in family power structures is seen as a

loss to the older adult in Japan, and there is grief over the loss as well as a struggle with the

perceived lack of power and connection. Suicide in the Japanese older adult is seen as a
GROWING OLD IN JAPAN 7

consequence of conflicting world views leading to dissonance without a way of relief outside of

death. Be they feeling as if they are a burden to their families, out of place, disconnected,

disempowered, or isolated, suicide is sometimes the only answer the Japanese older adult finds

(Kikuzawa, 2015; Traphagan, 2010).

Conclusion

There are many complexities involved in growing old in Japan related to changing

perceptions of familial responsibilities, declining health in a long-lived people, increases in aged

population, and disempowerment with family dynamic structure changes. Where once multi-

generational households were considered ideal and normal, and filial piety a societal expectation,

elders have become a burden to their families and a strain on their aging caregivers, leaving the

older adult disconnected from the family, isolated, and depressed.

As of 2006, Japans government acknowledged a trend of elder mistreatment and put a law

in place to prevent neglect and mistreatment, create programs of intervention in the case of abuse,

and to assist in support for the caregivers of the Japanese elderly. This law, plus the rising need for

in-home healthcare services, has helped bring more awareness to the problem and identified older

adults at risk for abuse and mistreatment in the home. With monitoring, prevention programs, and

interventions in place, the rates of elder mistreatment should lessen. Additional help for the

caregivers through support or medical in-home health professionals can also decrease elder neglect

and mistreatment.

Isolation and role dysfunction in the home, has led many Japanese elders to suicide. The

higher rates of suicide are not a sign of cultural tolerance but viewed as a consequence of changing

social values which is blamed mostly on American influences after World Word II (Traphagan,

2010).
GROWING OLD IN JAPAN 8

References

Abe, K., Kashiwagi, T., & Tsuneto, S. (2003). Coping strategies and its effects on depression

among caregivers of impaired elders in Japan. Aging & Mental Health, 7(3), 207211.

Ishii, S., Ogawa, S., & Akishita, M. (2015). The State of Health in Older Adults in Japan: Trends

in Disability, Chronic Medical Conditions and Mortality. PLoS ONE, 10(10), e0139639.

Kikuzawa, S. (2015). Elder Care, Multiple Role Involvement, and Well-Being Among Middle-

Aged Men and Women in Japan. Journal of Cross-Cultural Gerontology, 30(4), 423

438. https://doi.org/10.1007/s10823-015-9273-x

Okabayashi, H., & Hougham, G. W. (2014). Gender differences of social interactions and their

effects on subjective well-being among Japanese elders. Aging & Mental Health, 18(1),

5971. https://doi.org/10.1080/13607863.2013.788997

Sachiko, I., Yorifuji, T., Takao, S., Doi, H., & Kawachi, I. (2013). Social Cohesion and

Mortality: A Survival Analysis of Older Adults in Japan. American Journal of Public

Health, 103(12), e60-6. https://doi.org/10.2105/AJPH.2012.301311

Shibusawa, T., Iwano, S., Kaizu, K., & Kawamuro, Y. (2014). Self-Reported Abuse and

Mistreatment among Japanese Elders Receiving Respite Care. Journal of Aggression,

Maltreatment & Trauma, 23(1), 6780. https://doi.org/10.1080/10926771.2014.864742

Traphagan, J. W. (2010). Intergenerational Ambivalence, Power, and Perceptions of Elder

Suicide in Rural Japan. Journal of Intergenerational Relationships, 8(1), 2137.

https://doi.org/10.1080/15350770903520643