Abstract
Kodokushi or solitary deaths is one of the most important socio-medico problems in Japan that has emerged because of a super-aging society. In this paper, we provide the long-term trends and associated social risk factors of kodokushi in Tokyo, the only city that publishes detailed records of kodokushi in Japan. Overall, our results show that the age-adjusted mortality rate of kodokushi in the Tokyo Metropolitan area has consistently increased from 2003 to 2010, but since then has remained mostly unchanged in both genders. By age group, the age-adjusted mortality rate of kodokushi has increased throughout the study period of 2003–2016 in those aged ≥ 60. Males and those aged 60–69 and 70–79 years have notably higher odds of kodokushi. Since a quarter of all kodokushi cases in Tokyo were under the age of 60 in 2016, the issue may gain population-wide relevance in the future. More studies in this line are required for targeted public health policy to prevent kodokushi.
Similar content being viewed by others
Data availability
All data used for analysis in this paper are available from the corresponding author upon reasonable request.
References
Abell JG, Steptoe A (2019) Living alone and mortality: more complicated than it seems. Eur Heart J Qual Care Clin Outcomes 5:187–188. https://doi.org/10.1093/ehjqcco/qcz014
Akishita M et al (2013) Priorities of health care outcomes for the elderly. J Am Med Dir Assoc 14:479–484. https://doi.org/10.1016/j.jamda.2013.01.009
Arai Y (2010) 一人暮らし高齢者の孤独死の実態に関する一考察-A県Bニュータウンを中心に- (A consideration of the actual condition of isolated death for the elderly who live alone -the case of B new town from prefecture A). J Chubu gakuin Univ Chubu gakuin college 84–89
Arai H et al (2015) Japan as the front-runner of super-aged societies: perspectives from medicine and medical care in Japan. Geriatr Gerontol Int 15:673–687. https://doi.org/10.1111/ggi.12450
Caswell G, O’Connor M (2015) Agency in the context of social death: dying alone at home. Contemp. Soc Sci 10:249–261. https://doi.org/10.1080/21582041.2015.1114663
Caswell G, O’Connor M (2019) ‘I’ve no fear of dying alone’: exploring perspectives on living and dying alone. Mortality 24:17–31. https://doi.org/10.1080/13576275.2017.1413542
Coyle CE, Dugan E (2012) Social isolation, loneliness and health among older adults. J Aging Health 24:1346–1363. https://doi.org/10.1177/0898264312460275
Dickens AP, Richards SH, Greaves CJ, Campbell JL (2011) Interventions targeting social isolation in older people: a systematic review. BMC Public Health 11:647. https://doi.org/10.1186/1471-2458-11-647
Fujita Y, Inoue K, Seki N, Inoue T, Sakuta A, Miyazawa T, Eguchi K (2008) The need for measures to prevent “solitary deaths” after large earthquakes - based on current conditions following the Great Hanshin-Awaji Earthquake. J Forensic Leg Med 15:527–528. https://doi.org/10.1016/j.jflm.2008.05.005
Fukukawa Y (2011) Solitary death: a new problem of an aging society in Japan. J Am Geriatr Soc 59:174–175. https://doi.org/10.1111/j.1532-5415.2010.03216.x
Fukukawa Y, Kawaguchi K (2011) 孤独死の発生ならびに予防対策の実施状況に関する全国自治体調査 (A nationwide survey of Japanese municipalities on solitary deaths and countermeasures). Jpn J Public Health 58:959–966
Golden J, Conroy RM, Bruce I, Denihan A, Greene E, Kirby M, Lawlor BA (2009) Loneliness, social support networks, mood and wellbeing in community-dwelling elderly. Int J Geriatr Psychiatry 24:694–700. https://doi.org/10.1002/gps.2181
Gopinath B, Rochtchina E, Anstey KJ, Mitchell P (2013) Living alone and risk of mortality in older, community-dwelling adults. JAMA Intern Med 173:320–321. https://doi.org/10.1001/jamainternmed.2013.1597
Higginson IJ et al (2017) Social and clinical determinants of preferences and their achievement at the end of life: prospective cohort study of older adults receiving palliative care in three countries. BMC Geriatr 17:271. https://doi.org/10.1186/s12877-017-0648-4
Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D (2015) Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci 10:227–237. https://doi.org/10.1177/1745691614568352
Hori A, Morita T, Yoshida I, Tsubokura M (2018) Case Report: enhancement of PTSD treatment through social support in Idobata-Nagaya community housing after Fukushima’s triple disaster. BMJ Case Rep. https://doi.org/10.1136/bcr-2018-224935
Ikegami N et al (2011) Japanese universal health coverage: evolution, achievements, and challenges. Lancet 378:1106–1115
Irii T, Iwadate K, Aoki K (2013) 法医剖検例調査に基づく独居死と精神疾患の関連 (The relationship between dying alone and mental disorder based on the results of forensic autopsies). J Health Sci Mind Body 9:96–102
Ishida M (2011) 孤立の社会学 (Sociology of isolation). Keisō Shobō, Tokyo
Jensen MT, Marott JL, Holtermann A, Gyntelberg F (2019) Living alone is associated with all-cause and cardiovascular mortality: 32 years of follow-up in the Copenhagen Male Study. Eur Heart J Qual Care Clin Outcomes 5:208–217. https://doi.org/10.1093/ehjqcco/qcz004
Kakiuchi Y, Nagao R, Ochiai E, Kakimoto Y, Osawa M (2019a) A descriptive study of solitary death in Yokohama City Environ Health. Prev Med 24:12. https://doi.org/10.1186/s12199-019-0766-z
Kakiuchi Y, Nagao R, Ochiai E, Kakimoto Y, Osawa M (2019b) The importance of the rate of pure “attended deaths at home” for objective outcome indicator for assessing the prevalence of home care in Japan. Environ Health Prev Med 24:76. https://doi.org/10.1186/s12199-019-0838-0
Kanawaku Y (2018) 孤立 (孤独) 死とその実態 (Koritsu-shi (solitary death) and its actual situation). Med Assoc Nippon Med Sch 14:100–112
Kanawaku Y, Ohno Y (2020) Solitary deaths in the Tokyo Metropolis and labor force status: characteristics of unnatural deaths at home among persons living alone. J Nippon Med Sch 86:360–363. https://doi.org/10.1272/jnms.JNMS.2019_86-604
Kanawaku Y et al. (2010) 世帯分類別の異状死基本統計 (Basic survey on unnatural deaths by household). J Health Welfare Stat 57:20–25
Kandler U, Meisinger C, Baumert J, Lowel H, Group KS (2007) Living alone is a risk factor for mortality in men but not women from the general population: a prospective cohort study. BMC Public Health 7:335. https://doi.org/10.1186/1471-2458-7-335
Kellehear A (2009) Dying old—and preferably alone? Agency, resistance and dissent at the end of life. Int J Ageing Later Life 4:5
Kim D, Park C, Briesacher BA (2021) Socially-isolated neighborhoods and the risk of all-cause mortality among nursing home residents in the United States: a multilevel study. Prev Med Rep 21:101285. https://doi.org/10.1016/j.pmedr.2020.101285
Klinenberg E (2001) Dying alone: the social production of urban isolation. Ethnography 2:501–531. https://doi.org/10.1177/14661380122231019
Kobayashi E, Harada K, Murayama H, Fukaya T, Liang J (2017) Social Isolation among Older Japanese: do regional attributes matter? Innov Aging 1:1202–1202. https://doi.org/10.1093/geroni/igx004.4373
Kono A, Takada E, Okamoto F, Kunii Y, Yamamoto N (2009) 大都市に住む一人暮らし男性高齢者のセルフケアを確立するための課題 高層住宅地域と近郊農村地域間の質的分析 (Self-care issues of older men living alone A qualitative comparison between urban high-rise apartment and suburban farming districts). Jpn J Public Health 56:662–673
Kudo Y (2013) 都市部に引越した独居高齢者の危機管理 (Risk and Crisis Management of Relocated Elderly People Who Live Alone in an urban area). J Sch Nurs Soc Serv Health Sci Univ Hokkaido 9:43–53
Kumano F (2017) 堺区における死亡検案より見た死亡原因の検討(The investigation of the causes of unnatural deaths in Sakai ward). J Osaka-Fu Phys Assoc 26:174–177
Kurihara S, Shimoura S (2006) Rural/urban differences in community activities and its factors. Agric Inf Res 15:15–24. https://doi.org/10.3173/air.15.15
Luanaigh CO, Lawlor BA (2008) Loneliness and the health of older people. Int J Geriatr Psychiatry 23:1213–1221. https://doi.org/10.1002/gps.2054
Masuda S, Ooi M, Usui K, Tsumura C (2010) 地域特性別及び見守り専門職の有無別にみた高齢者の見守りネットワークの現状 (Current condition of watch networks for elderly residents in communities with different characterstics and whether or not there are professional people available to watch them) 甲南女子大学研究紀要(看護学・リハビリテーション学編) :231–245
Matsumiya A (2013) The poverty of social networks” on the elderly and “dying alone. Ann Jpn Assoc Urban Sociol 2012:15–28. https://doi.org/10.5637/jpasurban.2012.15
Ministry of Health Labor and Welfare (2007) 厚生労働省予算概算要求の主要事項 (Request for the budget of the Ministry of Health, Labor, and Welfare for next year). https://www.mhlw.go.jp/wp/yosan/yosan/07gaisan/syuyou2.html. Accessed 11 Sept 2018
Ministry of Health Labor and Welfare (2010). 孤立死という用語について (About the term "koritsushi"). https://www.mhlw.go.jp/shingi/2010/07/dl/s0720-2d.pdf. Accessed 11 Sept 2018
Miyanaga R, Poudyal H (2019) Participation of nurses and care workers in the decision-making process for people with dementia in Japan: discussion paper. Int J Nurs Stud 96:91–98. https://doi.org/10.1016/j.ijnurstu.2019.02.011
Morita S, Nishi K, Furukawa F, Hitosugi M (2015) A Survey of solitary deaths in Japan for shortening postmortem interval until discover. Pril (makedon Akad Nauk Umet Odd Med Nauki) 36:47–51
Morita S, Nichi K, Furukawa S, Hitosugi M (2016) 高齢者孤立死の現状と背景についての検討 (Investigation of the condition and background of solitary death among the elderly). J Jpn Council Traffic Sci 15:38–43
Murata C, Yamada T, Chen CC, Ojima T, Hirai H, Kondo K (2010) Barriers to health care among the elderly in Japan. Int J Environ Res Public Health 7:1330–1341. https://doi.org/10.3390/ijerph7041330
Murayama H, Shibui Y, Fukuda Y, Murashima S (2011) A new crisis in Japan-social isolation in old age. J Am Geriatr Soc 59:2160–2162. https://doi.org/10.1111/j.1532-5415.2011.03640.x
Nomura M, McLean S, Miyamori D, Kakiuchi Y, Ikegaya H (2016) Isolation and unnatural death of elderly people in the aging Japanese society. Sci Justice 56:80–83. https://doi.org/10.1016/j.scijus.2015.12.003
Nukada I (1999) 孤独死 [Kodokushi]. Iwanami Shoten, Tokya
Ong AD, Uchino BN, Wethington E (2016) Loneliness and health in older adults: a mini-review and synthesis. Gerontology 62:443–449. https://doi.org/10.1159/000441651
Osone T (2016) 検死からみた孤独死の現状(特に農村型孤独死について (Survey of rural solitary deaths through postmortem examination). Off J Jpn Primary Care Assoc 39:205–208
Runtuwene NF, Buster MCA (2019) Domestic-setting corpses, an urban problem? J Forensic Leg Med 61:22–26. https://doi.org/10.1016/j.jflm.2018.10.006
Statistics Bureau, Ministry of Internal Affairs and Communications (2019). Population Estimates. https://www.e-stat.go.jp/en/stat-search/files?page=1&layout=datalist&toukei=00200524&tstat=000000090001&cycle=7&year=20190&month=0&tclass1=000001011679. Accessed 07 May 2021
Suzuki H, Hikiji W, Tanifuji T, Abe N, Fukunaga T (2013) Medicolegal death of homeless persons in Tokyo Metropolis over 12 years (1999–2010). Leg Med (tokyo) 15:126–133. https://doi.org/10.1016/j.legalmed.2012.10.004
Tabue Teguo M, Simo-Tabue N, Stoykova R, Meillon C, Cogne M, Amieva H, Dartigues JF (2016) Feelings of loneliness and living alone as predictors of mortality in the elderly: the PAQUID Study. Psychosom Med 78:904–909. https://doi.org/10.1097/PSY.0000000000000386
The Cabinet Office (2018). Annual Report on the Ageing Society FY 2018. https://www8.cao.go.jp/kourei/english/annualreport/2018/2018pdf_e.html. Accessed 02 Feb 2021
Thompson G et al (2019) Who would want to die like that? Perspectives on dying alone in a long-term care setting. Death Stud 43:509–520. https://doi.org/10.1080/07481187.2018.1491484
Tokyo Medical Examiner's Office (n.d.-a). 東京監察医務院で取り扱った自宅住居で亡くなった単身世帯の者の統計 (Tokyo medical examiner's office statistics on people living alone who died at home). http://www.fukushihoken.metro.tokyo.jp/kansatsu/kodokushitoukei/index.html. Accessed 12 Nov 2018
Tokyo Medical Examiner's Office (n.d.-b). 統計データベース (Statistical database). http://www.fukushihoken.metro.tokyo.jp/kansatsu/database/index.html. Accessed 12 Nov 2018
Tomoyuki H (2009) 検案自験例から孤独死を考える (External postmortem examination in unexpected isolated death (Kodokushi)). J Jpn Phys Assoc 23:584–587
Udell JA et al (2012) Living alone and cardiovascular risk in outpatients at risk of or with atherothrombosis. Arch Intern Med 172:1086–1095. https://doi.org/10.1001/archinternmed.2012.2782
World Health Organisation (2018). Ageing and health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed 18 Nov 2019
Yamazaki K, Hemmi I (2017) 孤独死研究の動向と今後の課題 (Trends and future challenges in the study of solitary death). J Jpn Acad Health Behav Sci 32:66–73
Funding
No external funding was received for this work.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Toyama, S., Poudyal, H. Prevalence of kodokushi (solitary deaths) in the Tokyo metropolitan area. SN Soc Sci 1, 163 (2021). https://doi.org/10.1007/s43545-021-00169-8
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s43545-021-00169-8