CLOSING ADDRESS
Chairman of the Board; Sasakawa Health Science Foundation, Japan
Shigeaki Hinohara, M.D.
This concludes the two day session of the International Symposium on Elderly Care.
Twelve experts from six countries joined more than the equal number of their Japanese colleagues and helped us in concluding the Symposium successfully.
The biggest pleasure for us was that many groups and organizations supported the three sponsors of the Symposium, namely Japan Shipbuilding Industry Foundation. Sasakawa Health Science Foundation and the Yomiuri Shimbun. It is rare to see a meeting which lasted until the last moment without an empty seat such as this one.

I think it is particularly rare that people of different disciplines such as physicians, nurses, social workers, psychologists, physical therapists, occupational therapists, family members taking care of the elderly, and volunteer care givers should have gathered together to discuss issues of common interest of supporting human life.
The theme of this Symposium was how to care for the demented elderly who are in the terminal stage of life and for whom there is no solution in medical care, and how we can restore the dignity of humanity which appears to be lost in this stage. We humans are bestowed life and the life is bound to cease sooner or later. People with dementia are most unhappy as the last light of their life light flickers.

We feel that the humans should not be left in a state similarly as used cars abandoned in piles in a vacant lot in the suburbs.
Systems of medical care and nursing care differ radically from country to country, but we learned that all the countries share the common issues. Discussions we have had during the past two days are most significant in this context. I believe that we had the opportunities of learning knowhow and technology and sharing strategies and supports.
Dr. Fry asked a very timely question about the quality of life for the Japanese people who enjoy the longest life expectancy of the world. We are challenged to choose between a high quality but slightly shorter life and a poor quality but longer life. I believe that fundamentally we wish to live as long as we are permitted while keeping "the quality of life" high. Not only the professionals but every human should participate in dissolving the issue.

Dr. Lehr said that "aging is an individual process and utterly differs from person to person. There is no set formula. What support can we give to those people who are aging and suffering from dementia? Even a demented person leaves in himself something magnificent as a human being and it is not as if his entire self has become demented. When we think of this, we believe that there are no solutions to the issues without love and compassion for our aged friends who have become demented. It is essential particularly ｆor the professionals to have such sensitivity in addition to knowledge and technology. It is not the system or the facility but the content that is important."

In many of Japan's special nursing homes for the aged, people have to live together in a room without privacy. Can we improve the situation only by re-designing the buildings? Are we not the humans with wisdom? Wisdom, not knowledge helps us to contrive means if there is no tool. I believe we had the opportunity to share the wisdom, not to ex-change knowledge.
At the same time next year, we are planning the Symposium again.
The tentative theme is how to create a pleasant environment for the aged, and to consider the ideal environment for both physical and psychological life for them. We know what the outer environment is. What is the environment for a human as an individual? A personal environment consists of friends, teachers, books and his own growth. We propose to discuss how we can best adjust the inner and outer life to the environment and to further our objective.

Mr. Truschke, the president of Alzheimer's Association (U.S.A.), told us today of an admirable system of the volunteer movement in U.S.A. Why do we fail to appreciate fully the importance of building up such a system in Japan? Japanese business growth is largely due to its wonderful system although individual efforts had a lot to do. Plato said that humans needed the system most, and that efforts are wasted without a system. We would like to share the system and think about it.
People of different environment should gather together, share their wisdom, give encouragement to each other, and invigorate and further the volunteer movement particularly in Japan. The number of staff working in Japanese institutions for the aged is only one half or one quarter of their counterparts in foreign countries. The number of nurses working in Japanese hospitals is only one third or one quarter of those in American hospitals. Why does Japan with its affluence spend so little money to increase the quorum of speeialisls to support life? Why are people unwilling to pay taxes for such purposes? We should give serious thoughts to these matters.
We humans were not born to make money. I would like to think that we were born to use the property, which we had accumulated for the best possible purpose, and that this is applicable to the issue of the care for the aged.
Dr. Hajime Nakamura taught us of the spirit of the Orient in his keynote speech and gave us valuable suggestions on the aging process.
Whether in the West or the East, medical science alone is helpless in the face of aging, particularly dementia. In the final stage of life, medical science is only a part of care: we should include culture as well as religion.

According to Dr. Fry, dementia is one of the most common diseases which we contract with the highest incidence. We should then consider that this concerns everybody including young people. As Mr. Nakamura mentioned, a person should try to maintain his life well and to achieve serene calmness as long as our life lasts. We would like to try hard to create an environment where the demented can live quietly and calmly by caring for them with thoughtfulness and love, and not to treat them as if they are the used cars in the junk yard.
I would like to offer my word of thanks to the foreign guests, audience, and speakers for participating in the discussion so that we may take another step forward for care of the elderly and for meaningful exchange of information.