How the world’s most elderly country is fighting heat in a deadly double crisis

By Jessie Yeung, Hanako Montgomery and Yumi Asada, CNN

Tokyo (CNN) — Whenever he’s home, 84-year-old Toshiaki Morioka carries an alarm device that measures temperature and humidity, which can summon emergency responders at the press of a button. He takes it to bed, to the kitchen, even to the bath.

That’s because he knows he could easily fall victim to heatstroke – which kills hundreds of elderly Japanese each year, and which has impacted tens of thousands this summer amid record-breaking temperatures.

The alarm device is part of a government push to combat a deadly double emergency: the collision of Japan’s climate crisis and its aging population.

While elderly people everywhere are especially vulnerable to the effects of extreme heat, Japan’s problem is exacerbated by isolation and other cultural factors.

Like millions of other Japanese elders, Morioka lives alone and worries no one would know if he suddenly became ill. Heatstroke can come with little warning for older people.

“Just day-to-day living is tough,” he said. “When you get sick – if you’re alone, there’s nothing you can do.”

Japan isn’t the only country facing this predicament. South Korea and China also just had their hottest summers on record, while much of Europe faced its worst wildfire season, with human-caused climate change driving higher temperatures and more extreme, unpredictable weather.

Many of these places are seeing their own demographic decline. But Japan is widely considered the world’s oldest and fastest-aging society – meaning other countries will be watching closely for potential solutions as it races to protect its elderly residents on the front lines of rising heat.

Deadly heat

This past summer has been Japan’s hottest on record, according to the official Meteorological Agency. In August, Japan recorded its highest-ever temperature at 41.8 degrees Celsius (107.24 Fahrenheit).

The heat this year lasted for long, suffocating stretches. High temperatures began in June and lasted into September, long past the usual end of summer. In late August, central Tokyo sweltered through nine consecutive days of temperatures above 35 degrees Celsius (95 Fahrenheit) – the longest heat streak on record, according to the meteorological agency.

Through the unrelenting summer, Japan’s hospitals have received waves of elderly patients, including some who collapsed at home, or on the street under the scorching sun.

Climate change, largely caused by the burning of planet-heating fossil fuels, is making heat waves more common, intense and long-lasting. And as global average temperatures continue to climb, severe heat – as seen in Japan this summer – could be the new normal.

Hundreds of seniors already die of heatstroke every year in the country. Between May and August, 90,000 people nationwide were taken to the hospital for heatstroke – some of whom needed to be hospitalized for weeks on end, according to Japan’s Fire and Disaster Management Agency.

The elderly “often don’t feel the heat as much, have more difficulty regulating body temperature, and don’t notice thirst as easily,” said Takashi Shimazaki, section manager of the health department in Tokyo’s Nerima ward. “Because of that, there’s a high chance they may develop heatstroke without even realizing it.”

Humans sweat to cool themselves down through the process of evaporation. But “this mechanism actually becomes weaker for older people,” making it harder for the elderly to cool down, said Qiang Guo, an assistant professor at the University of Tsukuba who leads a lab group researching climate change solutions.

In Japan, the problem is heightened by specific cultural and demographic factors. For instance, said Guo, the falling birth rate means Japan has a shrinking workforce, with fewer young people available to fill the gaps left by aging workers – who in turn are forced to keep toiling instead of retiring.

“More than 70% of farmers in Japan are (aged) greater than 65, and these older people are vulnerable to heat stress,” he said. “So, when heat stress or a heat wave comes, it’s not only a public health issue … but also it is an economic issue.”

Another factor that may baffle outsiders is a reluctance to use air conditioners at home.

Out of the 101 suspected heatstroke deaths in Tokyo this summer, 66 happened in rooms with air conditioners (ACs) that weren’t being used, according to public broadcaster NHK.

It’s a long-standing problem that stems from both tradition and necessity.

“There was a time when summers weren’t as hot as now, so many (elderly) got used to living without air conditioning,” said Shimazaki. “Those people may try to get by with just a fan even during extreme heat.”

Others may avoid using ACs because they believe it’s not environmentally friendly, or because they can’t afford to pay high electricity bills – especially if they’re living alone without income, relying on welfare and government support.

That’s why Morioka, the 84-year-old in Tokyo, uses his AC sparingly. His kids call to check on him and ask whether he’s using air conditioning, he said – to which he responds, “Well, I want to, but it costs money.”

But he’s still wary of getting heat stroke, “so at night I set the AC with a timer. When the timer ends it shuts off, but then I wake up in the middle of the night because it’s hot. Then I turn it on again,” he said. “It’s that cycle, really.”

Widespread isolation

One of the biggest risk factors, however, is isolation.

Loneliness has been a national concern for years, extending across age brackets – even prompting the government to appoint a Minister of Loneliness and Isolation in 2021.

But the problem is especially acute for seniors, left vulnerable in their sunset years without support networks.

As of 2020, more than 13% of Japanese households were people aged 65 or above who lived alone, according to the National Institute of Population and Social Security Research. That number is expected to keep rising – making up one fifth of all households by 2050, the institute predicted in a report last year.

Many of these elderly live alone in small towns and in the countryside, after their children flocked to urban centers like Tokyo, said Guo.

The consequences of elderly isolation have become clear in several recent grim phenomena – such as the rise of “lonely deaths,” where people go undiscovered for weeks, or longer, after dying. Of 76,000 deaths last year of people who lived alone and died at home, more than 70% were aged 65 or older, according to NHK, citing police figures.

Some seniors resort to desperate means, such as stealing food, to survive. Others find they don’t want to leave prison, preferring regular meals, free healthcare, eldercare and companionship behind bars that they lack on the outside.

When it comes to heat, this isolation can be equally devastating. Seniors may not have anyone to call upon if they start feeling ill – and there’s nobody around to notice the symptoms for those who don’t realize they’re suffering from heatstroke until it’s too late.

Potential solutions

The clock is ticking for Japan to find solutions, with the impact from its demographic crisis expected to last decades – and Asia warming nearly twice as quickly as the rest of the world, according to the World Meteorological Organization.

“I think that China and also South Korea will look at what measures have been taken in Japan … and the effects, and whether they should learn something,” said Guo.

Japan’s initiatives range from the practical to the innovative. For instance, various cities including Tokyo, Osaka and Nagoya have offered subsidies for the elderly to buy AC units. They’ve also introduced “cooling spots” – air-conditioned indoor public spaces designed to help people rest and hydrate.

There are 270 such cooling spots in Tokyo’s Nerima ward alone, said Shimazaki. These include both government facilities and local private businesses that offer cool spaces in shops, pharmacies, community centers, libraries, cafes and more.

Nerima has also installed an emergency alert system – which is what Morioka uses in his home. These emergency alert devices, about the size of a large electronic tablet, play a warning message when there is a high risk of heatstroke, and allows users to make calls for help, said Shimazaki.

There are other technological solutions being trialed, such as a heatstroke prevention wristwatch that detects rises in body temperature, which the Tokyo government is helping develop and distribute.

But much of the government’s efforts focus on filling the biggest gap in elderly lives: human company and attentiveness.

Many local authorities have launched community programs, enlisting volunteers to go door-to-door and check in on the elderly.

Besides gauging their health and well-being, these volunteers offer information such as advice on how to stay cool – part of a wider awareness campaign that includes distributing pamphlets in public spaces and holding free talks on the topic.

For Morioka, these home visits are a valued resource after his wife died three years ago. He makes sure to drink water and wear a hat when he goes outside during the summer – his way of honoring an old vow.

“It was a promise with my wife – to live until 99 (years old),” he said, tearing up as he spoke to CNN inside his home. “We had said we’d live a long life together, but we couldn’t.”

“With the heat, I go about life sweating like this, but … living alone really is tough,” he said.

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