- Email: [email protected]
Global elderly care in crisis: a view from Japan
Correspondence
Corbis
developed in four steps: extensive review of the literature; the preparation of a first draft of the Rights of the Dying Child; revision of this draft by a larger group of 50 experts representative of a range of professional, institutional, and social figures (doctors, nurses, psychologists, philosophers, ethicists, parents, and journalists) at a consensus meeting held in Trieste, Italy; and finally the integration of comments and feedback, and finalisation and approval of the definitive version of the bill of rights entitled the Trieste Charter. The charter proposes ten fundamental rights for children who are approaching the end of their lives (panel). Each right has a series of duties and the charter proposes the most appropriate manner to fulfil them. The charter will have achieved its purpose when every individual caring for a dying child will be capable of staying near the child until the last moments of his or her life, prepared to accept his or her death, ensuring both respect and dignity. We declare that we have no competing interests.
*Franca Benini, Roberta Vecchi, Marcello Orzalesi [email protected] Paediatric Palliative Care and Pain Management Service, Department of Women’s and Children’s Health Padova University, 35121 Padua, Italy (FB); AGMEN FVG Nursing Home and Hospice Pineta del Carso, Duino Aurisina, Trieste, Italy (RV); and Maruzza Lefebvre D’Ovidio Foundation, Rome, Italy (MO) 1
2
3
4
5
1548
UN. Declaration of the rights of the child. UN General Assembly. New York, 1989. https:// www.un.org/cyberschoolbus/humanrights/ resources/child.asp (accessed April 16, 2014). Council of Europe. European Convention on the Exercise of Children’s Rights. Strasbourg, 1996. http://conventions.coe.int/Treaty/en/ Treaties/Html/160.htm (accessed April 16, 2014). Craig F, Abu-Saad Huijer H, Benini F et al. IMPaCCT: Standards for Paediatric Palliative Care in Europe. Eur J Palliat Care 2007; 14: 2–7. Maruzza Lefebvre D’Ovidio Foundation and European Association of Palliative Care. Palliative Care for Infants, Children and Young People: The Facts, 2009. http://www.eapcnet. eu/LinkClick.aspx?fileticket=DeiV2yhtOZA= (accessed April 14, 2014). Goldman A, Hain R, Liben S. Oxford textbook of palliative care for children, 2nd edn. Oxford: University Press, 2012.
Global elderly care in crisis: a view from Japan I read with interest The Lancet’s editorial (March 15, p 927)1 discussing the increase in demand for elderly care and how the UK and other countries are trying to cope with the situation. With more hospital beds (13·6 per 1000 individuals) and a far longer average length of stay (32·5 days) compared with other countries from the Organisation for Economic Cooperation and Development,2 Japan is also making efforts to manage and sustain its elderly care system in presence of growing demands. In the 1990s, a 10-year government policy with financial packages was implemented for developing longterm care facilities and personnel before the introduction of public longterm care insurance in 2000. These measures were to help elderly people live more independently, relieve the burden of family carers, and also facilitate transfer of elderly people from costly, unnecessary hospital care into the long-term care system.3 Today 25% of the Japanese population is older than 65 years. Policies are strategically aiming towards providing integrated care within the community. Disease prevention and health promotion are key to these policies. For securing sustainability of elderly care, finding the optimal balance of service use with containment of public expenditures is a huge challenge. Some countries in the Association of Southeast Asian Nations (ASEAN) are expected to have more rapidly ageing population than is Japan.4 To share our experiences with ASEAN countries, the Ministry of Health, Labour and Welfare formed the study group for Japan’s International Contribution to Active Aging, which I had the opportunity to chair. The group recently issued a report on useroriented strategies for international cooperation in elderly care and might provide useful information for other countries with ageing populations.5
The report gives an overview of ageing in ASEAN countries, a brief outline of the history of Japanese ageing policies, and current and future possible cooperations for each ASEAN country with Japan—including policy planning, human resource development, and measures for non-communicable disease prevention. I declare that I have no competing interests.
Shigeru Omi [email protected] Japan Community Health Care Organization, Takanawa, Minatoku, Tokyo, 108-0074, Japan 1 2
3
4
5
The Lancet. Global elderly care in crisis. Lancet 2014; 383: 927. Organisation for Economic Co-operation and Development. Health at a Glance: Asia/Pacific 2012. Paris, France: Organisation of Economic Co-operation and Development, 2012. Tamiya N, Noguchi H, Nishi A, et al. Population ageing and wellbeing: lessons from Japan’s long-term care insurance policy. Lancet 2011; 378: 1183–92. UN Population Division. World Population Prospects: The 2012 Revision. New York, NY: United Nations, 2012. Government of Japan, Ministry of Health, Labour and Welfare. Report of the Study Group for Japan’s International Contribution to Active Aging. http://www.mhlw.go.jp/stf/shingi/ 0000041697.html (accessed March 31, 2014).
Department of error Patton GC, Coffey C, Romaniuk H, et al. The prognosis of common mental disorders in adolescents: a 14-year prospective cohort study. Lancet 2014; 383: 1404–11—In this Article (April 19), in the second paragraph of the Procedures section, the cutoff point for the 12-item General Health Questionnaire should have been 3 or above (not 2 or above). This correction has been made to the online version as of May 2, 2014. Baeten D, Baraliakos X, Braun J, et al. Anti-interleukin-17A monoclonal antibody secukinumab in treatment of ankylosing spondylitis: a randomised, double-blind, placebocontrolled trial. Lancet 2013; 382: 1705–13— In this Article (Nov 23), the Oxford Comprehensive Biomedical Research Centre was missing from the affiliation list for Paul Wordsworth. His affiliation details should be “National Institute for Health Research, Oxford Comprehensive Biomedical Research Centre, Oxford Musculoskeletal Biomedical Research Unit, and the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK”. This correction has been made to the online version as of May 2, 2014.
www.thelancet.com Vol 383 May 3, 2014
Corbis
developed in four steps: extensive review of the literature; the preparation of a first draft of the Rights of the Dying Child; revision of this draft by a larger group of 50 experts representative of a range of professional, institutional, and social figures (doctors, nurses, psychologists, philosophers, ethicists, parents, and journalists) at a consensus meeting held in Trieste, Italy; and finally the integration of comments and feedback, and finalisation and approval of the definitive version of the bill of rights entitled the Trieste Charter. The charter proposes ten fundamental rights for children who are approaching the end of their lives (panel). Each right has a series of duties and the charter proposes the most appropriate manner to fulfil them. The charter will have achieved its purpose when every individual caring for a dying child will be capable of staying near the child until the last moments of his or her life, prepared to accept his or her death, ensuring both respect and dignity. We declare that we have no competing interests.
*Franca Benini, Roberta Vecchi, Marcello Orzalesi [email protected] Paediatric Palliative Care and Pain Management Service, Department of Women’s and Children’s Health Padova University, 35121 Padua, Italy (FB); AGMEN FVG Nursing Home and Hospice Pineta del Carso, Duino Aurisina, Trieste, Italy (RV); and Maruzza Lefebvre D’Ovidio Foundation, Rome, Italy (MO) 1
2
3
4
5
1548
UN. Declaration of the rights of the child. UN General Assembly. New York, 1989. https:// www.un.org/cyberschoolbus/humanrights/ resources/child.asp (accessed April 16, 2014). Council of Europe. European Convention on the Exercise of Children’s Rights. Strasbourg, 1996. http://conventions.coe.int/Treaty/en/ Treaties/Html/160.htm (accessed April 16, 2014). Craig F, Abu-Saad Huijer H, Benini F et al. IMPaCCT: Standards for Paediatric Palliative Care in Europe. Eur J Palliat Care 2007; 14: 2–7. Maruzza Lefebvre D’Ovidio Foundation and European Association of Palliative Care. Palliative Care for Infants, Children and Young People: The Facts, 2009. http://www.eapcnet. eu/LinkClick.aspx?fileticket=DeiV2yhtOZA= (accessed April 14, 2014). Goldman A, Hain R, Liben S. Oxford textbook of palliative care for children, 2nd edn. Oxford: University Press, 2012.
Global elderly care in crisis: a view from Japan I read with interest The Lancet’s editorial (March 15, p 927)1 discussing the increase in demand for elderly care and how the UK and other countries are trying to cope with the situation. With more hospital beds (13·6 per 1000 individuals) and a far longer average length of stay (32·5 days) compared with other countries from the Organisation for Economic Cooperation and Development,2 Japan is also making efforts to manage and sustain its elderly care system in presence of growing demands. In the 1990s, a 10-year government policy with financial packages was implemented for developing longterm care facilities and personnel before the introduction of public longterm care insurance in 2000. These measures were to help elderly people live more independently, relieve the burden of family carers, and also facilitate transfer of elderly people from costly, unnecessary hospital care into the long-term care system.3 Today 25% of the Japanese population is older than 65 years. Policies are strategically aiming towards providing integrated care within the community. Disease prevention and health promotion are key to these policies. For securing sustainability of elderly care, finding the optimal balance of service use with containment of public expenditures is a huge challenge. Some countries in the Association of Southeast Asian Nations (ASEAN) are expected to have more rapidly ageing population than is Japan.4 To share our experiences with ASEAN countries, the Ministry of Health, Labour and Welfare formed the study group for Japan’s International Contribution to Active Aging, which I had the opportunity to chair. The group recently issued a report on useroriented strategies for international cooperation in elderly care and might provide useful information for other countries with ageing populations.5
The report gives an overview of ageing in ASEAN countries, a brief outline of the history of Japanese ageing policies, and current and future possible cooperations for each ASEAN country with Japan—including policy planning, human resource development, and measures for non-communicable disease prevention. I declare that I have no competing interests.
Shigeru Omi [email protected] Japan Community Health Care Organization, Takanawa, Minatoku, Tokyo, 108-0074, Japan 1 2
3
4
5
The Lancet. Global elderly care in crisis. Lancet 2014; 383: 927. Organisation for Economic Co-operation and Development. Health at a Glance: Asia/Pacific 2012. Paris, France: Organisation of Economic Co-operation and Development, 2012. Tamiya N, Noguchi H, Nishi A, et al. Population ageing and wellbeing: lessons from Japan’s long-term care insurance policy. Lancet 2011; 378: 1183–92. UN Population Division. World Population Prospects: The 2012 Revision. New York, NY: United Nations, 2012. Government of Japan, Ministry of Health, Labour and Welfare. Report of the Study Group for Japan’s International Contribution to Active Aging. http://www.mhlw.go.jp/stf/shingi/ 0000041697.html (accessed March 31, 2014).
Department of error Patton GC, Coffey C, Romaniuk H, et al. The prognosis of common mental disorders in adolescents: a 14-year prospective cohort study. Lancet 2014; 383: 1404–11—In this Article (April 19), in the second paragraph of the Procedures section, the cutoff point for the 12-item General Health Questionnaire should have been 3 or above (not 2 or above). This correction has been made to the online version as of May 2, 2014. Baeten D, Baraliakos X, Braun J, et al. Anti-interleukin-17A monoclonal antibody secukinumab in treatment of ankylosing spondylitis: a randomised, double-blind, placebocontrolled trial. Lancet 2013; 382: 1705–13— In this Article (Nov 23), the Oxford Comprehensive Biomedical Research Centre was missing from the affiliation list for Paul Wordsworth. His affiliation details should be “National Institute for Health Research, Oxford Comprehensive Biomedical Research Centre, Oxford Musculoskeletal Biomedical Research Unit, and the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK”. This correction has been made to the online version as of May 2, 2014.
www.thelancet.com Vol 383 May 3, 2014