Japan is often held up as the global benchmark for longevity. From busy city streets to quiet rural towns, people regularly live well into their eighties and beyond.
This reputation has shaped public debate for decades and has influenced how other nations think about ageing, prevention, and health systems.
Yet new research suggests that the story behind Japan’s long life expectancy is more complex, and perhaps more surprising, than it first appears.
A large comparative study led by researchers from Karolinska Institutet, working with collaborators in Japan, has found that older adults in Japan and Sweden spend a similar number of years living independently without formal elder care.
In other words, when “healthy life” is defined not by medical diagnoses but by the ability to live at home without organised care services, the advantage often attributed to Japan largely disappears.
“Older people in Japan do tend to have lower mortality than their Swedish counterparts, but this difference is not evenly spread across the population. It is mainly seen among individuals who already receive some form of elder care“
The findings, published in the peer‑reviewed journal BMC Medicine, challenge a long‑standing assumption. Living longer does not automatically mean living healthier. Instead, the research points to striking differences in what happens once people begin to rely on elder care, and it is here that Japan’s longevity advantage appears to take shape.
The study examined remaining life expectancy from the age of 75 onwards, a stage of life when health needs often increase rapidly. Using extensive national and regional register data, the researchers analysed more than 850,000 older adults in Sweden and over 330,000 older adults from nine municipalities in Japan. This scale allowed for a detailed and reliable comparison between the two countries, both of which are ageing quickly and have well‑developed systems for elder care.
Participants were grouped into three categories. The first included people living independently without any formal elder care. The second covered those receiving home‑based care. The third included individuals living in residential care facilities. This structure made it possible to examine not only how long people lived, but how long they lived in different states of independence or dependence.
The headline result is clear. Older people in Japan do tend to have lower mortality than their Swedish counterparts, but this difference is not evenly spread across the population. It is mainly seen among individuals who already receive some form of elder care. Among those living independently without formal support, life expectancy is remarkably similar in the two countries.
For women aged 75, the numbers illustrate the pattern clearly. In Japan, a woman of this age could expect to live an average of 10.4 years without formal elder care. She could then expect to spend around 5.1 years receiving care, either at home or in a residential setting. In Sweden, a 75‑year‑old woman could expect about 9.9 years without care and 3.8 years with care.
The implication is not that Swedish women become dependent earlier in life. Rather, Japanese women tend to live longer after entering the care system. They spend more years in a dependent state, yet experience lower mortality during those years.
For men, the differences were smaller and more subtle. A 75‑year‑old man in Japan could expect roughly 9.8 years without formal elder care, compared with 9.6 years in Sweden. Time spent in care was also similar, with Japanese men averaging 2.2 years and Swedish men about 2.1 years. Even here, however, mortality among men receiving care was lower in Japan.
These patterns raise an important question. If healthy life years are broadly similar, why does Japan maintain its global lead in life expectancy?
The researchers suggest that the answer lies not in better health earlier in old age, but in how care is delivered, organised, and accessed once health begins to decline. The structure and timing of elder care appear to play a critical role.
One possible explanation relates to who qualifies for formal care and when that care begins. In Japan, people may enter the care system earlier, at lower levels of disability. This could mean that individuals receive support sooner, before health problems become severe. Earlier intervention may help prevent complications, reduce stress, and stabilise chronic conditions.
Another factor may be the organisation of care itself. Japan’s elder care system places strong emphasis on continuity, monitoring, and daily support. Even when care is provided at home, it is often frequent and structured. This approach may help reduce avoidable hospital admissions and detect health problems at an earlier stage.
End‑of‑life care practices may also differ. Previous research has shown that medical treatment near the end of life tends to be more intensive in Japan than in many European countries. This includes greater use of hospital care, medical technologies, and ongoing treatment even in advanced age. While such practices raise ethical and economic questions, they may contribute to lower mortality among people already in poor health.
Family involvement is another important piece of the puzzle. In Japan, family members continue to play a central role in caring for older relatives, often in combination with formal services. This blended model may provide emotional support, daily supervision, and practical help that complements professional care. In Sweden, by contrast, elder care is more strongly formalised and institutional, with less reliance on family networks.
The researchers stress that these findings do not suggest one system is inherently better than the other. Instead, they highlight how different approaches produce different outcomes. Longer survival in a dependent state may not always align with individual preferences or quality of life. At the same time, shorter periods in care may reflect stricter eligibility thresholds rather than better health.
The study also draws attention to how “healthy ageing” is defined and measured. Many international comparisons rely on life expectancy or on self‑reported health. This research uses a practical, functional definition: living without formal elder care. While imperfect, this measure captures a key aspect of independence that matters deeply to older people and to policy planners.
Importantly, the findings suggest that countries seeking to improve healthy ageing should look beyond prevention and early‑life health alone. The design and delivery of elder care can shape survival just as powerfully as lifestyle or medical risk factors.
Sweden and Japan offer a valuable contrast. Both have high life expectancy, advanced health systems, and ageing populations. Yet they organise care in distinct ways and reach different outcomes once people become dependent. Understanding these differences could help other nations adapt their own systems as the number of very old people continues to rise.
The research team describes this study as a first step in a broader collaborative effort. Future work will compare health status across different stages of care in greater detail. This includes examining physical and cognitive function, transitions between home care and residential care, and how social and medical factors interact over time.
Such research is urgently needed. By 2050, the proportion of people aged 75 and older will increase sharply in most high‑income countries. The question will not only be how long people live, but how they live, and how societies support them when independence fades.
This study offers a timely reminder that longevity statistics can hide as much as they reveal. Japan’s long life expectancy remains real and impressive. Yet it is shaped less by an extended period of robust health and more by what happens during the final, vulnerable years of life.
For policymakers, the message is clear. Improving survival among older adults may depend as much on the quality, timing, and philosophy of elder care as on traditional public health measures. For the public, the findings encourage a more nuanced view of ageing, one that recognises both the gains and the trade‑offs of living longer.
As populations age worldwide, the experiences of countries like Japan and Sweden will continue to inform global debates. This research adds depth to that conversation, shifting the focus from lifespan alone to the complex realities of late‑life care.
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