2021
Well-being of Japanese Older Adults in the COVID-19
Pandemic

ILC-Japan

2021/03/01

Foreword
International Longevity Center-JapanThe COVID-19 pandemic poses a considerable physical risk to older adults through infections. The
pandemic, however, can also have significant effects on their quality of life and well-being.
Although various measures have been put in place to address its risks, they do not necessarily takethe voices of older adults into consideration. In order to understand their views on different aspectsof the pandemic, ILC-Japan conducted interviews with various groups of older adults in Japan,
asking them what the pandemic meant to them and how it was affecting their lives. Through theseinterviews, we aim to explore the ways older adults can protect themselves and pursue well-being
based on their viewpoint. Another goal of this study is to make international comparisons on thisissue. ILC offices in other countries have also been conducting similar interviews. By comparing
their data with the results in Japan, we also aim to highlight the significance of Japanese pandemic
measures for older adults from an international perspective.
This study was approved on June 18, 2020, by the Foundation of Social Development for
Senior Citizens Research Ethics Review Committee (Approval number: 2020001), chaired by Dr.
Hiroshi Shibata (emeritus professor, J. F. Oberlin University). The actual interviews were conductedby the following research team members in June and July 2020.
Research Committee Members
Associate Professor, Department of Contemporary Societies, Faculty ofDaisuke Watanabe
Humanities, Seikei University: Committee Chair
Shino Sawaoka
Chief Research Scientist, the Dia Foundation for Research on Ageing Society
Associate Professor, Faculty of Healthcare Management, Nihon Fukushi
Taeko Nakashima
University
Associate Professor, Department of Social Education and Welfare, Faculty of
Yoko Matsuoka
Humanities, Tokyo Kasei University
Secretariat (ILC-Japan)
Ichiro Nakamura

Director

Shinichi Ogami

Advisor

Mamiko Fukuhara

Operations Director

Atsuko Tachibana

Administrative AssistantNami NegoroInternational and Communication Lead

Yoshiko Yamada

Visiting Researcher

Dr. Sawaoka, a member of the research committee and a councilor of the Japan
Socio-Gerontological Society, provided us with an opportunity to present the results of this study ina special edition of the Society’s research journal Japanese Journal of Gerontology (vol. 42-4) under
the title, Special Feature: Well-being under the New Normal in the Post-COVID Era. It is scheduled1

to be published in 2021. The present report is a summary of several articles in this journal. This
special edition begins with an introductory statement by Dr. Sawaoka, raising a question as follows:“Older adults are believed to face higher risk of adverse effects posed by the COVID-19 pandemic,
including anxiety as well as diminishing independence and cognitive functioning due to homeconfinement. In such challenging circumstances, how can they build the ‘new normal,’ aiming toprevent infections while also improving well-being?” Then, Ogami from ILC-Japan summarizes theimpact of the COVID-19 pandemic on and resilience of older adults in various countries. In hissummary, Ogami introduces the results of the interviews with older adults conducted by Leiden
Academy (ILC-Netherland) in its Wij & corona (Us & corona) research project, as well as studies
and statistics published by European institutions.
Following the broad question and international context, three articles are presented on our study
in Japan. Dr. Watanabe compares the responses between urban and rural older adults, Dr. Matsuoka
analyzes data on older adults in an urban apartment complex, and Dr. Nakashima examines themental and physical effects of the pandemic. The journal is published in Japanese, and the present
report is a summary of these three articles on the study in Japan, translated into English. Before thesummary of the three articles, an overview of the situation in Japan is also included in this report tohelp international readers to understand the context.
ILC-Japan is currently conducting the second round of the interviews and will continue tofollow up on the situation.

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Contents
Summary・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・４

Reorganizing Daily Lives of Older Adults and Social Relationships in the Coronavirus Disaster
Dr. Daisuke Watanabe・・・・・・・・・・・・・・・・・・・・・・１３

Changes Since the First Wave of COVID-19 Infections and Community-Led Activities in a Public
Housing Complex
Dr. Yoko Matsuoka・・・・・・・・・・・・・・・・・・・・・・・１８

Mental/Physical Changes and Coping Strategies among Older Adults in the COVID-19 Pandemic
Dr. Taeko Nakashima・・・・・・・・・・・・・・・・・・・・・・２３
APPENDIX・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・２８

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Summary
Introduction
In Japan, people have been strongly recommended to avoid the san-mitsu (three Cs:
confined and enclosed spaces, crowded places, and close-contact settings) to prevent the
spread of COVID-19 infections since May 4, 2020, when then Prime Minister Shinzo
Abe extended a state of emergency. When the emergency was initially declared in early
April, restrictions on social life were generally accepted as a temporary inconvenience.
This extension, however, transformed the nature of these restrictions to the “newnormal” with no end in sight, casting a dark shadow over people’s lives.
Young and working-age people are finding their own new normal, though it is not
the same as the pre-COVID time, along with the gradual reopening of schools andeconomic activities. Meanwhile, many people are still confined at home for various
reasons, including the fear of this seemingly endless pandemic and almost excessive
self-restraint in social life, resulting in serious social problems such as a sharp increasein suicides among young females.
Among older adults, known to be at higher risk of COVID-19 infections, many gounder an anxiety spiral, cannot go out because their families stop them, and experience
declines in physical and cognitive functioning. These problems are not limited to those
who had been frail or isolated since before the pandemic. Active seniors also share thesame problems. A growing number of welfare and health professionals are concernedthat older adults can face serious challenges, including depressive symptoms anddiminishing independence, even if they do not contract the virus. Particularly in urban
areas, where the situation is more serious, it is difficult to resume community-based
activities for older adults.
People have reacted to the sudden appearance of the phrase “new normal”
differently. Some feel that their pre-COVID lifestyles and values are denied., whileothers feel that they are expected to rebuild their lives in a completely different manner.
Although the number of COVID-19 cases has been relatively low in Japan comparedwith European countries and the United States, situations are significantly different
among communities within the country. While urban areas struggle to handle crisis
situations, people in rural areas are leading almost normal lives. In this report, we
would like to introduce how older adults in different Japanese communities adapted to
the new normal differently based on their own words.

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The report is prepared as part of the COVID-19 project by International Longevity
Center (ILC) Global Alliance and the first report from Japan. It is based on interviews
with 35 older adults living in urban and rural areas of Japan from late June to mid-July,
2020, shortly after the first wave of COVID-19 infections (March to May, 2020).
As of late February 2021, Japan went through the second wave of infections (July to
September, 2020) and has been in the third wave since December 2020. Japan is far
behind other countries in terms of vaccination schedule, and there is no end in sight to
the COVID-19 measures. In order to examine the long-term effects of these measures,
we are conducting follow-up interviews from late February to mid-March and planning
to present an updated report in June 2021. The present report consists of backgroundinformation on the pandemic in Japan, methodology of the study, and detailed analyses
on the following three themes.

Reorganization of daily lives and social relationships among older adults in
the COVID-19 pandemic
The COVID-19 pandemic has serious effects on various aspects of our society, including
comprehensive community care systems and community support programs that haveemphasized the importance of community-based relationships. This section discusses
how older adults’ lives changed since the beginning of the coronavirus.
While almost all respondents reported that the COVID-19 pandemic had changed
their daily lives, there were some regional differences in terms of daily activities,
including shopping and hospital visits. People in rural areas tended to maintain their
daily lives through farming. In both urban and rural areas, the respondents also started
new activities based on the existing relationships with their communities, such as
making masks for other people, trying new volunteer activities, and using ICT.

Changes since the first wave of COVID-19 infections and community-led
activities in a social housing development
A social housing development B, located in City A of Tokyo, consists of 3,243 households.
Of its 5,274 residents, 56.8% are older adults (as of October 2020). There is a gathering
program led by residents of this social housing under the national long-term careinsurance scheme, but its activities were suspended during the first wave of COVID-19
infections. We conducted semi-structured interviews with 8 users and 9 volunteers of
the program during the suspension. This section aims to examine how these residents
coped with this unprecedented situation through comparisons between users andvolunteers, and how their mutual-support activities changed through the pandemic.
5The suspension of all the activities had significant physical and mental effects on boththe users and volunteers. However, the volunteers particularly demonstrated resilienceby exploring the new normal in their own ways. Since the suspension of groupgatherings, these volunteers started new activities led by voluntarily without support
from local/central government. They also strengthened a sense of solidarity by using asocial networking application Group LINE, reexamined the meaning of volunteering,and realized something important in their everyday life. The results suggest theenhancement of community-based mutual support through challenges posed by the
COVID-19 pandemic.

Mental/physical changes and coping strategies among older adults in the
COVID-19 pandemic
Based on the voices of 35 older adults, this section examines what mental and physicalchanges they felt after the first wave of COVID-19 infections, as well as how they copedwith these changes and maintained their health.
The results confirmed anxiety, loss of energy, and stress felt by the respondents inthe suddenly restricted life, including cancellation of activities, strong advice to avoid
the san-mitsu, and limitations on interactions with other people. Some respondents felt
physical effects, such as weakening of lower body, fatigue, and loss of physical strength.
However, only a few respondents experienced a decline in physical activities in thisstudy. Many took creative measures to stay physically active while avoiding crowds toprevent infections, mainly by taking a walk in the early morning and doing radio
calisthenics.

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Background: Measures to Prevent and Control COVID-19 Infections in
Japan
As in other countries, the Japanese government has been taking various measures toprevent and control COVID-19 infections as a critical risk management issue, aiming toprotect the lives of its people.
These measures mainly focus on suppressing COVID-19 cases and maintaining thehealth care delivery system. Policies on suppression include the promotion of the newnormal and measures against clusters of cases. The new normal in Japan,
recommended on May 1, 2020, by the Expert Meeting on the Novel Coronavirus Disease
Control, consists of: basic measures to prevent infections in everyday life (washing anddisinfecting hands, social distancing, keeping rooms well ventilated, wearing a mask,
and avoiding the san-mitsu), measures to take in specific situations (e.g., shopping,entertainment, sports, public transport, dining, and attending events), and newworking styles (encouraging teleworking, online meetings, and staggered working
hours). In particular, san-mitsu (three Cs: confined and enclosed spaces, crowed places,
and close-contact settings) was named the 2020 top buzzword in the country. These key
points of the new normal are based on the recognition that we may face another surge
even if the number of cases declines temporarily. These recommendations therefore
urge people to transform their lifestyles to prevent the spread of infections in the longer
term.
The other measure on suppression is a cluster-based approach. It aims to preventthe spread of infections through contact tracing, mainly with close contacts, when
COVID-19 cases are found in small groups. This approach has been quite effective in
non-urban areas, preventing an increase in cases. In urban areas, however, thisapproach has not been able to handle a drastic increase in infections particularly sinceNovember 2020. In Tokyo and the neighboring prefecture of Kanagawa, contact tracing
has been nearly impossible as public health offices, which play a main role in this task,
are overwhelmed by the situation.
As for the efforts to ensure health care delivery, Japan is behind other countries.
Despite a relatively low number of COVID-19 cases, the country’s health care system
was already overwhelmed by December 2020, mainly in urban areas where infections
spread widely. In Japan, short-term public control is difficult as the country’s healthcare system is characterized by universal coverage, free access, and private hospitals
accounting for the majority (approximately 70% of the total). Further enhancement of
the health care delivery system is therefore a pressing issue in Japan.
While Japan still has some problems particularly with its health care delivery
7system, the country’s measures against COVID-19 have shown effectiveness to a certain
extent. The following summarizes three main characteristics of Japanese approaches
based on the measures taken over the last year.
First, the numbers of COVID-19 cases and deaths have been relatively low in Japan,
as shown in Figure 1 (positive cases) and Figure 2 (deaths) on weekly averages per
million people. As of February 16, 2021, there have been 413,304 cases and 7,013 deaths.
While both the cases and deaths are low in Japan compared with other countries, it
should be noted that these figures are among the highest in East Asia. It is still unclear
why Japan has low levels of infection and death. Further research will be needed to
examine the reasons for these phenomena in Japan despite the lack of strict infection
control measures, as mentioned below.
Second, Japan’s national infection control measures have been quite loose.
Although the number of infections is relatively low in the country, it is not necessarily
because of strict measures. Japan does not have a law that can enforce a lockdown,
limiting people’s movement and requiring closures of businesses in such industries as
restaurant and tourism. What the country has mainly done are raising publicawareness of infection prevention, enhancing the health care delivery system, andresponding to clusters of cases. In terms of restrictions on people’s movement andbusinesses, governments have stayed on course with their “requests.” In other words,
they have expected people to voluntarily change their behavior to prevent infections.
This unique approach is clearly reflected in government stringency. Figure 3, from
Coronavirus Government Response Tracker developed by the University of Oxford,
presents levels of stringency in different countries regarding measures in response to
the COVID-19 pandemic based on nine indicators (school closures, business closures,cancellation of public events, limitations on gatherings, closures of public transport,
stay-at-home requirements, public information campaigns, restrictions on movement
within the country, and restrictions on international travel). It clearly shows how loose
Japanese approaches are. Unlike European countries, Japan has not imposed a strict
lockdown. While Singapore, Taiwan, and China track people’s movements with ICT,
focusing more on controlling people’s behavior over privacy, Japan has not taken thatroute either. While Japanese measures are not significantly different from those ofEuropean and other developed countries, Japan does have particularly looser policies
than others.
As for facilities used by people at higher risk, such as medical institutions forpatients with underlying conditions and care facilities for older adults, although thegovernments have provided them with some material and financial support, they have8gone as far as requesting their efforts when it comes to facility closures.
Third, Japan has tried to take both infection control and economic measures at thesame time.

Since Japan had relatively few infection cases, the national government

started implementing programs to encourage people’s movement and consumption in
July 2020, when the first wave of infections was brought under control. Examples
include the Go To Travel campaign, which started in late July to support the tourism
industry, and the Go To Eat campaign, which started in October to help the restaurant
industry. While it is not known whether these economic policies had direct effects or not,Japan faced the second wave of infections in the summer, mainly in urban areas. Then,since November 2020, the country has been struggling with the third wave withsignificantly more cases. These economic policies, which some people describe as“stepping on the gas and brake pedals at the same time,” seem problematic as theyfailed to share recognition on the importance of COVID-19 measures.

Source: Our Word in Data, https://ourworldindata.org/coronavirus-data-explorer
Figure 1. Daily new confirmed COVID-19 cases per million people (as of February 16,
2021)

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Source: Our Word in Data, https://ourworldindata.org/coronavirus-data-explorer
Fig 2. Daily new confirmed COVID-19 deaths per million people (as of February 16,
2021)

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Source: University of Oxford, “Coronavirus Government Response Tracker”
https://www.bsg.ox.ac.uk/research/research-projects/coronavirus-government-response-t
rackerFigure 3. The Oxford COVID-19 Government Response Tracker (as of February 15,
2021)

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The First-Round Interviews: Overview and Methodology
The first-round interviews were conducted after the first wave of COVID-19 infectionsin Japan. Participants were 35 older adults aged 65 or over living in three prefectures:Tokyo, Kanagawa (south of Tokyo), and Yamaguchi (western Japan). Among them,seven males and 20 females were the members of exercise groups in their communities.
The other eight participants, all males, were the members of retirees’ group in an urban
area. We used snowball sampling to identify these interviewees, with the help of leadersof these groups. Semi-structured interviews were conducted between June 24 and July
14, 2020, either over the phone (n=32), via Zoom (n=1), or in person (n=2). Ourinterviews mainly consisted of three questions on the participants’ lives since aroundthe first state of emergency declaration: “What changes did they experience?”, “Whatwere some challenges of the pandemic?” and “Have you anything new/goodexperiences as a result of this pandemic experience?”
Before the interviews, we requested participation through the community groupleaders and arranged the schedules. Each interview took approximately 30 minutes andwas recorded with participants’ consent. The study was conducted with the approval of
the Foundation of Social Development for Senior Citizens Research Ethics Review Committee. All
participants’ names are pseudonyms or alphabets for privacy protection. Theinterviewees consisted of 15 (42.9%) males and 20 (57.1%) females. Their mean age was
78.24 (SD: 6.66, except for one participant who only identified their age as “late 70s”).
Among the interviewees, 19 (54.3%) lived in Tokyo, 6 (17.1%) in Kanagawa, and 10(28.6%) in Yamaguchi. Ten (28.6%) participants lived alone, 17 (48.6%) lived with aspouse, and 8 (22.9%) lived in other types of household. Sixteen participants lived in a
detached house while 18 lived in an apartment complex. One person lived in senior
housing. All but one participants owned the place.
Looking at the COVID-19 statistics in each prefecture, as of June 24, 2020, when
we started the interviews, Tokyo had a total of 5,894 cases and 325 deaths while
Kanagawa had 1,436 cases and 94 deaths. On the other hand, Yamaguchi only had atotal of 37 cases and no deaths. In the municipality within Yamaguchi where we
conducted the interviews, there had been a few COVID-19 cases. It should be noted,
therefore, that older adults in Yamaguchi seemed to have significantly different
perceptions of the pandemic and its risk.

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Reorganizing Daily Lives of Older Adults and Social Relationships in theCoronavirus Disaster
Daisuke Watanabe
Associate Professor, Department of Contemporary Societies, Faculty of Humanities, Seikei University

The COVID-19 pandemic has been transforming our society, and measures have been
put in place to address the invisible and seemingly endless infections. Meanwhile,
however, everyone including older adults has also been facing the various effects ofthese measures, including physical, mental, economic, and social. According to the “newnormal,” people must make further efforts to make a habit of taking measures to avoid
infections through droplets, touching, and close-range conversations. This new lifestylealso affects comprehensive community care systems and community support programs
that have emphasized the importance of community-based relationships. What about
the effects on older adults themselves who have been a significant part of these systems
and programs? How did they experience changes in the pandemic and how did they
reorganize their daily lives?
This section describes the way older adults restructured their daily lives as theyspent most of the time at home, comparing urban and rural respondents based on theinterviews conducted after the first wave of infections. The spread of COVID-19
infections is referred to as the “coronavirus disaster” in this section, aiming toemphasize its nature as disaster with significant effects on the daily lives of all
generations, including older adults.

1. Did Older People’s Daily Lives Change in the Coronavirus Disaster？
1-1) Changes in daily lives: urban areas
When the respondents talked about their daily lives, they often mentioned thecancellation of the activities they had enjoyed during the coronavirus disaster. One
example is a comment by Ms. Hiroko (in her late 70s), an apartment resident living
alone in Tokyo.
Ms. Hiroko: “I used to go to local club activities almost every day, taking classes likemusic and handicraft. But all of them were suspended. Without any
preparations, every class was closed all at once in March. I lost all the places to
go to, and I was stuck at home. So, I was really worried around March,
wondering what would happen then…. Although I had a lot of free time, I
couldn’t do anything in March because I was too worried.”13

Being a long-time resident of the apartment complex, she had been active invarious groups. In addition to the handicraft class mentioned above, she had also
attended several exercise classes and helped with a local senior citizens club. However,
all of these activities were cancelled. Since she lived alone, she stated, “I spent days
without any conversation at all. I didn’t talk with anyone.” She spent the entire month“feeling stuck at home.”
Other respondents also had similar changes in daily lives, including, “I watch TV
most of the time now” (Ms. Sumiko, early 80s) and “I’ve been lazy these days since we
don’t have local leaders’ meetings” (Mr. Tsukasa, early 80s). Many informants pointed
out this sudden slowdown of daily lives. Since most of them had been active before thepandemic, they were particularly confused about the loss of their normal lives outside
their homes and an uncertain future.
1-2) Changes in daily lives: a rural area
As in the urban areas, respondents in the rural area of Yamaguchi Prefecture alsomentioned the cancellation of the exercise program in their community. However, rural
respondents still had other things to do. A good example is farming.
Ms. Ume (late 80s): “I watch TV at home most of the time. Other than that, I just enjoy
growing things in a vegetable garden near my house.”
When the interview was conducted, she was growing vegetables such as green beans, corns,
edamame soybeans, and eggplants in a vegetable garden (approximately 10m2) owned by her older
sister who had passed away. She liked the activity, stating, “I really enjoy giving the vegetables tomy children and grandchildren.” This activity had not changed since before the coronavirus disaster.
Meanwhile, rural respondents tended to change their behavior by reducing the frequency of
shopping and hospital visits. For example, many of them had their children living close by go
shopping for them, thereby avoiding the use of public transport and trips to supermarkets far fromtheir houses.
Due to school closures and an increasing number of telecommuters in urban areas, some rural
respondents had their family members from urban areas stay at their places. One of them, Ms. Akiyo(late 70s), had her granddaughter temporarily stay at her house since the university she attended inTokyo went completely online in April.
Ms. Akiyo: “My daughter brought her daughter to my place, planning to have her stay on thesecond floor of this house. But since my husband has an underlying health condition, he
14

refused to let her stay…. Well, I took her to the second floor anyway. I brought meals toher, without letting him know. She hid there for about a week, keeping a mask on.”When Ms. Akiyo took her granddaughter, she was opposed by her husband who had anunderlying health condition and used a care facility. In the end, she hid the granddaughter on thesecond floor without letting the husband know. Since it was a secret, the granddaughter could not go
outside at all for a week. Living in a small rural area, Ms. Akiyo also needed to pay attention to herneighbors, making sure they never saw the granddaughter.
As described above, while the respondents in both urban and rural areas experienced changes indaily lives, there were some regional differences.

2. Creation of New Roles and Social Support
Social roles are formed based on social relationships. In the coronavirus disaster, people faceddifficulties in maintaining regular social relationships and finding alternative approaches.
Consequently, many respondents mentioned role loss during the interviews, and “cleaning a house”
was often chosen as a temporary measure to find the new normal.
However, since cleaning and decluttering were not what they could keep doing in the prolonged
coronavirus disaster, they also started finding new roles based on their previous experiences or trying
something new. The following presents three examples of such initiatives: interactions throughmask-making, new volunteering in their communities, and online communication using ICT.

2-1) Interactions through mask-making
Almost all of the respondents took thorough measures to prevent infections by wearing
masks, washing hands, and using sanitizer. Masks had been in short supply until
around May, 2020, and many respondents mentioned the difficulty in finding them.
Nevertheless, all of them were able to find masks one way or another. Many of them had
masks in stock as they had used them regularly even before the pandemic, for a pollen
allergy and hospital visits for example. It should be noted, however, that masks served
as one of the communication tools as older adults gave and received masks to and fromneighbors and friends. Such communication through masks was common both in urban
and rural areas, mainly among women as they had more extensive sewing experience. It
lasted at least until around July, when masks finally became available in the market
again.
2-2) New volunteer activities
Interactions through masks took place beyond their families and relatives; they were often seen at a15

community level as well. Such activities, turning the existing community-based relationships into
resources, may give the impression that these older adults kept interacting with friends even in thecoronavirus disaster. However, many respondents reported otherwise, stating that their interactions
with friends had rather declined.
Ms. Tome (late 70s), an apartment resident, began disinfecting the building in March, whenpeople started emphasizing the importance of disinfection.
Ms. Tome: “Well, I live in an apartment complex, and the residents’ association doesn’t
disinfect the building. So, four volunteers, including myself, disinfected the elevator
buttons from March to May.… We volunteered, four of us.”Interviewer: “Wow. Did you also buy disinfectant?”
Ms. Tome: “We bought disinfectant ourselves… But later, the residents’ association started
buying it so that we could use it. We made sure we wore rubber grabs and a face mask.
These items, we bought on our own.”
While Ms. Tome was an influential person in the neighborhood association, she did not holdany official position when the interview was conducted. She did participate in several activities, suchas volunteering at the exercise program. Since these activities were cancelled, she contacted othermembers of the volunteer group in the neighborhood and started disinfecting the building on theirown. While the coronavirus disaster made interpersonal communication extremely challenging, asshown in this example, people contacted each other and found a new role in a creative manner. The
existing relationships and trust seemed to make it possible.
It would have been difficult for just one person to continue such service. The key point of thisexample is a team work that enabled the activity to become a new routine.
2-3) New communication style using ICTWhen asked about new things they were able to start in the coronavirus disaster, several interviewees
talked about their new experiences with ICT, including LINE (a social networking application) andZoom.
For example, Mr. Hajime (late 60s) in Tokyo started using LINE in the wake of the disaster. “I
had never been interested in (LINE or Twitter) at all. I used to make fun of them.” Since the disasterbegan, however, “My family told us to start because I was the only one not using it. I didn’t want tobe left out in the family.” He started learning how to use it, with his wife as a teacher.
Around the beginning the coronavirus disaster, many respondents in both urban and rural areas
started using communication applications, including LINE, for their children and grandchildren.
However, LINE is not sufficient for communication in a larger group while using videos. Thanks to16

the leadership of local volunteer groups, some respondents started exploring new ways ofinteractions via Zoom while staying at home during the disaster.
These examples suggest that the coronavirus disaster provided opportunities for older adults,
many of whom had been reluctant to use ICT, to try new communication channels, which may also
have strengthened their existing relationships. It should be noted, however, that these newcommunication channels did not necessarily create new relationships. Also, the support by people
surrounding these older adults was the one that made the use of ICT possible.

3. Beyond the Disaster Utopia
The coronavirus disaster forced the cancellation of numerous activities, making people stay at homemost of the time. This section introduced how older adults tried to restructure their lives in thisdisaster based mainly on their narratives.
Solnit (2009) named extraordinary communities and mutual aid arising in disasters the “disaster
utopia.” Then, did the coronavirus disaster bring a disaster utopia? My answer is no. The disaster of
COVID-19 has been lasting for a long period of time. The disaster has hit the entire world instead of
specific areas, making it difficult to build supporter-recipient relationships. Above all, the mutual aid
introduced in this section is not a temporary utopia but rather built upon the existing mutual help.
The responses to the coronavirus disaster were not based on temporary enthusiasm. Hence, thisdisaster may clearly reflect the richness of existing community support resources already built byolder adults. In this sense, it is critical to foster local community resources even before the infection
control measures take place, just like strategies to prevent and control disasters. Further efforts
should be made to develop and help mutual support systems in which older adults can demonstrate
their resilience and go beyond “supporter-recipient” relationships in their communities.

Reference
Solnit, R. (2009). A paradise built in hell: The extraordinary communities that arise in disaster. The
Viking Press, New York.

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Changes Since the First Wave of COVID-19 Infections and Community-Led
Activities in a Social Housing Development
Yoko Matsuoka
Associate Professor, Department of Social Education and Welfare, Faculty of Humanities, Tokyo Kasei University

A social housing development B, located in City A of Tokyo, consists of 3,243 households.
With older residents accounting for 56.8% of the 5,274 residents (as of October 2020),
this apartment complex is considered what is called an urban genkai shuraku, meaninga marginal community on the verge of extinction due to the extreme population aging.
Those in their 70s constitute the largest age group there, with very few younger
residents. In other words, the demographic structure of this apartment complex looks
like Japanese society in and after the year 2040.
At the apartment complex B, a weekly gathering program called Café C is held
since May 2018, led by local residents as frailty prevention. Every Saturday morning,
residents with mild disabilities gather at the café, exercise for approximately 40
minutes and enjoy recreational activities such as talking, singing, and quizzes. The
program usually has 15 participants and 10 volunteers supporting its activities.
The café had been in operation for almost two years when the COVID-19 pandemic
hit the country. Its gathering program needed to be suspended for about seven months,
from March to September, 2020. During the suspension, the program volunteers started
making its newsletter and distributing it to the participants in the apartment complex.
Using the newsletter, these volunteers kept the participants updated and connected bytaking pictures of the apartment complex, introducing themselves, and writing stories
about the participants they met in the neighborhood. They made 10 issues in the sevenmonths.
This section introduces how the participants and volunteers of Café C experienced
the COVID-19 pandemic in the context of community-led activities in an urban housing
complex.

1. COVID-19 Experiences: Participants of Café C1-1) Painful/difficult COVID-19 experiences
Many participants had been quite active before the pandemic, going out a few times a
week. The spread of COVID-19 infections, however, led to the suspension of all theactivities they had participated in, which also meant the suspension of all theinteractions. The respondents described such experiences as difficult/hard; one
participant said it was as hard as the war time. For many of them, COVID-19 could be a18

serious health threat as they were at high risk of severe illness and/or afraid of deathfrom the virus. Meanwhile, the participants tended to spent more time watching TV
while also eating snacks, resulting in weight gain.
1-2) Resilience and the “new normal”
The participants engaged in light physical activities, such as exercising at home andtaking a walk in the neighborhood, thinking that they needed to do something to change
the situation. Some participants demonstrated resilience by using their free timeeffectively, such as cleaning their houses. In the meantime, whey also took thoroughmeasures to prevent COVID-19 infections while also receiving support from family
members.
1-3) Learning from COVID-19
Some participants demonstrated their resilience by making masks for other people.
Since they liked sewing, the volunteer representative of Café C asked them to makesome. Volunteers collected these masks and distributed them to other members of thecafé. Another participant sent postcards to her friends when she could not meet them inperson, with messages of encouragement. These examples show that the COVID-19
experiences led these participants to be kind to others and be positive. It was also an
opportunity for their personal growth, helping them realize that people cannot live
alone. It should be noted, however, that most of the participants had had mild
disabilities since before the pandemic, and some of them experienced significant
physical effects, including the weakening of lower body, loss of physical strength, andprolonged physical symptoms such as slipped disks and shingles.

19

Painful/difficult
COVID experience

•

•
•
•

Active life
I go out 23/week.
(exercise, etc.)
I swim every day.
I help w/ thecommunity
flower beds.
I’m a local leader.

No outing• I don’t go out anymore.
• I can’t do what I need todo.

No activities• Everything has
stopped.
• I’ve lost all theplaces for
activities.
• I don’t go out at
all.

Painful/hard• It’s painful.
• It’s as hard as the war
time.

No interactions• I can’t go out toeat w/ friends.
• I can’t see friends.
• I miss chitchatting
w/neighbors.

•
•
•
•

Resilience &“new normal”

Learning from
COVID

Light exercise• I walk (to a nearby hill, 2stations, etc.).
• I exercise at home.

Be kind & positive• I’ve got to know many people
through mask-making.
• I’ve become a kinder person.
• I send postcards to friends, andthey call me & thank me.

Effective use of
free time• I read books.
• I tidy up my place.

TV → weight gain
I watch TV all the time.
I eat while watching TV.
I might get dementia?!
I eat all day.

Family support• My daughter goes shopping
for me every Saturday.
• My daughter stops by.
• My children visit me.

Giving up• I’ve left a walking club.

Risk for severe illness• I ‘m scared of COVID
because I have respiratory
problems.
• I’d be dead in a day if I got
infected.

COVID measures• When I go shopping, I makeit quick.

Growth through the COVID
experience• I was able to experience the
COVID pandemic. Experiences
will help people grow.
• I’ve realized that people cannot
live alone.

Physical deterioration & illness• My lower body is getting weaker.
• I’ve lost physical strength.
• My slipped disc didn’t get betterfor a long time.
• I got shingles and hospitalized.

Figure 1: Stories of Café C participants

2． COVID-19 Experiences: Volunteers of Café C
2-1) My life has completely changed!
Most of the nine volunteers we interviewed had been out almost every day before thepandemic. In addition to the volunteering at Café C, they had also engaged in othercommunity roles (e.g., neighborhood association), hobbies, and health maintenance (e.g.,going to a gym and pool). These lifestyles were completely changed by the COVID-19
pandemic. Every place for activities was closed, and everything was cancelled. Somevolunteers described the lives in the pandemic as “nesting.” Since their pre-COVID lives
had mainly taken place outside, some volunteers felt that they had no places forthemselves at home.
2-2) Resilience and the “new normal”
These volunteers demonstrated resilience in a variety of ways in order to adapt to thedrastic changes in their lives. Some of them started getting up early and exercising,while others made effective use of extra free time and found new ways to enjoy theirlives by cooking from scratch, reading in a park, and watching movies at home. No
matter what they did, they always took thorough measures to prevent infections.

202-3) New development & layers through COVID-19
When the gatherings of Café C were suspended, the volunteers strengthened a sense ofsolidarity with each other while learning to use a variety of ICT. For example, they
started using a social networking application Group LINE, in which they not only
communicated on program management but also shared things not related to thevolunteering, such as beautiful videos, to keep each other’s spirits up. They also started
using Zoom, with the help of young college students, to have meetings and join music
events.
Within the apartment complex B, there is a place serving as a community infirmary,run by a private entity. As the volunteers heard an increasing number of concerns andproblems from the residents during the pandemic, they often referred these people tothe infirmary, which resulted in collaboration with professionals. The volunteers also
expressed their hope for the restart of activities. In addition, the COVID-19 experiences
made them realize what is truly important, appreciate being appreciated, and deeply
reexamine the meaning of volunteering.

My life has completely changed!
COVID experience•••

Being out everyday• I do thingsoutside every
single day.
(volunteering,etc.)• I’m out everyday.
• I go to local
clubs, seniorcitizens clubs,
gyms, etc.

•
Everything
being cancelled• All thefacilities haveclosed.
• Everythinghas beencancelled.
• Things havefallen apart.

•“Nesting”
I’m stuck at home.
I’m “nesting.”
I’m doing thesame thing everyday.
I have too muchtime to kill.
I have noconversation(living alone).

No place for me athome• I have no place
for myself athome.
• I’m not getting
along w/ myhusband.

Difficult/challenging• Staying at home
is difficult for me.
• It’s challenging.

Resilience &“new normal”
•
•
•
•
•

ExerciseI started taking awalk again.
I walk 10,000
steps a day.
I get up earlier.
I’m doing radio
calisthenics.
I pay attention to
exercise and diet.

New ways to enjoylife• I cook fromscratch now.
• I enjoy reading ina park.
• I send handwritten letters.
Perfect COVID
measures• I always use
hand sanitizer &wash my hands.
• I go shopping
only 2/week.
• I’ve started
using delivery
services.

New development & layers
through COVID
Staying connected via
the LINE app• We stay connected via
the Group LINE.
• I use LINE w/ my family
too.
• We tried Zoom w/ helpof young people.

Staying connected
w/group members• We talk every otherday.
• We got to dosomething.
• We work together anddistribute ournewsletters.

Working w/
professionals• If there’re any
problems, we referthem to pros.
• We learn from them.

Hoping to restart• I want to restart what I
used to do.
• I want to restart theactivities of theneighborhood
association.

Appreciating being
appreciated• Volunteering is goodfor me.
• Caring for others gives
me energy.
• I appreciate being
appreciated.

Realizing somethingimportant• The restrictions havereminded me how
precious the ordinary
life is.
• I’ve realized how hard
it is to discipline myself.

Volunteering to give back to the community• I’m giving back to the community that helped me raise mychildren.
• I’m giving back to the community where my mother spent
her life until 97.
• Serving my community is a natural thing to do.
• I want to stay connected with society.

Figure 2: Stories of Café C volunteers21

3. COVID-19 and Community-Led Activities
Both the participants and volunteers of Café C had been out frequently before thepandemic started, engaging in various activities including hobbies, neighborhood
associations, and volunteering. The pandemic stopped all of these and transformed theirlives. Despite numerous challenges, however, these interviewees demonstrated
resilience and found their new normal.
Café C is a community-based gathering program at the apartment complex B, but
its activities were suspended in the COVID-19 pandemic. Its volunteer group decided
that they shouldn’t stay quite doing nothing just because the gatherings weresuspended. Under the leadership of the group representative, these volunteers started
making its newsletter for residents. Later, a group member proposed that thevolunteers could make phone calls to residents to stay connected because some of them
lived alone. They started the phone program in August. A volunteer also found thatsome program participants were good at sewing. The group decided to ask them to makemasks and distribute them to other residents. All these ideas were shared through thesocial networking application LINE. The residents voluntarily proposed, discussed,
decided, and ran all of these activities rather than merely participating in programs
developed by the government. Hence, Café C should be considered a community-led
program, which goes a step further than a community-based one.
The resilience and community-led activities of Café C are built upon the residents’accumulated experiences and relationships over a long time. This study has confirmedthat such an initiative serves as an asset of the apartment complex B.

22

Mental/Physical Changes and Coping Strategies among Older Adults in the
COVID-19 Pandemic
Taeko Nakashima
Associate Professor, Faculty of Healthcare Management, Nihon Fukushi University

The COVID-19 pandemic has resulted in prolonged restrictions on people’s lives, suchas going out, interacting with others, and participating in society. Such restrictions areprojected to increase the risks of depression, dementia, need for care, physicaldeterioration, and immature death among older adults. In order to understand howchanges took place among older adults in the pandemic, including their daily lives andmental/physical health, the voices of older adults themselves should provide valuable
insight. This section therefore analyzes the mental/physical changes experienced byolder adults, using our interview data collected shortly after the first wave of infections.
The responses were coded, based on which categories and subcategories were created.

1. Mental/Physical Changes in the COVID-19 Pandemic (Table 1)
Regarding the respondents’ mental health, while only a few of them felt no particularchanges, many took it hard and had anxiety as they felt stuck at home. Some
respondents felt down and loss of energy. They were also stressed out because they
could not go out and/or meet other people. Even if the respondents themselves did not
feel any changes, some of them found other people having depressive symptoms andanxiety, suggesting the extensive psychological impact of COVID-19 on older adults. For
example, a female respondent (Ms. L) spent a month away from her apartment to staywith her daughter’s family in a neighboring prefecture because the daughter wasconcerned about the mother living alone. When Ms. L came back to the apartment, shefound a significant physical decline in her elderly neighbors. She also heard about agrowing number of people with “COVID depression.” Facing these effects of COVID-19
made Ms. L feel determined to stay strong and “beat COVID-19.”
Turning to their physical health, as in mental health, a few respondents felt no

particular changes in physical conditions or strength. In some cases, respondents felt aslight improvement of their physical health because their lives became less physicallydemanding or they exercised more during the pandemic. However, the most common
response was physical decline, such as having weaker legs, feeling tired, and losing

physical strength. In particular, they felt a decline in their ability to walk, including
lower-body strength and walking speed. Some respondents also felt the physical effectsof routine changes. They spent more time at home, watching TV for longer hours while23also having snacks, which resulted in weight gain (“putting on COVID weight”).
Meanwhile, other respondents lost appetite because they were not using brain as muchor due to invisible stress. Several interviewees were also at high risk of severe illness
from the virus because of their underlying health conditions.
Table 1. Changes in Physical and Mental HealthCategory
MentalhealthSubcategory
Feeling no particularchanges in mental
statusSuffering and feelinganxiousCode・ Not feeling any changes in terms of mental health

Feeling stressed out

・
・
・
・
・

Feeling down
losing energy

PhysicalhealthandSeeing other people
getting depressed andanxiousFeeling no particularchanges in physicalconditions/strength
Slightly
improving
physical healthHavingconditions

underlying

Weakeninglower
body, feeling tired,losingphysicalstrength
Facing physical effectsof routine changes

・
・

・
・
・
・
・
・
・
・
・
・
・
・
・

Gaining weight during
the COVID pandemic
Losing appetite

・
・
・
・

Feeling anxious and stuck at home
Feeling that the COVID pandemic is as mentally hard as the war
experience
Getting stressed out due to the home confinement
Feeling stressed
Finding the home confinement difficult
Gradually losing mental energy
Gradually feeling down and dull due to the loss of places for
activities
Seeing neighbors getting COVID depression
Hearing from neighbors over the phone that they are too scaredto go to hospitals but also worried about not seeing doctors
Not feeling any changes in terms of physical strength
Feeling no changes in physical health
Feeling that the life is less physically demanding since thesuspension of all the activities
Exercising more and feeling a little healthier
Having bronchial asthma and being told by the family doctor tobe very careful because of the high risk for severe illness
Being at high risk because of diabetes
Feeling that the body is becoming more painful and stiff due to asedentary lifestyle
Walking more slowly with the weakening lower body
Realizing the loss of physical strength in April (when the person
went shopping)
Having a problem with a nervous system due to unsuccessful
self-health management
Being physically affected by routine changes and inability tomake any plan
Spending more time watching TV and eating, resulting in weightgain
Gaining weight due to the closure of gyms
Not using brain as much since the activities stopped, resulting ina loss of appetite and inability to enjoy foodLosing appetite in a strange way, while feeling no particularchanges in everyday life, probably because of invisible stress24

2. Activities to Maintain Health (Table 2)
While the respondents tended to feel negative changes in their mental/physical health,they also started a variety of innovative and new activities to maintain their health.
Most of the interviewees experienced the suspension of the activities they had enjoyed
due to the pandemic. Their approaches to this change can be categorized mainly into
two methods: exploring new alternatives and trying to keep a daily routine. Those who
did not take any particular measures tended to feel no major changes but report a
decline in physical activities.
Under the category “exploring new alternatives,” many respondents started taking

a walk while avoiding crowds by doing it early in the morning. The interviewees
reported a wide variety of other innovative ways as well. For example, Ms. O found a
new routine, getting up before 6 a.m. and doing radio calisthenics at home. Ms. P founda new way to enjoy life by participating in an exercise program via Zoom, with the helpof college students who had been helping the community-based preventive exercisegroup which she was a member of. A few respondents from the same group tried
stretching and other exercise at home, using the menu introduced in the newsletter

made by the group. Other respondents who had been physically active refined their
existing/old exercise routines. Meanwhile, some respondents found it difficult to do
exercise alone no matter what they tried.
As for “trying to keep a daily routine,” the respondents seemed to stay as active as
possible and keep their daily routines as much as they could in everyday life, except forinteractions with others. Quite a few respondents had had a habit of walking regularly
since before the pandemic, and they continued to take a walk to keep a daily routine
even during the state of emergency in order to maintain their health. Some interviewees

continued to do radio calisthenics every day in a park with friends regardless of thepandemic. Mr. W, who teaches aerobic exercise every week as a volunteer, prepared forthe reopening of the activity by going over the exercise routine at home once or twice a
week, making sure he could teach properly once the program restarted. After the stateof emergency was lifted in late May, several respondents started using gyms again. Yet,they chose off-peak hours to avoid crowds.
Those who felt no major changes but reported a decline in physical activities tended
to be inactive to begin with but become even less active in the pandemic.

25

Table 2. Activities to Maintain HealthCategory
Exploring newalternatives

Subcategory
Taking a walk (while
carefully choosing thetime)

Starting
calisthenics

radio

Exercising even for a
few minutes to stayhealthy
Exercising while using
Zoom and the exercisegroup newsletters
Refining
existing/old
exercise routines

Code・ Taking a walk while carefully choosing the time (e.g., lesscrowded, not too warm)
・ Getting up at 5 a.m. and taking a walk around a hill in theneighborhood for about an hour, thinking that few people
would be out there early in the morning
・ Taking a walk to stores 2 stations away with the daughter
when the weather is good・ Coming up with the idea to start radio calisthenics,
leading to the new routine of getting up by 6 a.m., going to
the balcony to get some fresh air, and doing radio
calisthenics
・ Doing radio calisthenics and taking a walk every morning
・ Going outside at least once every hour, even for 5 or 6
minutes, during a TV commercial break・ Working on an exercise ball at home once or twice a day
when walking outside is not an option
・ Trying different kinds of exercise, introduced in theexercise group newsletters, with wife at home
・ Exercising via Zoom with the exercise group members
・・Having difficulty doing
exercise alone

・・
Trying to keepa daily routine

Continuing to take awalk to keep a daily
routine・

Doing radio calisthenics
every day・・・Preparingforthereopening of activities

・

Using gyms again

・
・

No
major
changebut
less active

Not active to start withbut even less active
since
the
COVID
pandemic・・

Riding a bike for a half day to see how the old favorite
cycling route has changed
Running about 350km a month, using the free timecreated by the reduced workload as a welfarecommissioner (a former marathon runner)
Trying to do radio calisthenics and stretching but realizingthat it would take a strong will to do exercise alone athome
Trying to exercise at home in the beginning, remembering
the things learned at the exercise group, but gradually
becoming lazyStanding near the bridge as a crossing guard and walking
7,000 steps a day to keep a daily routine
Taking a walk for an hour every day, usually the sameroute, with or without the COVID pandemic
Doing radio calisthenics in the park regardless of the
COVID pandemic
Continuing to do radio calisthenics every day even during
the COVID pandemic
Going over the exercise routine at home once or twice aweek to prepare for the reopening of the program(volunteer aerobic exercise instructor)
Going to a gym, which reopened in June, around lunch
time to avoid crowds
Going back to a gym but finding it difficult to run with amask onNot taking a walk because of the problems with legs/lower
back
Doing less and less while not feeling that the lifestyle haschanged much

26

3. Discussion
Many, although not all, interviewees reported mental and/or physical changes in the
pandemic. In particular, they tended to feel anxiety, loss of energy, and stress as they
faced sudden restrictions in their activities and interactions. Several respondents also
felt physical effects of the pandemic that could be considered mild frailty, such as having
weaker legs, feeling tired, and losing physical strength.
Nevertheless, none of them had significant deterioration of mental or physicalfunctioning thanks to their own efforts, family support, as well as relationships with
their friends and communities. While recognizing their own mental and physicalchanges, many older adults demonstrated resilience and explored their own ways tostay healthy. Some research points out that resilience tends to increase with age, which
seems to imply that older adults are better able to recover and maintain their statusthrough experiences.
However, it was difficult for them to keep exercising alone. Their existing networks,
including the newsletter from the local exercise program and people who had been
involved in their lives, provided significant support in addressing this challenge.

27

APPENDIX
Timeline of the COVID-19 pandemic in Japan
Date

Event/response

2020
1/6

Pneumonia cases of unknown cause are detected in Wuhan City, Hubei
Province of China.

1/15

The first case of COVID-19 is confirmed in Japan.

1/28

The Cabinet Office designates COVID-19 as an infectious disease under the
Infectious Disease Control Act.

1/30

The World Health Organization (WHO) declares the COVID-19 outbreak apublic health emergency of international concern.

2/1Japan bars foreign nationals who visited China's Hubei Province fromentering the country.

2/3

The Diamond Princess cruise ship, with positive cases of COVID-19,
anchors at the Yokohama port, having passengers and crew members
quarantined until February 19.

2/13

Japan's first COVID-19 death is confirmed (in Kanagawa Prefecture).

2/26

The national government requests cancellation of large-scale events.

2/27

Prime Minister Shinzo Abe calls for the closure of all Japanese elementary,junior high, and high schools (from March 2 to the end of spring vacations,which usually conclude in early April).

3/13

The parliament enacts the coronavirus special measures law.

3/24

The Tokyo 2020 Olympic and Paralympic Games are postponed to 2021.

3/25

The Tokyo Metropolitan Government calls on its residents to refrain from
unnecessary outing during weekends.

4/7

A state of emergency is declared in seven prefectures.

4/16

The state of emergency is expanded nationwide, with 13 prefecturesdesignated for tighter measures.

5/14

The state of emergency is lifted in 39 of the 47 prefectures.

5/25

The state of emergency is lifted in all prefectures.

6/19

The national government lifts its requests for voluntary restrictions on
crossing prefectural borders nationwide.

7/2

Tokyo records 107 new COVID-19 cases. (The number hits a record high on
July 23.)

7/22

The national government launches the Go To Travel campaign (except for28

Tokyo) to support the tourism industry. The country confirms a record highof over 795 new cases per day.
8/17

The Cabinet Office announces that Japan's economy in the April-June
period shrank at an annualized rate of 27.8 percent in real terms.

8/28

The national government announces its new policies on COVID-19
measures (e.g., ensuring health care delivery, enhancing a testing system).

11/7

The government of Hokkaido requested bars and restaurants in its largest
entertainment district to shorten their business hours in response to a
sharp increase in COVID-19 cases.

11/10

A government panel of COVID-19 experts releases an emergency proposal,
warning of surge in infections.

11/18

Japan and Tokyo reported record-high new cases. Tokyo raises its virus
alert to the highest level.

11/25

The

MinisterofEconomy,Trade,

andIndustry

announcesthereinforcement of measures against COVID-19, with an intention to call on
restaurants and other related businesses to voluntarily scale down
operations.
12/3

The government of Osaka issues a medical state of emergency due to a
sharp increase in severely ill COVID-19 patients.

12/14

The national government decides to suspend its Go To Travel campaign(starting in December 28 nationwide, while several municipalities starting
earlier).

12/25

Japan confirms its first cases of a new strain of COVID-19.

12/26

Japan bans new entry of foreign nationals from all countries and regions.

12/27

The country’s health care system becomes overwhelmed, with insufficientavailable hospital beds. (Seven prefectures in an extremely severe situation
raise the prefectural COVID-19 alert to the highest level on a four-tiersystem.)2021
1/7

The second state of emergency is declared in Tokyo and three otherprefectures (and expanded to a total of 11 prefectures on January 13).

1/13

Japan bans the entry of all nonresident foreign travelers, responding to a
rapid increase in cases of new COVID-19 strains in other countries.

2/3

Japan revises the coronavirus special measures law (introducing penalties
for noncompliant businesses and people).

2/15

COVID-19 vaccinations start for some medical workers.
29

Well-being of Japanese Older Adults in the COVID-19 <March 2021>
Published by International Longevity Cetnter-Japan (ILC-Japan)
KDX Nishishinbashi Bldg., 3-3-1, Nishishinbashi, Minato-ku, Tokyo 105-8446
E-mail: ilcjapan@mba.sphere.ne.jp

URL: http://www.ilcj.org

TEL: 81-3-5470-6767©ILC-JapanAll rights reserved. No part of this journal may be reproduced in any form or by any electronic ormechanical means including information storage and retrieval systems without permission in writingfrom the publisher.

30