Shaw Watanabe,Sayuri Kodama,Hideo Hanabusa
1亚太临床营养学会会长，惠阳保姆13825404095生命科学促进会，25-3-1004，日本东京，160-1115
2 Sagami女子初级学院，2-1-1Bunkyo，Minami-ku，Sagamihara-shi，Kanagawa-ken2520383，日本
3弘诊所，2-28-3道贤班，涩谷区，东京150-0043，日本
摘要
日本的预期寿命是世界上最高的，并且在不断增加。建立老年医院和养老院已经不能满足当前得需要，大多数人想在家里接受护理。在老年临床前阶段，通过饮食和体育活动促进健康和预防疾病是唯一有效的解决办法。
关键词：老年人；公共卫生；医疗成本；健康促进；疾病预防
快速增长的老龄化社会
日本100岁以上得老年人在2016年超过7万[1]。1963年实施《老年人福利法》时，百岁老人的人数仅为153人，但在1998年超过1万人，在2012年迅速扩大 到5万人以上，估计在今后五年内超过10万人。日本的老龄化速度(即65岁及以上人口所需的年数)在26年内从7%上升到14%，而法国为115年，美国为69年，英国为45年[2]。此外其它亚洲国家，老龄化速度预计将比日本更短，韩国和越南只需要18年，新加坡19年，泰国22年，中国23年。
图1显示了1990年、1995年和2025年人口金字塔的变化，是典型的老龄化社会。在20世纪30年代，像一个美丽的富士山的形状，然而1995年开始出现了低出生率，战后曾出现的高出生率的婴儿潮，使当时的日本出现了最低的抚养比，因此日本实现了强劲的经济增长。到2025年，65岁以上的老年人口将达到35%，一个超级老龄化的社会将出现，但如营养改善、抗生素感染减少和住房环境的改善可能能改变这种情况。
然而，最严峻的问题使对医疗和护理服务的需求越来越多。到2025年，医疗费用将增加24%，护理费用将增加36%。健康预期寿命的延长被认为是老年社会的载体，老年人需要更健康的生活。
老龄化社会的卫生政策
1999年，世界卫生组织发起了一项新的运动，强调“积极的老龄化”[3]。这与国际年“建立一个不分年龄，人人共享的社会”的口号完全一致，口号强调了社会融合和健康在整个生命过程中的重要性。该运动指出“为了在以后的生活中保持积极和健康，个人可以做很多事情”。正确的生活方式、参与家庭和社会以及有利于老年人的环境都能保持积极的状态。
为了应对肥胖率和相关慢性疾病的增加，日本颁布了几项政策、指导方针和方案[4-8]。1998年的《积极80健康计划》，提出了九项目标，重点是饮食、体育活动、休息、禁止吸烟、适度饮酒、癌症早筛、高血压、肥胖和牙齿健康；2000年的《健康日本21世纪计划》；2005年的《日本饮食教育基本法》，目标是儿童要培养健康的身心，大众能保持身心健康，活得生动；2006年的《预防照料法》，在2008年，政府推出了健康体检计划，包括测量腰围和营养建议，以减少代谢综合征和相关疾病的数量。
2013年，健康日本21计划第二阶段启动[9]。口号是“智慧生活工程”，它由步行、饮食、呼吸（无烟）和健康检查组成。还鼓励建设高级实体发电站。这是一个转折点，从个人卫生努力转向更多的公共卫生支持。在日本，超过三分之一的地方政府设立了体育设施，以进行体育干预。当地政府的体育设施中心最常见的目的是通过对久坐的人进行习惯性锻炼和健身来预防代谢综合征的患病率，通过更多的密切交流来减少人的认知功能障碍。这些计划的实施是为了未来老年人更健康的生活[10]。
日益增长的老年人医疗费用
日本的预期寿命是世界上最高的，并且在持续增加[11]。随着寿命的延长，健康的预期寿命也在增加。2013年，女性的预期寿命是86.6 岁，男性为80.2岁；女性的健康预期寿命为74.21岁，男性为71.19岁。预期寿命与健康预期寿命之间的差距并没有缩小，男性为9.0岁，女性为12.4岁，这更加明确了医疗保障的必要性。日本在1990年代到2000年代，开始不断建造老年医院和养老院，从1990年的2260所增加到2011年的6254所，养老设施在过去20年里增加了277%。2016年，日本医疗支出占国内生产总值(GDP)7.81%，即10.76%的国民收入，达到42万亿日元以上，大部分是由各种医疗保险覆盖的[12]。老年人口（65岁以上）医疗费用的支出占总医疗费用的60%；75岁以上的老年人医疗支出占总医疗费用的33.6%[12]。由于医院和养老院的增加，在医院的死亡比例迅速增加， 1950年左右，家庭死亡率为82%，目前80%以上的在医院去世。目前应避免过度依赖医院和养老医院，会导致医疗费用和护理费用的激增，使医疗系统不堪重负，可持续性减弱。
家庭的医疗和护理
认识到家庭的医疗和护理的必要性，日本在2014年实施了一项重大法律修正案。计划到2025年，取消18万张重症监护床位，希望能带来更好的家庭护理[13]。
但是这造成了另一个问题，即家属必须放弃工作并在家照顾父母，这使劳动人口一代代的减少使经济和社会的活力减弱。这已经成为一个很大的社会问题，因为它最终会影响到每个人。
目前，大多数人希望在家接受医疗护理[14]。患者人数的变化使支持家庭护理得诊所/医院需要增加家庭营养师、医生和护士。每年病人和医疗机构比例的增加，供给端的资源也需要增加。
营养师的探访指导是指由有管理者指派营养师每月定期两次到患者家中对患者进行探访，访问时间从30分钟到1小时，费用仅为530日元。营养指导是治疗的必要手段，例如，根据医生的要求改善吞咽障碍患者的膳食。
根据家庭医疗护理管理指南，目标人员是需要特殊护理的人，护理程度是根据护理保险认证确定的，比如处于营养不良状态的患者。营养师探访的对象是由医生判断需要特别的饮食和营养管理的病人。
预防性降低医疗和护理成本的必要性
在日本需要护理的主要原因中[15]，生活方式相关的疾病占 30.5%，如脑血管病（18.5%)、心脏病(4.5%）、呼吸系统疾病和癌症。还有51.9%是由于认知障碍（15.8%)、虚弱(13.4%)、关节疾病(10.9%)和骨折(11.8%）。老年人通常会出现生理恶化，特别是心脏、肾脏、呼吸功能和肌肉力量。预防卧床不起的目标主要集中在身体虚弱、肌肉衰减征、骨质疏松症，大部分是可以预防的。
通过纠正饮食习惯[16]，医疗支出可以减少10万亿日元，并且保持远离临床前状态健康的重要性。一些检查结果异常但感觉健康，例如代谢综合征，临床前阶段是可以确定的。也有情况是感觉很不舒服，像抑郁症和失眠，但检查正常。西医倾向于对这些处于临床前期的人使用药物。然而，这些临床前阶段可以通过适当的干预而无需药物治疗便恢复正常。
在中国，一些中心已经在进行研究，通过各种综合方式，通过饮食疗法、体育锻炼、水疗、心身疗法和自然疗法，防止进展到临床阶段。饮食和物理性干预变得越来越重要。
多药治疗的频率和潜在的药物相互作用，使治疗老年患者治疗很难平衡利弊。这些问题需要抗衰老医学进一步研究。
整合医疗护理资源
医疗协调员如果在当地，它可以充分利用当地的各种医疗资源，提供最佳的干预方案（图2）。第二代医疗资源整合旨在实施更好、更完善的“饮食习惯、心理保健和身体处理”[16]。
在一个空荡荡的教室里，可以很容易地建立一个综合医疗保健单位。它的好处是，在紧急情况发生时，所有居民都可以步行集合。目前，日本的小学数量约为25000所，儿童数量的减少空出了很多教室。在这里能尽可能的提供饮食教育和饮食服务、有机农业和沟通、护理、康复等，实现区域振兴和区域发展。
单身老人往往不活跃，甚至与邻居没有交流。很难找到一个合适的地方让社区活动来支持他们。近年来，随着老龄化的加深，供养寺庙的户籍人口和周围人口逐渐减少，寺庙中的年轻僧侣们开始在自己的小城镇和村庄中寻找新的生存方式。社会经济地位对人类健康和寿命有着强大的影响[17]。
通过增加独立生活老年人的人数，使其健康长寿，就是解决老龄化的最好方式。提高全社会的意识，“有质量的生活”在“有生活质量的死亡”之前，最终达到死亡。
注：病人个体不能独立使用各种设施。从杂乱无章的构成到以病人为中心的理念，有赖于健康基础、沟通中心的协调。这样的中心产生就业机会，并通过社区共生增加社会活动。中心的候选对象是学校的空房间、空庙宇、地方政府的房子等，提供饮食服务和各种志愿活动等支持社区的服务。
饮食和体育活对临床前干预的重要性
初级卫生保健是一项以实际行动为基础的必要干预，科学上合理、社会上可接受的方法和技术，使社区中的个人和家庭能够通过充分参与而普遍获得，并以社区和国家能够承受的代价，本着自力更生和自决的精神，在其发展的每个阶段维持这些方法和技术。它是国家卫生系统和整个社会经济发展的组成部分。它是个人、家庭和社区与国家卫生系统的第一级接触，使卫生保健尽可能接近人们生活和工作的地方。
饮食习惯与健康的横断面研究（GENKI研究）阐明了6000名参与者中肥胖者和糙米饮食者的特征[18,19]。肥胖者有各种与生活方式有关的疾病，其比值为2-3，而吃糙米者的比值小于0.3。糙米者食用的胡萝卜、绿色黄色蔬菜、萝卜、姜、牛蒡、藕、红薯、山药、咸李泡菜、芝麻、花生、栗子、蘑菇、香菇、干萝卜、海带干、海带、红豆、豆浆等都要多。糙米者不吃肉，大豆蛋白取代了肉和鱼[20]。他们感到健康而生动[21]。
米糠和米油中含有许多功能性成分。米糠中的膳食纤维能很好地平衡支持免疫系统的细菌类群。肠道微生物群由丁酸和其他短链脂肪酸生产商组成[22]。糙米作为主食是一个非常有用的工具，减少肥胖的方法是很有效的[23]。与抛光白米相比，糙米饮食似乎能改善或预防肥胖。良好的排便习惯和大便表明良好的肠道环境有助于避免肥胖和保持更好的健康。饮食以糙米为主，蔬菜丰富，忌吃肉，能保持健康的生活。
在最近的研究中已经阐明，糙米除了作为普通营养物质的功能外，还含有对生理功能有各种影响的物质。糙米γ-谷维素等功能性成分可以控制糖尿病，GABA可以保持心理健康。最初米糠被认为有丰富的维生素和矿物质，之后发现各种物质如长链脂肪酸，阿魏酸和肌醇也包括在内。从这个意义上说，糙米对健康的是非常有益的，可以称为“医学大米”[24]。
全球70%的人的主食为大米，年产量约6亿吨，全球变暖可能会使小麦产量减少，水稻很可能成为全球的主要粮食。90%以上的大米是亚洲国家产出的，是许多发展中国家蛋白质和脂肪摄入的主要来源。在这些国家，大米作为主食可以提供除必要能源以外的各种营养，但是抛光白米会失去这些营养。
糙米可以使人健康长寿，其健康效果可以降低老年人未来的医疗成本。
结论
日本人是世界上预期寿命最长的国家之一，其它亚洲国家在未来20年也会紧随其后。随着寿命的延长，健康预期寿命也在增加，但与健康预期寿命相差近10年，在这范围内的人要花费60%的医疗费用。建设老年医院和养老院并不能满足老年人口迅速增长的需要。
现在多数人希望在家里接受医疗护理，并在那里安详地死去。通过饮食和体育锻炼促进老年人的健康，预防老年人临床前的疾病是唯一有效的解决办法。建立地方交流中心，可以综合的解决老龄化问题。日本在老龄化方面的经验有助于全球卫生事业的进步。
【原文】
Longevity and elderly care: lessons from Japan
Shaw Watanabe1*, Sayuri Kodama2, Hideo Hanabusa3
1 President, Asia Pacififi c Clinical Nutrition Society, Life Science Promoting Association, 25-3-1004, Daikyo-cho Shinjuku-ku, Tokyo 160-1115, Japan2 Sagami Women’s Junior College, 2-1-1 Bunkyo, Minami-ku, Sagamihara-shi, Kanagawa-ken 252-0383, Japan3Hiro Clinic, 2-28-3 daohyun ban, shibuya district, Tokyo 150-0043, Japan
Abstract
Japanese life expectancy is among the highest in the world and it keeps on increasing. Along with the extension of life span, healthy life expectancy is also increasing. Building geriatric hospitals and nursing homes could not cover the necessity. At present, the majority of people want to receive medical care at home. Health promotion and disease prevention at preclinical stage of elderly by diets and physical activity is the only effective resolution.
Keywords: elderly; public health; medical cost; health promotion; disease prevention
Rapidly growing ageing society
The elderly people over the age 100 years in Japan exceeded 70,000 in 2016 [1]. In 1963, when the Elderly Welfare Law was implemented, the number of centenarians was only 153, but in 1998 it exceeded 10,000, rapidly expanding to over 50,000 in 2012, and it is estimated to exceed 100,000 during the next fi ve years. Ageing was so quick in Japan. The Japanese speed of ageing, defi ned as the number of years required for the percent of population aged 65 and over, rose from 7% to 14% in only 26 years, comparing with 115 years in France, 69 years in the USA and 45 years in the UK [2]. Furthermore, in Asian countries, this speed is expected to be even shorter than Japan. South Korea and Vietnam take only 18 years, and 19 years in Singapore, 22 years in Thailand, and 23 years in China.
The changes in the population pyramid in 1990, 1995 and 2025 showed a typical ageing society (Figure 1). In the 1930s, it resembled a beautiful Mt Fuji shape. However, in 1995 the low birth rate happened, and the so-called baby boom generation, which represented a high birth rate after the war, produced the demographic dividend in Japan because the lowest dependency ration appeared at that time, thus Japan achieved strong economic growth. An ultra-elderly society should appear in 2025, when the population of elderly age over 65 years will reach 35%. Such increased survival could be attributed to three causes, such as nutritional improvement, decreased infection by antibiotics and better housing in improved environments.A serious problem, however, is an increasing necessity in medical and nursing care services. In 2025, medical costs will increase by 24% and nursing care benefit costs will increase by 36%. The extension of healthy life expectancy is required to be the carriers in the elderly society and healthy life is defined as not having activity limitations due to health reasons.
Health policy for an ageing society
In 1999, during the International Year of Older Persons, WHO launched a new campaign highlighting the benefifi ts of “Active Ageing” [3]. This was in perfect harmony with the slogan for the International Year “Towards a Society for All Ages” which stressed the importance of social integration and health throughout the life course. The campaign stated “there was much an individual can do to remain active and healthy in later life”. The right kind of life style, involvement in family and society and a supportive environment for older age all preserve positive wellbeing.
In response to increasing rates of obesity and associated chronic disease, Japan has implemented several policies, guidelines and programs [4-8]. The Active 80 Health Plan was implemented in 1988, in which nine targets were focused on, such as diet, physical activity, rest, no smoking, modest drinking, early detection of cancer, hypertension, obesity and dental health.Healthy Japan 21 Programme began in 2000, followed by the Shokuiku (means eating education) Basic Law, which was implemented in 2005. The Shokuiku Basic Law aimed that “children should be able to cultivate a healthy mind and body.” It is important for the public to ensure physical and mental health and to be able to live vividly throughout their lives by themselves.The Care Prevention Law started in 2006. In 2008, the government launched a special health check-up plan, involving measurement of waist circumference and nutrition counseling to reduce the number of metabolic syndrome and related diseases.In 2013, the second phase of Healthy Japan 21 Programme started [9]. The slogan is “Smart Life Project”, which was composed of a smart walk, smart diet, smart breath (non-smoking), and smart check-up (health check). Construction of senior physical power-up stations was also encouraged. It was a turning point from individual efforts for health to more public health support. In Japan, the places for athletic facilities were set by more than one third local governments for physical intervention. The most frequent purposes of the physical facility center of the local government to prevent locomoter syndrome and to care for aged by making habitual exercise and physical fitness for sedentary people. These can decrease the prevalence of metabolic syndrome, and hopefully decrease the cognitive dysfunction by close communication. These were planned for healthy longevity in numerous regions [10].
Increasing medical cost by elderly
Japanese life expectancy is among the highest in the world and it keeps on increasing [11]. Along with the extension of life span, healthy life expectancy is also increasing. It was 74.21 years old for women, and 71.19 years old for men in 2013. However, the gaps between the life expectancies (86.6 years old in women and 80.2 years old in men) and the ages of healthy life has not shrunken, remaining 9.0 years in men and 12.4 years in women, and it pushed up the necessity of medical care. During the 1990s and 2000s, geriatric hospitals and nursing homes were constantly constructed, from 2,260 in 1990 to 6,254 in 2011. Facilities increased by 277% or 3,994 nursing homes during the past 20 years. However, the gap between the survival and healthy age did not reduced.
In 2016, the medical expenditure in Japan was 7.81% gross domestic product (GDP), or 10.76% national income, reached more than 42 trillion JPY, which is mostly covered by various health insurance system [12]. Aged population (more than 65 years) contributed nearly 60% national medical expenses. The medical expenditure for late-stage elderly (more than 75 years) accounted for 33.6% of total medical expenses, in Japan [12].
From the 1990s to the 2000s, hospitals and specialized nursing homes were built, so the proportion of deaths at hospitals increased rapidly. Around 1950, the rate of death at home was 82%, but currently, more than 80% have passed away in hospitals. Overly dependence on hospitals and nursing care facilities should be avoided. This leads to a surge in medical expenses and a rapid increase in nursing care expenses, which causes the sustainability of medical care systems to become diffifi cult.
Medical and nursing home care
The necessity to enrich and disseminate medical and/or nursing home care was recognized, and a major law amendment was implemented in 2014. By 2025, 180,000 intensive care beds are planned to be abolished and hopefully lead to better home care [13].
However, it has caused another problem that workers from the child generation who have to take care of their parents at home tend to leave their workplaces for nursing care. They have spurred the declining population of workers’ generations and dynamism on the economy and society. This has become a big social problem because it will eventually effect everybody.
At present, the majority of people want to receive medical care at home [14]. Changes in the number of patients in charge at home care support clinics / hospitals demand for additional home dietitians, physicians and nurses. The number of patients per medical institution is increasing year by year, and the supply volume for home use is also increasing.
Visiting nutritional guidance means that a managed dietician regularly visits patient’s homes twice a month for those who have diffifi culty to visit hospitals, and nutritional guidance is necessary for medical treatment. One visit lasts from 30 minutes to one hour, and the cost is only 530 JPY. For example, improved meals for patients with swallowing disorders by the request of a doctor or care manager is now possible.
According to the guidance for in-home medical care management, target persons of it are people who require special care, because the degree of nursing care is determined on the basis of the nursing-care insurance certification, or patients in a malnutrition state. Home patient visit nutrition guidance subjects the patients to whom the physician judges that a special diet and nutrition management are necessary for the patients
Necessity of prevention to reduce medical and care cost
In Japan, among all main causes requiring nursing care [15], 30.5% is due to lifestyle related diseases, such as cerebrovascular disease (18.5%), cardiac disease (4.5%), respiratory disease and cancer. And 51.9% is due to cognitive disorders (15.8%), frailty (13.4%), joint trouble (10.9%) and bone fracture (11.8%). A physiological deterioration is commonly observed in elderly people, in particular, cardiac, renal, respiratory functions, and muscle strength. The frailty, sarcopenia, osteoporosis and dementia are the targets for the prevention of bedridden.
Most of these could be prevented. A few years ago, the authors proposed that medical expenditures could be suppressed 10 trillion JPY by correcting dietary habits [16], and the importance keeping healthly from a preclinical state. Preclinical stage could be determined if laboratory tests come out as being abnormal but feeling healthy, like metabolic syndrome for example. Or, feeling very ill, like depression and insomnia but there is no laboratory test abnormalities. Western medicine tends to easily use drugs for these preclinical people. However, these preclinical stages could return to normal by proper intervention without drug therapy.
In China, several centers are already in progress in order to prevent progression to clinical stages by dietary therapy, physical training, spas, psychosomatic approaches and natural therapy through various integrated ways. Dietary and physical intervention becomes more and more important.
The frequency of polypharmacy and potential drug interactions make it diffifi cult to balance the benefifi ts and harms of therapy in older patients. These problems need further research in antiageing medicine.
Integrated medical care units
If the integrated medical co-ordinator is present in the local area, it can provide optimal intervention programs by making full use of various medical resources in the region (Figure 2). Second-generation integrated medical care aims at implementation of better and improved “eating habits, mental health care and physical handling” to be assembled [16].
Integ rated medical care units could easily be made in an empty school classroom. It has a benefit that at the time of emergency all residents can gather on foot. At present, the number of elementary schools is about 25,000 in Japan, and the decreased number of children could easily provide enough empty classrooms for this purpose. The center can provide food education and meal service, organic agriculture and consumer communication, nursing care, rehabilitation, etc., as much as possible in order to consolidate and activate the area. We will be able to live a safe and secure life, lead to regional revitalization and regional development.
The single living elderly tends to be inactive and loses communication with neighbors. However, it is difficult to find a proper place for citizen’s activity to support them. Recently young monks in Buddhist temples have started a new way to survive in their small towns and/or villages, because the registered members and surrounding population to support a temple is decreasing in elderly society. Socioeconomic status (SES) has a powerful inflfl uence on human health and longevity [17].
The solution of the elderly is to increase the number of elderly people living independently on health and longevity, and this will need to support society as a whole such as living worth and motivation. We will need a social consensus to raise the “quality of death” that confronts the “quality of life” and eventually confronts the ongoing death.
Importance of health promotion by diet and physical activity for preclinical intervention
Primary health care is an essential intervention based on practical, scientifically sound and socially acceptable methods and technology that make universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self- reliance and self-determination.
It forms an integral part of both the country’s health system and of the overall social and economic development of the community. It is the first level of contact to individuals, the family and community with the national health system bringing health care as close as possible to where people live and work.
Our cross-sectional study on dietary habit and health (GENKI study) clarififi ed the characteristics of obese people and brown rice eaters among 6,000 participants [18, 19]. Obese people have various lifestyle-related diseases at Odd Ratio (OR) of 2–3, while OR of brown rice eaters showed less than 0.3. Brown rice eaters consume signififi cantly more carrots, green yellow vegetables, radish, ginger, burdock, lotus root, sweet potatoes, yam, salty plum pickles, sesame, peanut, chestnut, mushroom, dried mushroom, dried radish, dried seaweed, kelp, red bean, and soy milk. They did not consume meat, but soy protein was substituted in place of meat and fish [20]. They felt healthy and vivid [21].
Many functional ingredients are present in the rice bran and oil. Dietary fibers in rice bran keep a good balance of the bacterial flfl ora which support the immune system. Intestinal microbiota are composed of butyric acid and other short chain fatty acids producers [22]. A population approach to reduce obesity is very effective, and brown rice as a staple food could provide a useful tool [23]. The brown rice diet seems to improve or prevent obesity compared with polished white rice eating. A good bowel movement and stool fifi gures suggest a good intestinal environment which leads to avoid obesity and maintained better health. Dietary habits with brown rice, rich vegetables, avoiding meat, should support a healthy life.
It has been clarififi ed in recent studies, that brown rice contains substances that have various effects on physiological functions in addition to the function as ordinary nutrients. Functional components like γ-oryzanol of brown rice could control diabetes, and GABA may keep mental health. Rice bran was originally known to have a rich amount of vitamins and minerals, in addition, various substances such as long-chain fatty acids, ferulic acid and inositol are also included. In that sense, the inflfl uence of brown rice on health is extremely benefifi cial and could be called “medical rice” [24].
Rice is the staple food of 70% people across the world. The annual production is about 600 million tons, and it is likely that rice will become a major grain when the amount of wheat production can reduce by global warming in the future. More than 90% of rice is made in Asian countries. There are a lot of developing countries in which are the sources of protein and fat intake. Rice as a staple food can provide various nutrients beyond a necessary energy source in these countries. Polished white rice should lose these benefifi ts.
Brown rice should support a healthy longevity and its health effects could reduce the medical cost of the elderly in the future.
Conclusion
Japanese has one of the longest expected life in the world, followed by most other Asian countries by 20 years. Along with the extension of life span, healthy life expectancy is also increasing, but the gap between the life expectancy and healthy life expectancy is nearly 10 years, and those within this year range expend 60% of medical cost. Building geriatric hospitals and nursing homes could not cover the necessity of rapidly increasing elderly population.Recently the majority of people want to receive medical care at home and die peacefully there. Health promotion and disease prevention at preclinical stage for the elderly by diets and physical activity are only effective resolution. Establishment of local communication center could give the integrated resolution for ageing society.The Japanese experience in ageing could contribute to the construction of global health.
Additional files
Acknowledgements
A part of this work was presented at the 2nd Belt & Road Initiative Global Health International Congress. The authors appreciated Professor Youfa Wang and Professor Tieru Han for their kind help.
Competing interests
All authors do not have any conflict of interests to the government and company.
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