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Mar. 10, 2015 - Updated 04:16 UTC

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Overcoming Self-Neglect

Feb. 23, 2017

The problem of self-neglect is growing in Japan as the number of seniors in the country rises, but efforts are underway to combat the problem.

Ordinary people confronted with unexpected difficulties can sometimes fall into a pattern of self-neglect. The trigger could be illness, job loss, or a death in the family. The home falls into disarray and some people become unconcerned about hygiene, turning inward and refusing help.

Last November in the city of Gifu in central Japan, the bodies of 3 people were found in a home. They were a husband and wife in their 70s and their son, who was in his 40s. The parents had died 2 months earlier. Their son had been dead for about a week when the bodies were discovered.

It's thought they died of illness or starvation, and it could be a case of self-neglect. The 73-year-old father was a retiree and his son was a recluse. A few years earlier, the father had begun showing signs of dementia and the family stopped interacting with neighbors.

“Hardly anyone in the area knew what their life was like. I didn’t,” one neighbor says.

The regional support center had received reports that the family was in need of help, and had visited their home several times to encourage them to make use of homecare services. But official only managed to speak to the family twice, and since they refused the offer no further action was taken.

"In order to access services, individuals have to sign an application, so it’s hard to proceed if they say they don’t need help," says a staff member with the local homecare service.

Individuals struggling with self-neglect often refuse support even as their circumstances deteriorate. One woman in her 60s has experienced self-neglect. She spent many years caring for her father, who had dementia. Her social life gradually dried. Her father died 10 years ago and around the same time she developed diabetes and her eyesight began to fade. She became reluctant to go outside.

"They come twice a week to collect the garbage. I managed to go to the designated location and drop the garbage off, but then I couldn’t figure out how to get home. I felt very miserable, and I thought I shouldn’t go out anymore. I had my hands full just living day-to-day," the woman says.

Slowly, her house began to fill with garbage but she says she couldn’t bring herself to ask for help. Her diabetes got worse and when an employee from the regional support center suggested she get treatment, she refused because she didn’t think her condition was that serious.

Two years ago, a support center employee found her unconscious in her home. She was lucky to escape death. Today she still needs help with her day to day needs, and lives in a nursing home.

"I am really grateful to be alive right now. Being able to live like this is the best thing that has ever happened to me," she says.

Emiko Kishi, a professor at Toho University, says people experiencing self-neglect isolate themselves from society for long periods. This causes their sense of judgment to gradually deteriorate, to the point where they can’t see that they're putting themselves in danger.

“I think very few people in a state of self-neglect think they are in that state. Since they don’t ask for help, there are thought to be many hidden cases,” Kishi says.

In some areas, local governments and residents have been working together to address the problem. For example, the city of Tajimi in Gifu Prefecture and is covered with signs stating the goal of achieving zero solitary deaths.

The city of 110,000 people teamed up with 86 industries including insurance companies and newspaper delivery services. They all wanted to get a clearer picture of residents’ lives.

“If you find a home with newspapers piled up or other unexpected changes, please contact this office,” says Enichiro Sato, a worker at a newspaper delivery shop.

Among the team members is Yoshikazu Nagaya, who has been delivering newspapers for almost 30 years. He tries not to miss the warning signs that lead to self-neglect. Noticing these signs once led him to save someone’s life.

“The newspapers were piled up, so I thought they might be out. I waited until the next morning, and then noticed that the second-floor window was open and the lights were on. I thought that was strange, so I called the office," Nagaya says.

The office that received the message sent out a team. It discovered an elderly man unconscious on his bed and called for an ambulance. The man survived.

It has been 2.5 years since the team was formed and so far, it has saved 3 lives.


Hiroki Obi, a reporter from NHK's station in Gifu who has researched self-neglect, joins anchor Aki Shibuya in the studio.

Shibuya: In the report, we saw an example of self-neglect in Gifu Prefecture. How serious is this situation in Japan?

Obi: A government survey in 2011 found about 11,000 cases around Japan.

Shibuya: And how does that compare with other countries?

Obi: A study in the US found 9 percent of elderly Americans suffer from self-neglect. If this rate were applied to Japan that would amount to 2 million people.

Shibuya: Are you saying there are perhaps many unreported cases in Japan?

Obi: Yes, experts point to traits that are common among Japanese, like being too timid to ask for help, too proud to depend on others and too shy to share personal details.

Shibuya: What do you think needs to be done to help those people?

Obi: There's no legislation in Japan covering self-neglect, like the one on child abuse. So even if signs are evident the authorities cannot step in. First, I think we need legislation.