Reflections on Home-Based End-of-Life Care in an Aging Society

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Across the nation, young physicians are bringing a new energy to the field. 

What sparks their resolve, and where is their journey leading them?  

Here, we pause to capture the heart and soul behind their mission. 

Physician, Orange Home Care Clinic

Currently Director, Kokoiruyo Clinic (“I’m Here With You” Clinic)

Feeling the Pulse of Our Aging Society in Home Care

I am currently in my fourth year as a physician, working at the Orange Home Care Clinic(hereinafter referred to as Orange)in Fukui City. After completing my residency in Kagoshima, I moved into the field of home-based medicine.

As we find ourselves in a rapidly aging society, the need for geriatric care is soaring—not just in Japan, but as a focus of global attention. To give you an idea of the scale: a quick search for "Gerontology" on PubMed shows that the number of published papers has jumped from around 3,000 in 2013 to over 12,000 in 2023. That’s a fourfold increase in just a decade.

Japan is at the very forefront of this demographic shift, having the highest proportion of elderly citizens in the world. And there is no better place to feel the reality of this "front line" than in the homes of our patients.

A Look at Emergency Calls in the Final Month

Since my student days, I’ve been part of the research team at Orange, where we’ve published 25 papers so far. Recently, in May 2025, our study was featured in the journal Medicine (Baltimore).

We looked into what actually happens during emergency house calls in the final month for patients spending their last days at home. Not surprisingly, we found that calls tend to spike just before the end. About 60% of these visits involved hands-on medical care—like prescriptions, IV drips, or blood tests. However, the remaining 40% were managed through careful observation and "being there."

These findings suggest that some of these urgent visits might be handled through telemedicine. If we can use technology wisely, we can make better use of our limited medical resources while still providing compassionate terminal care.

The Rise of "Elderly Caring for Elderly" Within Families

Beyond the data, I’m deeply interested in the human side: "Who are the people using home care, and how do their journeys unfold?" or "How can households of super-elderly family members live safely and happily together?" I spend my days balancing clinical visits with the research that helps us find those answers.

In the year and a half I’ve been at Orange, I’ve cared for about 50 elderly patients. The median age is 82. For those in their 70s, I often see patients with terminal cancer. But for those in their 80s and 90s, the focus shifts to dementia, frailty, or simply the natural weakening of the body.

One thing that stands out is family structure. While those in their 70s often live alone or with a spouse, those in their 90s almost always live with their children. This is creating a new reality: "Parent-child caregiving," where a 90-year-old is being looked after by a child in their 60s or 70s. This dynamic is only going to become more common.

Home care is for people who find it hard to get to a clinic. But "difficulty" means something different for everyone. While this new form of family caregiving can be a beautiful thing, it also brings unique challenges that we haven't seen before.

Building a Kinder Support System

I’ll never forget one particular family. I was treating a woman in her 90s with heart failure who lived with her 70-year-old son. The son was actually a doctor himself. He had been working in Tokyo but moved back home years ago when his father had a stroke.

After looking after his father for over a decade, it was then his mother’s turn. He was determined to keep her out of a facility. He did everything—helped her eat, adjusted her heart medication himself, and always made sure she had her favorite ice cream.

It was a beautiful example of high-level care, made possible by his medical background. But we can’t expect every family to do that on their own. We need to design better systems and support structures that don't just rely on individual sacrifice. I want to keep using my experiences on the ground to research and build a future where home care is better for everyone.

This article has been reprinted and translated from the Japanese original text published in Web Medical Times.20250820.