DEMENTIA IN JAPAN
65,000 dementia exams seen each year under revised law
September 14, 2016
The Yomiuri Shimbun
Mandatory dementia examinations for elderly drivers aged 75 or older may need to be performed on about 65,000 people every year after the revised Road Traffic Law (see below) is enforced in March next year, a Yomiuri Shimbun survey found.
This would be about 40 times the 1,650 drivers aged 75 or older who were examined last year under the current system. With less than six months until the new system is introduced, police departments are rushing to find doctors to perform the exams and make other preparations.
Relevant departments at police headquarters in all 47 prefectures were asked to take part in the survey, which ended in August. The poll asked for estimates of how many elderly drivers suspected of having dementia in a cognitive function test would need to be diagnosed by a doctor.
Responses were received from police departments in every prefecture except Tokushima, and the total estimated number was 64,968 people per year.
The estimates were based on the number of elderly drivers who were assessed as possibly having dementia in 2015 ? about 54,000 nationwide ? plus an expected increase in the elderly population and the number of infractions.
By prefecture, the largest figure was from Fukuoka at 3,300 people, followed by Saitama and Shizuoka at 3,000 each. Tottori estimated only 200 people and Okinawa 440.
Nearly all the prefectures expected a major increase from 2015, reflecting the rapid aging of society.
When asked what issues they faced in implementing the new system, 19 prefectures said it would place a major burden on staff at drivers license centers. Thirteen prefectures said license renewals would be delayed because of holdups at medical institutions, and the same number said there were not enough dementia specialists. Multiple answers were allowed.
Eleven prefectures said there were not enough doctors to perform the exams. Many prefectures also indicated that cooperating with municipal welfare administrations, medial associations and other entities would be essential.
Twenty-seven prefectures, or about 60 percent of the total, said they were trying to educate the public about the new system. Since revoking a drivers license would have a major impact on an elderly personfs life, many other issues also need to be addressed, such as figuring out transportation for elderly people in more rural areas.
Masaru Miura, a professor of geriatric psychiatry at Keio University who was involved in revising the law as a member of a National Police Agency committee, called the new system ggroundbreaking.h
gWith the increasing number of elderly drivers, itfs a necessary system. However, it will impact many people, so society as a whole needs to be educated about it. Itfs also important to promote community-building, to ensure that elderly people who lose their licenses have access to transportation,h he said.
Revised Road Traffic Law
Drivers age 75 and older undergo cognitive function tests when they renew their licenses every three years. If dementia is suspected, they will have to be examined by a specialist, their regular doctor or a medical institution designated by the public safety commission. Tests will also be conducted after every traffic violation. If diagnosed with dementia, their license will be suspended or revoked. Under the current system, licenses are renewed as a rule even if dementia is suspected. An examination is required only if a driver commits an infraction.Speech
photo : Memory and judgment capability tests are conducted at a driving school in Yokohama.
Japanese City Takes Community Approach To Dealing With Dementia
August 23, 2016
Early mornings are routine for 69-year-old Hiroyuko Yamamoto(photo). He's typically at a busy intersection in the city of Matsudo, near Tokyo, where he volunteers as a school crossing guard. But one rainy morning a little over a year ago, an old woman caught his attention.
She was pushing a bicycle. She was kind of disheveled. Despite the rain, she didn't have an umbrella. When Yamamoto spoke to the woman, she said she was trying to get to the city of Kamisuwa. That's about four hours away by train.
Yamamoto recognized that the woman had several signs of dementia he'd learned about when he took his city's dementia awareness training.
Yamamoto volunteers with Matsudo's Orange Patrol. The organization's formal name in Japanese ? Olenji koe kake tai ? translates awkwardly into English as "Troop that calls out to the elderly." But the name accurately describes what the members do. Yamamoto says that just a simple, "Hello, what a nice day," can tell you if someone is OK or needs help.
Because of his training, Yamamoto says, he knew how to talk with the old woman pushing the bicycle.
"I talked to her about things that, according to the training manual, would not upset her," he says. "And I spoke in a gentle manner." These things helped him persuade the woman to stay with him until the police arrived about 20 minutes later.
If it hadn't been for her chance encounter with Yamamoto, the woman might have gone missing, or worse. Last year, 12,208 people with dementia were reported missing to the National Police Agency in Japan. Most were found alive within a week. But 479 were found dead, and 150 were never found.
These numbers have been increasing every year as the number of older people in Japan continues to rise. Nearly 27 percent of the Japanese population is now 65 or older. And, as the number of older people grows, so does the number of people with Alzheimer's disease or other dementia. The Japanese government expects that by 2025 more than 7 million of the nation's residents will have dementia.
A comprehensive plan for dealing with that expected rise in dementia cases was passed by the national government last year. But Matsudo has been providing dementia awareness training for city residents since 2010. Thousands of people have taken it.
Atsuko Yoshioka conducts dementia awareness classes for the city of Matsudo. She says the sessions are brief ? just 60 to 90 minutes ? so she tries to customize the content for students.
For example, pharmacist Takayuki Yoshida says he sometimes had clients who "even after I gave the medication to them, they'd come back and say they didn't get the drugs." Now he knows that may be a sign of dementia, and he contacts the patient's doctor.
Many post office workers have also taken the training. In Japan, post offices also conduct some banking transactions. Hiroki Yaita says sometimes an older client will come in several times to say that someone has stolen their bankbook. Now, because of the training, "we would think that maybe that person has dementia and we would talk to the family about that possibility."
The purpose of the training isn't to make Matsudo residents experts in dementia, says Tadashi Watanabe, chief of the city's Welfare and Longevity Department. The goal, he says, is just "to support those with dementia, as well as their families, and make this a town where it's more comfortable for them to live."
Some communities in the United States have begun similar programs. And in Japan what's been going on in Matsudo is now national policy. The comprehensive plan adopted by the government last year includes research and prevention and nursing services. It also includes a campaign for increasing dementia awareness among the general public. The country is on track to train 8 million people by the end of the next fiscal year.
Hidenori Kawashima, deputy director for dementia policy in Japan's Ministry of Labor, Health, and Welfare, says the expected rise in dementia cases should not be seen as a threat. Interacting with people with dementia will become normal.
"It would be a familiar thing," says Kawashima. "So we wanted the plan: First, to create a structure in the local communities to support those with dementia and, second, to create a society where it will be natural for them to live."
No government plan can keep people with dementia from wandering. But health officials in Japan hope there eventually will be entire communities prepared to help keep them safe, if and when they do.
Manga artist offers lessons on treating people with dementia
August 21, 2016
The Asahi Shimbun
KYOTO--A once-struggling manga artist has revived his career by drawing cartoons based on his experiences and observations of working with people with dementia.
Natsu Kitagawa, 44, said his works now are intended to help people with dementia and offer advice on care giving.
He recommends treating patients as individuals instead of lumping them together as people whose minds have been taken over by the brain disease.
The title of his latest book can be translated as: gWhy do people with dementia often get themselves into trouble?h
Previously, Kitagawa, who is based in Kyoto, primarily published his works in comic anthologies for young men. But he gave up his manga career after poor sales.
When he was past 30, Kitagawa entered the nursing-care industry despite having no experience in the field.
He worked for about seven years at a special nursing home for the elderly and became a senior staff member at a group home for people with dementia.
Kitagawa also passed the national exams for nursing-care workers and care managers.
Around 2009, he started drawing manga again while continuing his work. He said he felt uncomfortable whenever he saw reports that only played up the difficult challenges associated with dementia.
gEven if you have dementia, every situation is different depending on those around you and the circumstances,h Kitagawa said. gThere are many moments when we can laugh and spend some serene time together.h
He decided to use his artistic skills to show the realities on the front line of nursing care.
Although the subject matter of his short manga stories can be heavy, the episodes carry a message of hope and are full of humor. His drawings are characterized by round figures and a rich use of colors.
He recalled a woman in her 90s who refused to bathe. On one occasion, she gave the straightforward excuse that taking a bath was too troublesome. On another day, she claimed to be having her period.
Staff members used a whole bag of tricks to get her to take a bath, often with failed results. But once she got into the bathtub, she always said, gSo comfy.h
Another woman constantly hurled bitter insults at staff members. But every now and then, the sweetest smile appeared on her face and she would say, gThank you, much appreciated.h
Kitagawa initially posted such manga episodes on his blog. In 2012, he compiled these stories into a self-published book. A new edition with additions and revisions was released in May this year.
The artist said he gave the book the candid title because that was the question on his mind while working in the nursing-care industry. He admits that he himself raised his voice when his assistance was rejected.
But he eventually realized that how the residents were treated influenced their symptoms of dementia.
Kitagawa suspected that people with dementia got into trouble because they were all broadly viewed simply as gdementia patientsh by caregivers and others who would lose it if things didnft go as planned.
The book shows home-care workers using their imagination to guess how residents see the world and explore ways to treat them. One resident continuously strolls on the floor while another never lets go of a doll because she believes it is her child.
Caregivers are constantly left wondering if the residentsf behavior is triggered by dementia or is an intrinsic response, Kitagawa said.
gThere are many things I donft understand,h he said. gNot because they have dementia, but because they are people after all. I donft want to stop thinking about what they are feeling right now even if I canft find the answer.h
Elderly woman with dementia safe because of 16-year-old boy
THE ASAHI SHIMBUN
August 19, 2016
TAGAWA, Fukuoka Prefecture--It was the sort of exchange that happens all the time between a bus driver and an aged passenger, but a high school student who happened to eavesdrop on this occasion felt something was not quite right.
Following up on his intuition, Hiroto Kitaoka got off the bus with the woman. His decision may well have saved the life of the 91-year-old. She suffers from dementia and had been reported missing by her family.
Hiroto, 16, was on his way home after finishing a drill of the kendo club at Inatsuki Shikokan High School in Kama in this southwestern prefecture. He boarded the bus around 7 p.m. on July 7 for home in the neighboring city of Iizuka.
The woman sat behind him and asked the driver whether the bus was going to Inatsuki, which is part of Kama.
The driver said no and recommended she get off.
gI felt she definitely should not be left alone,h Hiroto recalled feeling after hearing the exchange.
After the the woman got off the bus, he did, too, and immediately contacted his mother for help. She turned up in her car, and the three drove to Kama, where the elderly woman apparently lived.
After reaching Kama, Hirotofs mother drove slowly and asked the woman to try to recall what her neighborhood looked like.
As soon as the three got out of the car to search for the woman's home on foot, they came across a Kama city employee who was hurrying to her house.
By a stroke of luck, they were standing right in front of the woman's home. After talking with the employee, Hiroto and his mother realized that the woman had been reported missing.
It was past 9 p.m., six hours after the woman vanished while visiting the Tagawa Museum of Art in Tagawa in the prefecture with her son.
gIf Hiroto had not been on the same bus, we have no idea what would have happened to her,h said Iwao Ikeda, chief of the section tasked with the care of elderly people at the Kama city government. gHis courageous action may well have saved her life.h
The boy said he acted the way he did because it could have happened to his own grandmother.
gI am glad that she made it OK,h he said.
The Tagawa police handed Hiroto a letter of appreciation for his quick-witted action.
gIf she had been left by herself, the worst possible outcome could have resulted,h said Keiji Watanabe, head of the Tagawa police station.
eCosmetic therapyf said to stem dementiafs effect on seniors
JUL 17, 2016
The Japan Times
Applying makeup may halt the progress of dementia among elderly people, helping keep their brains active, recent studies say.
Cosmetic therapy also appears to be effective in treating depression in younger people and stress.
In 2013 Shiseido Co., the nationfs largest cosmetics firm, launched what it called a gcosmetic therapy programh for elderly people and organized makeup lessons at about 400 care facilities across the nation.
Nursing Plaza Kohoku in Yokohama organizes Shiseidofs makeup lesson for residents in their 80s and 90s twice a month.
During the hourlong event, participants do stretching exercises and apply makeup with partial support from staff.
An official of the nursing home said some residents are now able to sit up straight and eat without assistance, while others have developed enough muscle strength to support their own bodies and walk to the toilet by themselves.
A Shiseido official said the process of applying foundation and rouge to the face apparently helps gchange the state of mind and stimulate both the brain and body.h
Kaoru Sakatani, a professor specializing in brain science at Nihon Universityfs College of Engineering, conducted a separate study about the effects of cosmetic therapy on development of dementia by comparing two groups of elderly patients in the early and moderate stages.
In the study, one group took makeup lessons for three months, while the other took none.
The research showed the level of cognitive decline in the first group was milder than in the second. Sakatani concluded the therapy prevented early-stage dementia from worsening.
The professor said cosmetic therapy will also likely benefit younger people suffering from stress, fatigue or depression.
Some psychiatric clinics have introduced such therapy for their patients.
Sapporo Ota Hospital in Sapporo started a makeup program in 2003.
gThis makes me feel cheerful and will be useful for my job interview,h said a 43-year-old woman who participated in a lesson in June. She is looking for a job while coming to the hospital on a regular basis.
Instructor Rina Kurosu said, gWhen wearing makeup, the patients seem to be able to forget the troubles they face.h
Miyako Harasaki, chairman of the Makeup Therapy Association of Japan, said many patients hospitalized for long periods no longer care about their appearance.
But their self-confidence gets a boost when they get compliments after applying makeup, Harasaki said.
Record 12,000 people with dementia reported missing in Japan in 2015
JUN 16, 2016
A record 12,208 people with dementia were reported missing in 2015, mainly as a result of wandering off, the National Police Agency said Thursday. The figure is up 1,425, or 13.2 percent, from the previous year.
The same year, 12,121 people were located, of which nearly 70 percent, or 8,310, were found on the day they went missing and almost 98 percent, or 11,872, were tracked down within a week. But 479 were found dead, and 150 people remain missing, including some who went missing prior to 2015, according to the agency.
The Health, Labor and Welfare Ministry said about 4.62 million people had dementia in 2012. It expects the figure to rise to 7 million by 2025.
The NPA began compiling data on missing dementia sufferers in 2012, and the number has continued to rise.
As a result, police have enhanced efforts to locate missing dementia sufferers.
In 2014, however, they failed to detect signs of dementia in an 83-year-old man who had wandered off from a day care facility in Yokohama despite police officers questioning him several times on the streets in Tokyo. He later died from dehydration in a park.
To address the issue, municipalities are joining with local cooperatives, gas station operators and taxi companies to watch out for dementia patients who may have wandered off.
According to the Japanese Consumersf Co-operative Union, about 800 out of 1,741 municipalities had signed agreements as of December with 90 co-ops across the country to keep an eye on people with dementia and respond in times of emergency.
Under the agreement, co-op delivery personnel will check for signs something is wrong, such as unopened mailboxes when they visit the homes of those with dementia, and report any irregularities to authorities.
To alleviate the burden on families taking care of dementia patients, the city of Kushiro in Hokkaido has set up a system with police, taxi companies and other outlets to look for dementia patients who go missing.
The scheme has helped locate up to 50 sufferers who have wandered off every year since it was implemented.
In Takasaki, Gunma Prefecture, the city offers a global positioning system service free of charge that allows police to track down dementia patients if their families report them missing.
Dementia's growing impact on corporate Japan
May 20, 2016
Nikkei Asian Review
TOKYO -- As the Japanese population ages, the impact of dementia continues to widen across all facets of society and age groups, and the corporate world is no exception.
What happens when business leaders start to exhibit the memory loss, delusions and other symptoms that attend the disease?
Japan's health ministry estimates that some 4.6 million seniors were afflicted with dementia in 2012. That figure is expected to jump 50% to roughly 7 million in 2025, meaning one in five people over 65 will suffer from the illness.
Now consider this: 23% of Japanese corporate presidents are over 70, according to Tokyo Shoko Research. Perhaps more worryingly, nearly 60% are over 60. Last year, the average age of a Japanese corporate boss was 60.8, up a year from five years earlier.
Let's look at two cases that highlight how the disease can manifest itself in the business world.
Case 1: During a meeting with clients at one Tokyo-based company founded over a century ago, the president, then in his 80s, started disclosing information that should have remained confidential due to compliance reasons. When a junior colleague stepped in to stop his boss from saying more, the president berated him in front of everyone. The employee was able to steer the conversation back to safe ground, but it was a close call.
Starting from around the beginning of the year, the president had been making inappropriate comments, leaving his colleagues confused and concerned. Finally, the problem got so bad that they decided they had to take action.
The president's family was briefed on the situation and decided it was time for him to retire, which he finally did in April. The move was greeted with relief by those who had to deal with the executive regularly. Said one colleague, "His doctor diagnosed him with dementia, and it appears that he accepted that diagnosis."
Case 2: "I should have noticed it sooner," said a man in his 40s who lives in Saitama Prefecture, north of Tokyo. His father was running a midsize parts manufacturer and had been exhibiting signs of dementia. By the time the son realized the problem, the dementia had become so pronounced that his father was incapable of making important business decisions. At the time, the company was engaged in fierce competition and the profits were slim. Last year, the son quit his previous job on short notice and took over his father's business. He is now agonizing over whether to close up shop.
Yoshihiro Aramaki, a representative at Chester Certified Public Tax Accountant's, said the company is receiving more inquiries from people with dementia-stricken relatives who are running small or midsize companies.
When dementia sets in, it interferes with decision-making and such tasks as working on contracts. That can make it difficult to prepare for business successions or dealing with inheritance tax, said Aramaki.
The higher the age, the greater the risk of dementia. For a graying Japan, that means the working population is increasingly exposed to the risk of having a family member with the disease.
By one estimate, some 100,000 Japanese leave their jobs each year to provide nursing care for a family member. The country's health ministry said about 16% of those cases are because of dementia. Concerns about adequate nursing care may drive some people to leave their jobs to help a family member with the disease, even if the illness is still only at an early stage, said Yoko Yajima, chief researcher at Mitsubishi UFJ Research and Consulting.
To better serve its customers, Tokio Marine & Nichido Fire Insurance started holding in-house training sessions about dementia six years ago. "Employees who have a family member who has been diagnosed with dementia have especially been participating in the sessions lately," a company official said.
NPA eyes March 2017 for extra elderly driver dementia tests
MAY 12, 2016
National Police Agency will embark on extra testing of senior drivers next year as part of an initiative to strengthen dementia checks, it announced Thursday.
Under the revised Road Traffic Act, extraordinary cognitive tests will be conducted when an elderly driver violates specific traffic regulations often breached by those diagnosed with dementia.
The agency unveiled a draft ordinance for the lawfs enforcement that lists 18 specific traffic violations, such as driving on the wrong side of the road, that would lead to an extraordinary cognitive test.
After inviting public opinion about the ordinance from Friday through June 11, the agency plans to seek Cabinet approval in early July. The tests would take place from next March.
Once diagnosed as having dementia, people will have their driverfs licenses revoked.
Under the current law, drivers aged 75 or older need to undergo cognitive tests only once every three years, when they renew their licenses. They are not required to see a doctor, even if signs of dementia are detected in the tests, unless they have committed traffic violations.
Under the revised law, elderly drivers will be required to take medical checkups to look for signs of dementia if an extraordinary or triennial cognitive test indicates a possibility of the condition.
The revised law is supposed to be enforced within two years of its promulgation in June last year.
The agency decided on the lawfs early enforcement as it saw the need for urgent action on the dementia issue following frequent incidents of driving on the wrong side of the road and other traffic violations typically committed by dementia sufferers.
The criteria for implementing extraordinary cognitive tests were set on the basis of the agencyfs analysis, conducted together with experts, on traffic violations committed by elderly drivers over the past five years.
The analysis showed that the share of drivers who committed the 18 traffic violations, which also include running red lights, is higher for those with signs of dementia, or drops in cognitive functions, than for those with no such signs.
Those who do not take the required cognitive tests without unavoidable reasons, such as illness or disaster, will have their driverfs licenses suspended or revoked.
Elderly drivers will have to take special driving lessons if their extraordinary cognitive test scores deteriorate from the previous results.
In 2015, some 1.63 million drivers aged 75 or older took cognitive tests across Japan. A total of 53,815 drivers showed signs of dementia, but only 1,650 drivers, or 3.1 percent, had medical checkups. Those who got their driverfs licenses suspended or revoked came to 564.
The agency estimates that 180,000 elderly drivers will take the new extraordinary cognitive tests a year. It expects to give special driving lessons to 60,000 elderly drivers annually.
Japanfs dementia time bomb
APR 22, 2016
Senile dementia is causing serious social problems in Japan and much of the blame lies with the Health, Labor and Welfare Ministry as it attaches importance to aiding those who have physical difficulties while neglecting those with low degrees of dementia.
It is estimated that in the 2020s, 1 in 8 elderly people aged 65 years or older will fall into that glow degree dementiah category, with the potential of related wandering and reckless driving increasing.
According to six companies operating toll expressways, there were 739 cases of vehicles driving in the wrong direction from 2011 to 2014. People 65 or older were involved in about 70 percent of these incidents, and about a tenth of these drivers were suspected of having dementia. This would mean that about 7 percent of cases of driving the wrong way on expressways involved people with dementia.
It is difficult to detect dementia in its early stages, especially among those who are capable of driving. It is all but certain, though, that those in such stages will keep increasing in number in line with the aging of the population. So will cases of driving the wrong way by such people.
To cope with this situation, the National Police Agency adopted new rules in 2009 requiring people aged 75 and older to take a dementia test before renewing their driverfs license.
But of the roughly 1.45 million people who took the test in fiscal 2013, an infinitesimally small 118 had their license suspended or revoked. Given that about 15 percent of the people 65 or older in Japan are believed to have dementia to some extent, the test apparently fails to catch a large number of drivers in the early stage of dementia.
Thus the burden of looking after and controlling elderly drivers with dementia falls on their family members. But according to a survey conducted by a physician at Kochi University on 7,300 patients with dementia, 11 percent continued to drive even after they were diagnosed as having the disorder and 16 percent of these people caused accidents leading to injury, death or material damage. Thus such elderly people become glethal weapons on wheelsh while they have no sense of guilt.
In October 2015, a 73-year-old man made the news when his car hit six pedestrians and bicyclists, killing two people and injuring four. It was subsequently revealed that he had been under treatment for dementia for several years, that he had his driverfs license renewed and that he had continued to drive despite his doctorfs and familyfs advice against it.
Worse still are cases in which a person is in such an early stage of dementia that it goes unnoticed until he or she actually causes a traffic accident. In December 2014, at a railway crossing in Nagano, a limited express train hit a car standing on the tracks and dragged it 300 meters. Nobody, including the 77-year-old driver ? who was standing outside the car ? was injured, but he was later determined to be in an early stage of dementia. In March 2015, an 85-year-old man drove his car the wrong way on the Tomei Expressway in Shizuoka Prefecture and hit a truck. Although he was not seriously hurt, he said he did not know where he was driving and was later found to have dementia.
In both cases, the drivers had not been diagnosed as having dementia prior to their accidents. As a result, although people close to them may have noticed symptoms such as them repeating the same thing or becoming forgetful, it did not occur to them to advise against driving.
Of the various types of dementia, Alzheimerfs disease is the most difficult to handle. It accounts for 50 percent of dementia cases in Japan, followed by cerebral vascular disorder and Levy body dementia, each at 20 percent. A 1998 study by the Carolinska University Hospital in Sweden showed that of 98 elderly people who had died while driving and whose brains had been anatomized, 47 percent showed signs of Alzheimerfs. The study pointed to a high possibility of drivers in the early stages of this illness causing fatal traffic accidents.
Why is it that sufficient care is not being extended to those in the early stages of dementia? A doctor specializing in treatment of patients with dementia says the reason lies in the present nursing care insurance system, which places primary emphasis on looking after those who have physical disabilities. This, he says, is a fatal shortcoming in Japanfs system of caring for those with dementia.
The degrees of care that an individual is entitled to receive under the insurance system is determined on the basis of the amount of time a care giver needs in helping an elderly person with such daily activities as going to the bathroom and eating. Thus, those who tend to go wandering or have fits of anger are not certified to be in need of a high degree of care. This system discourages entities engaged in the nursing care business from taking care of such people.
Figures released by the National Police Agency show that during fiscal 2014, 10,783 elderly people with dementia were reported missing and the whereabouts of 168 of them were not known at the end of 2014. The number of such people is bound only to increase. But given its tight fiscal conditions, the government will tinker with the nursing care insurance system in the direction of continuing its policy of neglecting senior citizens with dementia.
This kind of policy is a boon to entities in the nursing care business because the more serious the physical conditions of elderly people taken care of by these entities become, the greater amounts of money are poured into the sector from the publicly administered insurance system.
But the number of people with dementia, which stood at about 4.6 million in 2012, is forecast to rise sharply to more than 7 million by 2025. Of them, about 4.7 million are expected to be in glighth stages of the disorder, which means that 1 out of every 8 people aged 65 or older will have the potential to go wandering or to cause traffic accidents.
Economic burdens caused by those types of elderly people are immeasurable. If they cannot be accommodated at cheaper care facilities under the nursing care insurance system, they have to be looked after either by their families or at expensive private-care facilities. But only the wealthy can afford to use private residential homes with care provided, which usually require an up-front payment of about \5 million and monthly fees of no less than \150,000 to \300,000. In most cases, children of the residents will have to pay the cost.
A family that has to take care of an elderly relative with dementia has to put in an average of 1,300 hours a year for the care, which translates into lost profits of \3.82 million a year per person with dementia for the family and \6.2 trillion for the whole society ? close to the \6.4 trillion for care covered by the nursing care insurance system, according to studies by Keio University doctors. Those families also tend to lose contact with other members of society, with their mental and physical health deteriorating under this crushing burden.
There has been a growing number of cases in which elderly people with dementia have been murdered by family members who had found it no longer possible to care for them. Etsuko Yuhara, an associate professor at Nihon Fukushi University, says that there have been at least 672 such murder cases during the past 17 years ? accounting for about 4 percent of the total number of homicides in Japan. But this is just a tip of the iceberg because about 15,000 cases of cruel treatment of the elderly by care-givers are reported every year.
The health and welfare ministry shows no signs of correcting its wrong approach to the problem. Although it has proposed various plans, they are clearly designed to increase the practice of people caring for elderly family members with dementia at home. The plans are just pie in the sky because it is simply impossible for elderly people to care for family members with dementia on their own without any assistance.
The only way out is to increase the number of necessary care facilities and entrust the care of people with dementia to experts. Unless a system in which such people live in a facility together with medical and care experts involved in their care is quickly established, Japan will soon be filled with elderly dementia sufferers wandering around aimlessly and causing traffic accidents. There will also be many tragic cases in which people with dementia are murdered by their family caretakers because they can no longer cope with such a heavy burden.
This is an abridged translation of an article from the April issue of Sentaku, a monthly magazine covering political, social and economic scenes.
Dementia frontrunner Japan destigmatises condition, stresses community care
15 Apr 2016
TOKYO: When Masahiko Sato was diagnosed at age 51 with early-onset Alzheimer's, he felt his life was over. A decade later, Sato has a mission: destigmatising a condition with a growing social impact in a country that leads the global aging trend.
"What I want most to tell people is, 'Don't underestimate your abilities. There are things you cannot do but there are lots of things you can do, so do not despair," Sato told Reuters in an interview at a park outside Tokyo, where he and his supporters gathered for traditional cherry blossom viewing.
"The most painful thing is when someone says 'I am pitiable'. I am not pitiable. There are inconveniences, but I am not unhappy," said Sato, a former systems engineer who has lectured around Japan and written a book with the same message.
Encouraging people with dementia to speak out is part of Japan's effort to ease the negative image of a disorder that affects nearly 5 million citizens and is forecast to affect 7 million, or one in five Japanese age 65 or over, by 2025.
Japan is a global frontrunner in confronting dementia, the cost of which has been put at 1 percent of world GDP.
"Whether people with dementia can 'come out' depends on the values and culture of the community," said Kumiko Nagata, research director at the Dementia Care Research and Training Centre, Tokyo, adding that attitudes were changing.
To be sure, people with dementia like Sato, a bachelor who managed to live alone until last year by using his phone and now an iPad to make up for memory loss, are a minority.
Many live with relatives who struggle to juggle care with jobs. Some 100,000 workers quit each year to care for elderly relatives, a figure Prime Minister Shinzo Abe aims to cut to zero by 2025, when all Japan's babyboomers will be 75 or older.
Families providing care accounted for nearly half of the estimated 14.5 trillion yen (US$133 billion) in social cost of dementia in Japan in 2014.
Kanemasa Ito is one such care-giver. Ito had to shut the two convenience stores he and his wife, Kimiko, ran together when she was diagnosed with dementia 11 years ago at the age of 57.
"I had planned to work until I was 85," Ito told Reuters, sitting with Kumiko at their home in Kawasaki, south of Tokyo.
"I thought, will the rest of my life just be caring for my wife?" added Ito, 72, who later became a home helper himself and now entrusts his wife to a day-care center several times a week.
To keep Kimiko from wandering off, he installed a special bolt on the front door and makes sure she wears a GPS tracking necklace when they go out in case she slips away.
Nearly 11,000 people with dementia were reported missing, most temporarily, in 2014. Others are abused or even killed by relatives.
Policy-makers and experts hope the positive message will help achieve a goal of dementia-friendly communities where elderly can stay at home or in small group homes rather than in large, costly institutions that can aggravate their condition.
"There has been a tendency to view dementia as a disease of which to be ashamed," Tadayuki Mizutani, head of the health ministry's dementia policy promotion office, told Reuters.
"We have been campaigning to increase understanding of dementia. What is new is to have people with dementia speak out in their own words."
That was an element in government proposals unveiled last year for improved dementia care that include a stress on early detection, more doctors and primary care-givers to look after those with dementia, "SOS networks" of police, residents and businesses to find missing people and volunteer "Dementia Supporters" trained to help people in the community.
The government has budgeted 22.5 billion yen for the plan in the year from April 2016, up from 16.1 billion last year.
Experts give Japan high marks for its community-oriented programs as well as its efforts to destigmatise the disease.
"The focus in Japan is on care - what do you do for people with dementia living in the community?" said John Campbell, a University of Michigan professor emeritus.
Still, some worry that reforms of Japan's Long-term Care Insurance system, under fiscal pressure in a country with huge public debt, are boosting families' burdens by making it harder for those with lighter disabilities to access services.
For Kanemasa Ito, any cutbacks could threaten his dream of caring for Kumiko at home.
"I want to live with her at home as long as possible," he said, gently touching her wrist.
(Reporting by Linda Sieg; Editing by Robert Birsel)
Diet enacts law to promote adult guardianship as dementia cases rise
APR 8, 2016
The Diet has passed a law promoting adult guardianship for people with dementia and others who have lost the full ability to make decisions.
The law was approved Friday by a majority vote in the Lower House that drew cross-party support from the Liberal Democratic Party and ruling coalition partner Komeito, as well as the Democratic Party.
Given the national uptick in dementia, the promotion of guardians who have the legal authority to manage properties and sign contracts on behalf of people who are incapable of making their own decisions is becoming increasingly important.
The new law states that the adult guardianship system has not been put to full use despite its valuable and urges the government to promote the role more diligently.
The law, which will take force shortly, also calls for expanding support for citizens who serve as guardians, such as through training and consultation programs and spells out a need to recruit and train specialists to this end.
To guard against embezzlement and other abuse that could take place at the hands of such guardians, the law seeks measures to allow family courts and municipalities to strengthen supervision over them.
In addition, it obliges the central government to develop a basic plan for promoting adult guardianship.
The Cabinet Office will form a committee to draw up the plan that will be chaired by the prime minister and be staffed by his ministers.
6 liability criteria set in dementia case / Who must pay for damage by patients left unclear
The Yomiuri Shimbun
March 02, 2016
The courtroom of the Supreme Courtfs Third Petty Bench when the ruling was handed down on Tuesday afternoon.
While the Supreme Courtfs decision to absolve the family of a man with dementia of liability for damage he caused will likely ease the burden on families caring for elderly people suffering dementia, the ruling leaves open questions over how plaintiffs should be compensated.
In the case, the man was struck and killed by a train after he had wandered onto the tracks.
The railway operator was demanding the manfs family pay for damage incurred when train services were interrupted.
Rulings change course
gThis clarified that being a family member does not mean being obligated to provide supervision. It is a ground-breaking ruling,h said Teruhiko Asaoka, the familyfs lawyer.
Article 714 of the Civil Code stipulates that when a third party is damaged by someone who is unable to assume liability, such as a child or elderly person with dementia, whoever is obligated to provide supervision of that person is liable for damages.
Previously, courts had focused on providing relief to plaintiffs, ordering people who were obligated to provide supervision to pay compensation.
This trend changed with a Supreme Court ruling last April.
In the case, a boy kicked a soccer ball out of a schoolyard, striking a man riding a motorcycle and causing him to fall.
The court applied an exception provision to Article 714 ? which states that people are exempt from liability if they fulfill their supervisory obligation ? and absolved the boyfs parents of responsibility.
Unlike children, whose parents are unconditionally obligated to supervise them, families care for elderly people with dementia in a variety of ways, which has made it difficult to determine who is in fact obligated to provide supervision.
The latest ruling reversed those by district and high courts, finding that neither the manfs eldest son nor his wife were obligated to supervise him.
gThe number of dementia patients is increasing. If the obligation to provide supervision were applied strictly, families would be unable to give nursing care. This ruling reflects the actual conditions,h said University of Tokyo Prof. Norio Higuchi, who specializes in laws concerning elderly people.
The criteria the top court gave for determining whether a person is obligated to provide supervision has also drawn attention.
The top court laid down six factors to use to determine if supervision is gpossible and easy.h If so, the person should be considered liable, according to the ruling.
These factors include a personfs relationship to the dementia patient, whether they live together and whether they regularly witnessed problem behavior caused by dementia.
From now on, courts must consider these six factors when deciding whether a person is obligated to provide supervision.
gThis will limit the range of family members who are liable for compensation to people like healthy spouses and children who live with the person,h one experienced judge said.
Yet under these criteria, someone who lives nearby and has regular contact with or manages the assets of a person with dementia could be liable for damages.
gThe Supreme Courtfs criteria for deciding are ambiguous. People who serve as devoted caregivers could end up shouldering a heavier responsibility. Some people may avoid getting involved in nursing care,h said University of Tokyo Associate Prof. Shigeto Yonemura, who specializes in civil law.
Of the five judges who ruled on the case, Kiyoko Okabe, the presiding judge and a former academic, and Takehiko Otani, a career judge, offered opinions on the case.
They held that the oldest son, who essentially decided his fatherfs care plan, was obligated to provide supervision. They also noted that since he took efforts sufficiently to create a care system that would have prevented such accidents, he should be absolved the responsibility.
In cases such as this, when nobody is considered obligated to provide supervision, people damaged in accidents caused by elderly people with dementia will have no recourse.
Judge Otani noted that Article 714 was created to protect plaintiffs, saying, gThe persons who are obligated to supervise elderly people with dementia should be decided objectively and unambiguously.h
He added, gPeople obligated to provide supervision should respect the desires of elderly people with dementia. If the duty to take adequate care is fulfilled, and a personfs physical and mental condition and living situation are taken into consideration, the scope of exemption from responsibility should be applied in a wider manner.h
Otanifs view ? that decisions about liability for damages should be based on whether or not mistakes were made after clearly determining who was obligated to provide supervision ? attempts to strike a balance between the families who provide care and compensating for damage, and will likely be referenced in future debates over this issue.
Criteria stated by Supreme Court
The caregiverfs mental and physical condition and living situation
Existence and strength of family relations
Whether the people involved live together and degree of daily contact
Involvement in managing assets
Existence of problem behavior in the person with dementiafs daily life
Whether care and other support were given to deal with problem behavior
29 railway accidents reported last fiscal year
There have been a great number of railway accidents involving elderly people with dementia being hit by trains, and in many such cases, the victims and their families have been asked for compensation by railway companies.
According to the Land, Infrastructure, Transport and Tourism Ministry, 29 accidents in which people believed to have dementia were hit by trains were reported in the 2014 fiscal year, and 22 of them were fatal.
Central Japan Railway Co. based in Aichi Prefecture and Kintetsu Corp. based in Osaka Prefecture both claim damages in principle regardless of whether the person concerned has dementia. East Japan Railway Co., Odakyu Electric Railway Co. and Keio Corp., all based in Tokyo, on the other hand, said they decide whether to seek compensation based on the cause and other factors.
Waseda University Prof. Hajime Tozaki, an expert on transportation policy, pointed out, gIt is somewhat unavoidable [that railway firms seek compensation] because families [of dementia patients] may neglect to keep them from being involved in accidents if companies did not press responsibility at all.h
However, Tozaki also said, gIn an aging society, each railway company is required to take multifaceted countermeasures such as training its employees to prevent such accidents.h
Implementation of hardware countermeasures has spread nationwide in the form of platform doors to prevent passengers from falling onto the tracks. However, few railway companies have prepared software countermeasures, such as having station staff take lectures on how to interact with dementia patients.
Meanwhile, the number of car accidents caused by elderly dementia patients is also high. According to the National Police Agency, the number of car accidents caused by drivers aged 75 and older in 2014 was 471, of which 181 are suspected to have been caused by those with dementia.
In many car accidents, insurance money is paid to victims if drivers have a voluntary insurance plan. However, if the amount of compensation is not sufficient, a damage suit may be filed against drivers or their families.
In Miyazaki Prefecture in 2012, for example, a then 75-year-old male dementia patient ran over three boys. The parents of one of the boys sued the man for \360 million to cover the cost of medical treatment and other expenses.Speech
Municipalities tie up with co-ops to watch over dementia patients
MAR 2, 2016
Tuesdayfs Supreme Court ruling siding with a family over a rail operator in a case where a dementia suffer was struck and killed by a train highlights the burdens faced by family caregivers and the need for society to offer them assistance, an expert on the mental illness has said.
The high court ruled that the family was not obligated to compensate a railway operator for damages sustained after the man wandered onto the tracks and was killed.
The case marks the first time the top court has ruled on a familyfs responsibility in supervising dementia patients.
gThe ruling should be an opportunity to change peoplefs mindset that the wandering of dementia patients is a negative thing,h said Mariko Hattori, an executive at Japan Society of Care Management. gThe family, the local society and companies should cooperate with each other to watch over the patient and create an environment where patients can live in peace.h
To address the issue, municipalities are joining together with local cooperatives, gas station operators and taxi companies to watch out for dementia patients who have wandered off and gone missing.
According to the Japanese Consumersf Co-operative Union (JCCU), roughly 800 out of 1,741 municipalities have signed agreements as of December with some 90 co-ops across the country to keep an eye on people with dementia and respond in times of emergency.
Under the agreement, co-op delivery personnel will check for signs something is wrong, such as unopened mailboxes when they visit the homes of those with dementia, and report any irregularities to authorities.
The initiative began in 2007 and quickly spread across the country, leading to many situations where delivery personnel have stepped in to offer assistance, the organization said.
gWhen I called in at the door because there was no response, I heard a voice calling for help. I then called the police and paramedics,h said a delivery person who works at a co-op located in the city of Saitama but which also operates in Tokyo and Chiba.
gI once noticed food products I delivered the day before still on the doorsteps,h said another worker at the same co-op. gWhen I called the family and went inside with them, the elderly resident had collapsed due to a stroke.h
In other cases, delivery workers found elderly people who were lost and escorted them to nearby day centers, or called for ambulances after they were found collapsed on the side of the road.
The Health, Labor and Welfare Ministry estimated there were some 4.62 million people in the country, aged 65 and over, with dementia as of 2012.
In a separate 2013 survey by the ministry, it was found that 51.2 percent of households with a family member aged 65 or older needing nursing care was taken care of by another family member around the same age or older.
gWe want to sign contracts with more municipalities and contribute to creating communities in which people feel safe,h said Atsushi Yamagiwa, who leads the effort at the JCCU.
Delivery staff at the JCCU have also taken special government-sponsored courses on how to deal with dementia sufferers and respond to their needs.
The organization said it now has over 25,000 workers who have been certified, comprising about a quarter of the total number of co-op workers nationwide.
To alleviate the burden on families taking care of dementia patients, the city of Kushiro in Hokkaido has set up a system with police, taxi companies and other outlets to look for dementia patients who go missing. The scheme has helped locate an estimated 30 to 50 sufferers who have wandered off every year since it was implemented.
In Takasaki, Gunma Prefecture, the city offers a global positioning system service for free which allows police to track down dementia patients if their families report them missing.
In December, police found a man in his 80s about 10 kilometers away from his home in the neighboring city 45 minutes after family members reported him missing.
Dementia and Justice / 6-7 minutes of inattention led to disaster for a family
The Yomiuri Shimbun
February 27, 2016
The tracks at Kyowa Station where a man suffering from dementia was hit and killed by a train are seen on Feb. 12 in Obu, Aichi Prefecture. The man likely used the steps in the foreground to reach the tracks.
On Tuesday, the Supreme Court will hand down a ruling on whether the family of a man suffering from dementia should be held responsible and pay damages to a railway company in a case in which the man was hit and killed by a train in Obu, Aichi Prefecture, eight years ago. As at-home nursing care becomes increasingly common, we will take up the issue of dealing with the risk of gdementia accidents.h This is the first installment of two-part series.
On the evening of Dec. 7, 2007, a then 91-year-old man disappeared from his home, while his wife, 93, dozed off on the sofa for about six or seven minutes.
About an hour later, the police contacted her to say he had been killed by a train on the JR Tokaido Line at Kyowa Station near the couplefs house. The police were able to contact her fairly quickly because a phone number had been sewn onto the manfs clothes and hat.
One year later, the manfs eldest son, 65, received a certified letter from Central Japan Railway Co. stating: gWe demand that the heir pay damages as soon as possible.h They said the damages ? about \7.2 million ? were for train delays caused by the accident. The letter also said legal action would be taken if payment was not made within 14 days.
gWe wanted my father to spend his last days at peace in the home he had lived in for such a long time. We promised that we, as a family, would do whatever we could to make that happen,h the eldest son said.
The man began wandering off by himself from August 2005, and was certified in February 2007 as gnursing care level 4,h meaning that day-to-day life for him would be difficult without nursing care.
His family considered placing him in a nursing facility. However, when the man had been hospitalized previously because of an injury, he was confused by the changes to his surroundings and ripped blood transfusion tubes out of his arms. The family decided to take care of him at home and resolved to support him together.
The eldest sonfs wife, who had been living in Yokohama, moved nearby, and together with the manfs wife, looked after the elderly man day and night. The eldest son visited on weekends and took the man for walks. The man seemed to be content whenever he saw the desk he was so accustomed to using.
The Civil Code stipulates that when an accident is caused by someone who cannot be held responsible, such as an elderly person suffering from dementia or a child, whoever is responsible for him or her must pay damages.
Although the eldest son questioned whether the family was really responsible when they had done all they could to look after the elderly man, the Nagoya District Court found the manfs wife and the eldest son responsible. In the second trial, the Nagoya High Court found the wife responsible, and ordered the damages to be paid.
The Civil Code states that the person responsible for nursing care should not be held responsible in cases where they have committed no fault. However, in dementia cases the criteria for determining whether a person is responsible are unclear.
On Feb. 2, the Supreme Court held discussions on the ruling, indicating it is highly likely the ruling from the second hearing will be reconsidered.
gI hope they will take the realities facing people suffering from dementia and their families into consideration when making the decision,h the eldest son said.
Increasing incidents: Need to deepen the discussion
gWhat more was I supposed to do?h a 74-year-old Osaka woman said tearfully as she remembered an evening in April 2013.
On that evening, she left her home for about one hour, leaving behind her then 82-year-old husband, who was suffering from dementia. A fire started near a room on the third floor and spread to the walls of a neighborfs house. After the fire, the husband became weaker and on November 2014 he died at the age of 84.
The fire was said to have been caused by the husband setting alight a scrap of paper with a lighter and throwing it onto a mattress. Although she paid \1 million in compensation to the neighbor on April 2014, the neighbor sued for an additional \2 million in damages.
At the first trial, the Osaka District Court ruled that the woman was grossly negligent and ordered her to pay around \400,000. But at the second trial, the Osaka High Court advised the two parties to reach a settlement on the premise that the woman had not committed gross negligence. The neighbor ended up dropping the claims and they reached a settlement.
The woman kept a detailed nursing care diary, and had taken her husband to a psychiatrist regularly. She left the house on the day of the fire because he appeared calm.
gEven though I was saved by the high court, I canft help but blame myself for leaving him by himself that day,h she said.
The Health, Labor and Welfare Ministry estimates that the number of elderly people suffering from dementia will rise from the current 5.2 million people to 7 million people by 2025.
During fiscal 2014, there were 29 railroad accidents involving elderly people suffering from dementia. The same year, there were 181 fatal automobile accidents involving dementia sufferers. Cases where compensation becomes an issue are bound to increase.
Shigeto Yonemura, an associate professor of the University of Tokyo and a specialist in civil law, said: gIf strong supervision responsibilities are imposed, the strain on families will become too great, but if the bar for exemptions from responsibility is set too low, it will make it difficult for victims to receive help. Should no one be held responsible even in the case of severe damage? As society ages, we should take the Supreme Courtfs decision as an opportunity to have more in-depth discussions.hSpeech
Behind the Scene / Training vital for dementia patientsf care
February 19, 2016
The Japan News
By Yusuke Saito / Yomiuri Shimbun Senior Writer
Nursing care workers abused elderly people in a record 300 cases in fiscal 2014, with 70 percent of the victims suffering from dementia, according to a survey released on Feb. 5 by the Health, Labor and Welfare Ministry.
This highlights the need for training to improve the knowledge and skills of people taking care of dementia sufferers.
Caring for dementia patients is extremely challenging. When they resist or struggle against receiving care, inexperienced workers sometimes abuse them.
There have been cases in which a nursing care staffer pinched a dementia patient who balked at having diapers changed, while another worker dragged and forced a patient to take a bath when the patient resisted. In a third case, a nursing care staffer shouted at an elderly person for trying to stand up from a wheelchair.
The cases were among those in which people sought advice from Junichi Kominato, vice director of the Miyagi Welfare Ombudsman Network Yell, a Sendai-based nonprofit organization working to prevent abuse of the elderly or disabled.
gThese are typical abuses by people who do not know the basics of caring for those with dementia,h Kominato said. gCare workers with sufficient knowledge would first try to understand why a patient disliked having diapers changed or bathing, and then consider how to address the problem. Nursing care workers who lack such knowledge try to make them comply through sheer brute force.h
Among care facilities where the survey found abuse, 31.7 percent were special nursing care homes, followed by private nursing care homes, which accounted for 22.3 percent.
According to the survey, which allowed multiple answers, the primary factor leading to abuse was glack of education, knowledge or skill on the part of staff,h at 62.6 percent.
This is deemed to be a serious problem among care facilities in Japan. While many would assume that nursing care workers at nursing homes had professional qualifications, this is not necessarily so. Home helpers, who assist in looking after the elderly at their homes, are required to undergo the kind of training provided to new nursing care workers, but this is not required for staff working at nursing care facilities.
In a report that disclosed the abuse of residents at a nursing home in Kanagawa Prefecture, it was discovered that 15 of its nursing care staff had no qualifications.
Yuko Yamada, a Nihon University professor and specialist in the prevention of abuse of the elderly, said: gIt is often the case that many nursing homes where abuse has occurred employ unqualified and untrained workers. Therefore, these facilities bear a heavy responsibility.h
Dementia sufferers often cannot provide details about who abused them and what the abusers did. It therefore is difficult to uncover abuse in such cases. Nursing homes where patients are alone in private rooms are in danger of becoming hotbeds of elderly abuse.
Among all reported cases of abuse at nursing homes, administrative authorities could confirm the facts in only 27 percent of the cases. In many cases, it could not be determined whether abuse had actually taken place. This indicates how difficult it is to confirm the facts of abuse cases at nursing care facilities.
Workers at nursing homes are obliged by the Elderly Abuse Prevention Law to report abuses to municipal governments immediately after they are sure of the facts. But there is a loophole that makes whistle-blowers reluctant to do so.
The law has a provision to prevent whistle-blowers from unfair treatment such as dismissal, but such protection is not applied if reports on abuse turn out to be false or erroneous. Therefore, people who suspect a colleague of abusing a patient may hesitate to report their suspicions for fear that those suspicions may be brushed aside as baseless.
gNursing care staff should report suspected abuse immediately. Apportioning blame onto a whistle-blower makes no sense. To encourage immediate reporting of abuse, a whistle-blower must be protected even if a report turns out to be erroneous,h said lawyer Naoki Ikeda, chairman of the Japan Academy for the Prevention of Elder Abuse.
Importance of work climate
Educating and training nursing care workers on how to deal with dementia patients is the only way to reduce the number of elderly abuse cases.
Sakurai no Sato Fukushikai, a social welfare corporation that operates special care nursing homes and other facilities in Niigata Prefecture, sends all of its new nursing care staff members on a five-day training course that includes a one-night stay at a camp. After that, the new recruits are supervised and guided individually for three months by their superiors or nursing home managers, with further training taking place after six months on the job.
One practice the new recruits are taught is to stop, stand still and listen when a resident of the facility calls out to them.
Katsunori Sasaki, executive di-rector of Sakurai no Sato, empha-sizes the importance of teaching new care staff such lessons.
gWhen a resident calls out to you, do you stop and listen to them properly or not?h he said. gDoing or not doing this makes a huge difference. In a working environment where improper care is widespread, the possibility of abuse increases.h
Having a clear set of principles is also important for nursing homes. The Sendai NPO Yell suggests that staffers work together to draft their own set of regulations for the facility. Simple, common sense rules are sufficient. For example, one rule might be, gWe, the staff, pledge to protect the right of each individual resident to live an ordinary life.h
gManagers of facilities should praise staffers who conform to the rules, while giving advice and support to those who fail to do so,h Kominato said. g We must create a workplace where nursing care workers feel that their work is rewarding.hSpeech
In Japan, dementia-friendly malls train staff to serve with empathy
Channel NewsAsia's IT FIGURES travels to Japan to learn some of the ways the country with the oldest population mobilises a nation to care for its elderly.
11 Feb 2016
Some of its elderly shoppers would sometimes be caught for shoplifting. They would leave the mall without paying for their purchases, and other times, they would eat food they had not paid for. Others would sometimes circle shops for hours on end, getting lost in the mall.
"We had to consult the head office more and more often about matters like these," explained Ms Kanamaru Haruko, General CSR Division Manager of AEON. "Elderly people were getting lost. They would suddenly start eating products without paying."
After consultation, mall management realised they were dealing with a growing nationwide problem in Japan, that of dementia.
AGEING AND DEMENTIA
A quarter of Japanfs population of 128 million are above the age of 65 and categorised as gelderlyh. According to the Japan Times, 4.6 million of Japan's silver generation have been diagnosed with dementia. This constitutes 15 per cent of its elderly population. Within the next 10 years, at the countryfs current rate of ageing, the number of dementia patients is expected to reach 7 million.
Singapore is also set to face a similar rise of dementia cases with its own ageing population. According to statistics from the Institute of Mental Health, one in 10 people in Singapore aged 60 and above suffer from dementia. The disease affects half of those aged 85 and older. By 2030, the number of dementia sufferers in Singapore is expected to more than double to 103,000.
Dementia is a term used for a group of brain diseases that cause brain cells to die faster than normal, affecting cognitive abilities. The most common form of dementia is Alzheimerfs, responsible for 50 to 75 per cent of all cases. Dementia is also commonly associated with old age, known to be the biggest risk factor for dementia.
When Alzheimerfs spreads to the front part of the brain, it impacts logical thinking, making it tough to calculate and make plans. Then, it hits the area affecting emotions. The patient loses the power to control moods and feelings.
Progressing from mild to moderate to severe dementia, the disease wreaks havoc throughout the entire brain. And right at the very end, shuts down breathing and the heart.
ALL ABOARD IN JAPAN
To serve its elderly shoppers better, AEONfs Japanese malls engaged the help of Japanfs Dementia Supporter Caravan, which offered a training course to give service staff advice on dealing with dementia sufferers.
"When I was introduced to this training, I thought I would be able to find solutions from these courses on dementia support," said Ms Haruko, now empowered with more knowledge on this cognitive disease.
Founded in 2005, the Dementia Support Caravan has been on a mission to support dementia patients all over Japan. The programme aims to educate and empower everybody to support and integrate dementia patients into a more inclusive society, using a pyramid framework in their organisational structure.
At the top of the pyramid, founder Hiroko Sugarawa and her team travel to companies and municipalities all over Japan to train people to become gcaravan matesh.
Caravan mates sit in the middle of the pyramid and are trained to understand how dementia patients live and view the world.
In turn, caravan mates help to train the base of the pyramid, which includes primary caregivers of dementia patients, as well as children of dementia sufferers, service staff and domestic workers.
After training with the Dementia Support Caravan, Ms Koizumi Shoko, a service counter supervisor with AEON, is now proud to be a dementia supporter. She said her team is committed to making the mall dementia-friendly.
"We will spend some time trying to understand the feelings of the customers who have dementia," said Ms Koizumi. "We look into their eyes when we speak to them, and we would speak at a slower pace."
For example, should an elderly customer buy the same items excessively from AEONfs supermarkets, the family can refund the extra purchases if they are still unopened. This measure helps relieve the burden of spending unwittingly for dementia sufferers and their families.
"Dementia can happen to anyone," said Ms Koizumi. "I think itfs great that we learn how to see things from the customerfs point of view."
photo1: TOKYO: At malls in Japan run by AEON, Asiafs largest retailer, mall managers noticed a peculiarity
photo2: About 4.6 million people, or 15 per cent of Japan's elderly population, have been diagnosed with dementia
photo3: Ms Koizumi Shoko, a service counter supervisor with AEON, has been trained to serve elderly customers in a bid to make the mall dementia-friendly.
Expert highlights dangers of over-prescribing psychotropic dementia medication
NOV 30, 2015
The Japan Times
As a massive wave of Japanese enter their twilight years, an expert is calling for prudent use of psychotropic drugs to treat dementia patients, some of whom have suffered ill health due to over-prescription.
The Health, Labor and Welfare Ministry released guidelines on how to prescribe such drugs for dementia patients in 2013 to avoid casual prescription by doctors. The Japanese Society of Psychiatry and Neurology is also training doctors on the appropriate application of the drugs.
Dr. Yoshimasa Takase, director of the Takase Clinic in Ota Ward, Tokyo, warns that psychotropic drugs, while known to improve the condition of some patients, come with risks of side effects, including falls.
During his recent visit to the home of Etsuko Okizaki, 79, Takase made a flower circle, a gold star awarded to children for good work at school, with his hands after examining her. A dementia patient who had left a psychiatric hospital in Tokyo two months before, Okizaki beamed.
gShe looks like a completely different person. I never expected her to be this much better,h said her husband, 81, at her side.
Okizaki is one of 330 patients Takase visits regularly in and around Ota Ward. Most of them suffer from dementia.
Psychotropic drugs - such as antipsychotics and antidepressants - are widely used to control the so-called behavioral and psychological symptoms of dementia (BPSD), which result in loitering, hallucinations and aggressive behavior.
BPSD also causes some patients to become depressed or caught up in delusional thinking, leading some to mistakenly believe that someone is trying to steal from them.
From around last year Okizaki suddenly lost her appetite and then weight, saying food didnft taste as good as before. She became depressed, would throw food and tableware at others, and began to require assistance to use the toilet.
Her family consulted Takase and checked Okizaki into a hospital in April. She was prescribed psychotropic drugs and administered intravenous feeding. After a while, her BPSD symptoms subsided, and she left the hospital in July.
She has received visits by Takase twice a month since, and now she enjoys knitting and spends her days calmly.
The health ministry guidelines urge doctors to use psychotropic drugs with caution because their effect is particularly pronounced on elderly patients with a low metabolic rate.
The guidelines further recommend that doctors explore nondrug options first, and that if drugs are deemed necessary, the prescription begins with low doses.
Takase said some of his patients, before coming to his clinic, had been prescribed several different drugs. Some had suffered from falls and bone fractures because of the side effects they caused. Such drugs can cause a patient to suffer impaired consciousness.
gThey can be a medicine or a poison,h Takase said. gIf you have concerns about the drugs, please consult with patient groups or talk to doctors who can help reduce their dosage.h
Dementia patient Etsuko Okizaki smiles after doctor Yoshimasa Takase makes a circle with his arms to indicate she is doing well Okizaki's home in Ota Ward, Tokyo, in September. | KYODO
How Japan is training an entire country to help with dementia
Nov 22 2015
By: Jennifer Yang
Japan: Dementia lessons from the worldfs oldest country
Nov 22 2015
By: Jennifer Yang (photo)
Hospitals bracing for rise in dementia sufferers
November 14, 2015
By Hirofumi Noguchi / Yomiuri Shimbun Staff Writer
How to support dementia patients while they are hospitalized for other ailments has recently become a key issue. Unable to understand their treatments for illness or injury, patients with dementia may pull out intravenous drip needles or roam around aimlessly, preventing hospital staff from administering proper care.
Their hospital stays also tend to be prolonged, and there are calls to transfer them to hospitals where they can be treated safely and discharged early.
A nurse was making her rounds in the in-patient ward of Nagoyafs Kamiiida Daiichi General Hospital when she came across a female patient in her 90s with dementia who had undergone gallstone surgery. She was pulling a feeding tube out of her nose.
In another room, a patient in need of bed rest for a broken bone was attempting to get up. An unnerved patient screamed gHelp me!h during the night, eliciting complaints from other patients.
gTherefs been a sharp increase in such elderly patients with dementia, and the nurses tend to be exhausted as they struggle to keep up with them,h said nurse Chie Matsui, who works exclusively with dementia care at the hospital.
People with dementia are prone to be confused by changes in their environment, such as physical pain and hospitalization. They also tend to exhibit such behavior as roaming about aimlessly and lashing out verbally, and in some cases they cannot receive necessary treatments, or cause trouble with other patients.
As a result, many hospitals simply tie such patientsf hands and feet to their beds or administer medicine to calm them down, citing medical treatment and preventing falls as reasons why.
However, these measures may actually worsen a patientfs symptoms and prolong their stay in the hospital.
Nurses at the Nagoya hospital, centering primarily around Matsui, work in collaboration and have kept bodily restraint to a minimum. However, Matsui confesses: gWe know itfs important for patients with dementia to be in the hospital, but itfs difficult to have them there in reality, because wefre too busy. Itfs a dilemma.h
The number of senior citizens with dementia, currently about 5.2 million, is predicted to reach 7 million by 2025.
gMedical care in the country will be rendered unviable unless we put more effort into dealing with dementia,h said Katsuyuki Ukai, chief of the hospitalfs Department of Psychogeriatrics.
Admission sometimes refused
According to a survey conducted by researchers with the National Center for Geriatrics and Gerontology, including department head Akinori Takeda, 94 percent of emergency hospitals said handling patients with dementia is difficult. Common reasons given were grisk of tripping or fallingh and gthe difficulty of obtaining cooperation for tests and treatments.h
When faced with difficulties in handling patients with dementia, most hospitals said they grequest early discharge of the patient,h guse physical restraintsh or grequest family members to be present.h
Half of the families of dementia patients who have been hospitalized said gthere were problems with the hospital stay.h There have even been cases in which admission was refused on the grounds of dementia.
gHandling patients with dementia is exhausting, so we end up trying to avoid it as much as possible,h said one physician from a general hospital.
gThere are sparse opportunities for nurses, who are in closest contact with the patients, to acquire specialized knowledge on dementia. The fact that nurses are unaccustomed to handling patients with dementia is a factor in this situation,h said Prof. Mizue Suzuki of Hamamatsu University School of Medicine.
There are many cases in which dementia has worsened upon hospitalization. Suzuki said, gItfs essential to develop a system, in hospitals as well as in nursing care, that includes education on dementia care and the assignment of expert personnel.h
Nurse training in dementia
Initiatives to improve the current situation are getting under way, including personnel training.
The Japanese Nursing Association is advancing the cultivation of certified nurse specialists in dementia care. With the growing need from hospitals, the number of these certified nurses increased by 150 percent over the last three years, reaching 657.
The government also began dementia training for hospital physicians and nurses, with the aim of increasing the number of people participating in the training program to 87,000 by the end of fiscal 2017.
Another initiative is the introduction of dementia support teams that consist of staff with a variety of expertise. Tsushima City Hospital in Tsushima, Aichi Prefecture, introduced in 2014 a support team that now comprises 18 staff members including physicians, nurses, pharmacists, occupational therapists and counselors.
When the team is asked for support for patients who are difficult to treat, pharmacists review medications while occupational therapists conduct rehabilitation to regulate the patientfs lifestyle and prevent falls, to assist their stays in the hospital.
gWith the collective strength of the staff, the patients can now undergo treatment safely and nursesf fatigue has eased,h said Tomoko Yamana, head of the hospitalfs Neurology Department. gWe want to become an even more dementia-friendly hospital.hSpeech
photo:Chie Matsui, a certified nurse specialist in dementia care, listens to a patient at Kamiiida Daiichi General Hospital in Nagoya.
Dementia treatment making progress in urban centers, but rural areas still lacking
NOV 13, 2015
In May, a nurse and other members of a team that supports people with dementia visited a man in his 80s living in Machida, on the outskirts of Tokyo, and urged him to gaccompanyh his wife to the hospital.
They struck up a natural conversation, but carefully avoided the word gdementia.h
As a team that provides early-stage support for those with dementia in the municipality, they offer advice to patients and their families in seeking medical attention as well as local government services.
The man, who lives with his wife, recently took a turn for the worse.
He regularly goes to a nearby medical clinic for diabetes treatment, but lately he has been missing appointments or going two days in a row, forgetting he had been the day before. When his wife notes how forgetful hefs become, the man brushes her concerns aside.
His doctor at the clinic consulted with the cityfs dementia support team, and together they formulated ways to persuade the man to seek medical attention.
As he used to be a teacher, the manfs pride may have prevented him from accepting that he had dementia, team members suggested. So they attempted to persuade him to seek treatment without angering him.
A month after team members first visited his home, the man gaccompanied his wifeh to see another doctor specializing in dementia. From there, his home doctor and a dementia doctor started cooperating. Soon, medication for the mental disorder was being filled alongside the diabetes prescription, with no need to mention the fact out loud.
In Machida, there are four such teams offering consultation to 45 people between August 2014 and June.
As with the Machida manfs case, it often takes time for patients with suspected dementia to actually see a doctor for treatment.
According to a survey conducted in 2013 by a Kyoto-based group on dementia patients and their families, it took an average of 9? months for patients to seek medication after family members noticed symptoms of the disease.
Citing reasons for this lag between display of symptoms and treatment, 38.7 percent said the patient didnft want to visit a hospital, 33.6 percent said they thought it was simply due to old age and 21.2 percent said family members couldnft tell the patient to seek medical attention.
Getting medical attention or nursing care at an early stage will reduce the burden on family members, the health ministry said, which is why such support teams are needed.
But there is another dimension to the issue.
The number of doctors who have taken training sessions on dementia ? a necessity to be recognized as an expert in the field ? stood at 3,895 as of the end of March 2014. It varies by prefecture, from 18 in Aomori and Kagawa to 665 in Tokyo.
The venues for such training sessions are often urban, making it hard for doctors in rural areas to attend.
But regional governments in rural areas have been making efforts.
Of Hokkaidofs 179 municipalities, only 6.7 percent have set up a dementia support team. This is because many municipalities had to send doctors to Tokyo for training, requiring a costly overnight trip.
This year, however, Hokkaido negotiated with the National Center for Geriatrics and Gerontology, which organizes the training sessions, to hold the event in Sapporo, allowing more than 100 doctors in the prefecture to attend.
gMany municipalities are likely to be able to set up new teams from next fiscal year,h a Hokkaido prefectural official said.
Other municipalities opt to share doctors with expertise.
The city of Nagai and the town of Shirotaka, both in Yamagata Prefecture, share a dementia doctor.
gIn a municipality with (a) low population, it is hard to find a doctor with expertise that fulfills the condition,h said an official from Nagai, which was later than Shirotaka in setting up a support team.
gThere are patients and families who are having trouble because they canft receive sufficient treatment and services at an early stage,h said Kumiko Nagata, an official at Dementia Care Research and Training Center in Tokyo. gEven if itfs not perfect, I hope the local governments will do what they can.h
photo:Members of a dementia support team in Machida, Tokyo, hold a meeting in 2014. | MACHIDA CITY/KYODO
73-year-old driver who hit pedestrians had treatment for dementia
October 30, 2015
MIYAZAKI -- The 73-year-old driver of a car that hit and killed two pedestrians here was receiving treatment for dementia and has a history of epilepsy, prefectural police have learned.
Miyazaki Prefectural Police investigators searched his home in Hioki, Kagoshima Prefecture, on Oct. 29 on suspicion of dangerous driving resulting in death and injury.
The man had been in a hospital until Oct. 26, police also learned. They are carefully looking into any connection between the man's illnesses and the Oct. 28 incident, in which the man's car traveled around 700 meters on the sidewalk in the middle of the city of Miyazaki. Two pedestrians were killed and four injured in the incident.
According to an investigative source, there were no obvious signs of braking at the scene of the incident. The driver was conscious at the time, but simply responded "yes" to everything he was asked by police officers. He was hospitalized with a brain hemorrhage. He had reportedly left his family's home unnoticed on the morning of the day of the incident.
Under the Road Traffic Act, prefectural public safety commission officials question drivers who are obtaining or renewing their license to determine if they have dementia, epilepsy or other ailments that may impair their ability to drive. The questions include ones like, "Within the last five years, have you lost consciousness or been temporarily unable to move your body as you liked?" If the driver answers affirmatively to any of these questions, a doctor's opinion will be consulted before deciding whether to grant the license. There are criminal penalties for lying when answering the questions.
In June this year, the Road Traffic Act was reformed, adding a test for memory and other cognitive abilities when renewing a license to check for possible dementia cases. If dementia is suspected, the driver has to be seen by a doctor, and if they are diagnosed with dementia their license will be suspended or revoked. However, this system has not begun yet, and even if it had, it only applies to people 75 and older so the 73-year-old man would not have been tested.
Yoshihiko Ikeda, professor of criminal law at Tokai University, says, "There should be debate on countermeasures, including cognitive ability tests, without regard to age."
Osaka City University develops system to track dementia sufferers lost near home
October 25, 2015
Osaka City University has developed a system that utilizes low power wireless technology to help locate elderly individuals with dementia within their communities after they have wandered away from home, university officials announced on Oct. 19.
The scheme works by placing a small wireless receiver, which serves as a base station, at one's home or other location. After a network has been created, a compact-sized transmitter -- which weighs around 22 grams and may be sewn into users' clothing or bags -- sends information to a server on their estimated location, which may then be tracked via the Internet.
By placing a number of small base stations in various locations within individual communities, the whereabouts of lost individuals -- who are often found within a 1-kilometer radius from home -- may be tracked over an area covering several kilometers in all directions.
Tetsuo Tsujioka, an associate professor with Osaka City University's Graduate School of Engineering, developed the system -- called the "wireless protection system for community independence" -- in conjunction with Tokyo-based software development company Vital Information.
While similar systems have utilized functions such as smartphones' GPS, this has proven problematic for reasons including the fact that most elderly individuals do not use smartphones.
The new system will help support efforts already underway by local governments and community-based nonprofit organizations to provide support for elderly dementia sufferers.
An experimental demonstration of the system is set for the city of Sakai's Senboku New Town area in November, and commercialization is scheduled for next fiscal year. The fee for renting the devices will likely be around 2,500 yen per month.
Osaka convenience stores to help wandering dementia sufferers
SEP. 25, 2015
TOKYO ?Some years ago, convenience stores made the news by agreeing to serve as safe havens for people after dark. While mainly conceived as a means of assisting women, anyone who feared he or she was the target of a stalker or potential assailant could, in theory, seek sanctuary in a store while the employee summoned the police.
With the aging of Japanfs population, another use for the stores is being promoted in Osaka. As reported by the Sankei Shimbun this week and other news sources, four major convenience store chains have agreed to function as gdementia supportersh to assist seniors who appear disoriented.
The system, said to be the first of its kind in Japan involving convenience stores, provides for managers at outlets operated by 7-Eleven Japan, Lawson, Family Mart and Circle K-Sunkus?which total about 3,500 in Osaka Prefecture?to attend training sessions conducted by local cities and towns. They will be taught on how to recognize and deal with people exhibiting characteristic symptoms of dementia, as well as how to contact police or family members. The sessions will take from 60 to 90 minutes.
In addition, convenience stores in the prefecture will tie up with the quasi-governmental gPatrol and Watch SOS Networkh that shares data on missing elderly via emails and faxes. The network is already in use at schools, welfare offices, by railway and bus companies, gasoline stations and others. Once a family has reported a person missing, the network distributes the information to participating organizations.
According to sources in the Osaka prefectural government, since many convenience stores operate round the clock, they are considered particularly helpful in spotting missing seniors at night or in the early morning hours, when most other businesses are closed.
Last year, a total of 10,783 seniors suffering from dementia went missing nationwide, and Osaka Prefecture, with 1,921 reported cases, led the nation. In many instances the missing people were found while in convenience stores, where they had gone to make purchases.
According to recent marketing data, convenience stores are patronized more by those in the over-50 age group than teenagers and people in their 20s.
Free app helps families diagnose loved ones for dementia
August 06, 2015
A new, free app for smartphones and tablets that helps families and neighbors keeping an eye on elderly persons diagnose whether those people may have dementia was announced by an NPO on Aug. 5.
Named "Ninchisho ni Sonaeru Apuri" (app for preparing against dementia), the app was developed by the Tokyo NPO Orange Act. Among the seven questions users are asked are, "Does the person choose clothing not appropriate for the season?" and "Does the person buy the same thing over and over?" Users pick from four responses, such as "very frequently" or "sometimes," and receives a diagnosis that the developers say is around 90 percent accurate.
The app was designed in cooperation with three doctors' associations in Ota Ward, with the diagnosis calculations devised by doctors and others from the Kamata Medical Association.
While others apps for people to diagnose themselves for dementia have previously existed, the developers of the new app say it is the first one in Japan aimed for use by associates of the diagnosis target, and aids those people in looking after a potential dementia patient without hurting their pride.
The app includes functionality to share information with local municipal governments or doctors' associations. The NPO is aiming to have support for this functionality in over 100 municipalities.
The app is downloadable for Android devices as of Aug. 6, and is soon to be available for iPhone as well.
More people getting inheritance wills certified by notaries
June 28, 2015
The number of certifications of fairness created for wills by notaries in 2014 was the first yearly total to break 100,000, it has been learned.
According to the Japan National Notaries Association, since the will certifications by notaries in 1971 reached around 15,000, the number created has been on the increase, up to 104,490 in 2014.
The association says that in recent years, more people have wanted to leave their inheritances to people different than what the law defines. For example, couples without children may wish to stop inheritances from going to distant siblings, or people living together but not married may want to leave an inheritance for their partner.
Lawyers and incorporated nonprofit organizations that care for the elderly recommend will certifications by notaries. Trust banks are even competing with each other in offering will trust services using notary certifications.
Changes to the tax system in January this year lowered the standard deduction on the inheritance tax to 60 percent of what it was before, so more people will have to pay inheritance tax, increasing the potential demand for notary certifications.
Wills certified by notaries are seen as having greater legal authority and are more likely to be complete than those without certification. They can help prevent fights over inheritance as well. There are cases where people suspected of having dementia or other ailments affecting their judgment have left wills, and this has led to court disputes among relatives over the validity of the will. To address this problem, the Japan National Notaries Association says it has stepped up training to allow its notaries to better determine will leavers' capacity for judgment.
Storage of the wills is also an important issue. In the Great East Japan Earthquake, the notary public office of Ishinomaki, Miyagi Prefecture, was hit by the tsunami, and the documents stored there came in danger of being washed away. After this, starting in April 2014, notary offices around the country began saving their will certifications electronically, scanning the documents and saving them on servers located in mountainous regions.
Kensaku Iuchi, 66, head director of the Japan National Notaries Association, says, "The benefits of will certifications have come to be recognized as a solid measure for inheritance. We want to continue to promote the role of notaries public and raise (the public's) trust in us."
More than 10,000 people with dementia reported missing in Japan last year
Jun 25, 2015
The number of people with dementia who were reported missing in 2014 was 10,783, up 461 from the previous year, the National Police Agency said Thursday.
Of these, 10,615 people, or 98.4 percent, were found by the end of 2014. The whereabouts of 168 remained unknown.
gWe hope to enhance cooperation with related authorities and institutions in order to beef up searches for missing people,h an NPA official said.
The agency alerted prefectural police headquarters across the country in June last year to act quickly to trace missing persons with dementia and to treat them appropriately.
But in August 2014, police failed to detect signs of dementia in an 83-year-old man who had wandered off from day care in Yokohama despite police officers questioning him several times in Tokyo. He later died from dehydration in a park.
The NPA began compiling a DNA database of missing persons with dementia in April, using samples from relatives.
Including those who disappeared in 2013 and earlier, 10,848 missing people with dementia were located in 2014. Of these, 6,427 were traced by the police, 3,610 were reported to have returned home and 429 were found to have died. Another 382 cases were dropped after the reports were found to be mistaken.
The police agency said 7,091 people were found on the day relatives contacted police; 10,539 people were tracked down within a week; and 73 people were found more than two years later.
Info on unidentified people largely withheld despite possible leads to missing persons
June 21, 2015
Information on just 16 of 300 or more unidentified people thought to be in care because they cannot remember their name or address due to dementia or other problems is publicly available at police stations nationwide, it's been learned.
After a series of cases in which unidentified elderly dementia patients who went missing and were taken in custody surfaced last year, the National Police Agency (NPA) notified all police forces in June last year to create files on unidentified people at prefectural police headquarters or police stations at the request of municipal governments. The aim was to have families that reported missing persons refer to the files to help identify those taken into custody. By November the same year, police departments across the country established a framework to give people access to the files of unidentified people.
However, because municipal governments are in charge of filing the information and deciding whether it can be made public, police cannot disclose the files without local authorities' permission, even if they have photos of the unidentified people.
According to NPA, information on just 16 unidentified people was made public across the country as of April 23 this year. Information on another 23 people was also accessible, but only within the prefecture where they had been placed in care.
One prefectural government official commented that many municipal governments are hesitant to provide photos in consideration of ordinances on the protection of personal information.
Osaka Prefectural Police Department launched a disclosure system for information on unidentified people in September last year ahead of other prefectural police forces. However, of 40 unidentified people in the prefecture's care, information on only four is publicly available. The Osaka Municipal Government, which cares for around 30 of those people, says it plans to consult a committee on personal information protection about whether to disclose the information.
The Ministry of Health, Labor and Welfare has a special page on its website to provide information on unidentified people, but few municipal governments are utilizing the ministry's information system. As of May 2015, basic information such as the gender and estimated age of 68 unidentified people was posted on the ministry's website, but photos were available for only 25 of them.
A 71-year-old woman in Fukuoka Prefecture, whose 75-year-old husband with dementia has gone missing, told the Mainichi Shimbun, "Families (of missing dementia patients) wish for their early return. I want municipal governments to properly disclose information."
Drivers with dementia will lose their license under new law
Jun 11, 2015
The Japan Times
A legal revision to prevent elderly people with dementia from driving was enacted Thursday.
Under the revision to the Road Traffic Law, which will take effect sometime in the next two years, drivers aged 75 and older who have developed symptoms of dementia will have their license suspended or canceled.
The current system requires drivers aged 75 and over to take a cognitive function test every three years. Even if they are suspected of having dementia, elderly motorists are allowed to keep their license if they have not violated any traffic rules in the past year.
Under the revision, people suspected of having dementia will need to provide a medical certificate that they are capable of driving.
Among the countryfs 130 million people in 2012, 4.62 million elderly had dementia, according to the Health, Labor and Welfare Ministry.
The National Police Agency said that of 471 fatal accidents caused by drivers aged 75 and over in 2014, drivers in 181 cases, or 38 percent, had some form of cognitive impairment.
The legal revision passed the Lower House on Thursday after clearing the Upper House in April.
Of the 53,000 people whom police suspect of having dementia, only 1,236 went to the doctors for a detailed test, according to the NPA. Of them, 348 were diagnosed as having dementia and had their driverfs license revoked. Eight others had their license suspended while doctors monitored their conditions.
Meanwhile, a separate study by the National Center for Geriatrics and gerontology found that 61 percent of men aged 65 and older suspected of having dementia continue to drive.
If such people continue driving without consulting doctors about their memory loss and other cognitive problems, it could lead to serious crashes, the researchers warned.
gWe canft say for sure all of these people have dementia, but people who know dementia sufferers should urge them to see doctors immediately,h said Hiroyuki Shimada, director of the centerfs preventive gerontology research division.
The Aichi-based center conducted memory tests on 10,000 men and women aged 65 and older in Nagoya and Obu, Aichi Prefecture, between 2011 and 2013.
Based on the test results, the researchers broke them down into three groups: people with no signs of dementia; those with signs of mild dementia who still had no problems in daily living; and those suspected of having dementia.
By gender, of the 162 men who were categorized as possible dementia sufferers, 99 drove cars. Twenty of the 130 women who were in the same category ? or 15 percent ? were drivers.
Among people suspected of having mild cognitive impairment, 86 percent of the men, or 2,078 men, and 37 percent of the women, or 854 women, said they drove cars, according to the study.
60% of older men with suspected dementia continue driving
June 09, 2015
The Yomiuri Shimbun
Sixty percent of elderly men who are suspected of being affected by dementia continue driving cars, according to a large-scale survey by the National Center for Geriatrics and Gerontology.
The survey revealed the fact that many elderly men whose cognitive functions have deteriorated do not stop driving. In a nation where there is an increasing number of elderly drivers, measures have to be taken urgently to handle this situation.
A study team at the national center, based in Obu, Aichi Prefecture, is set to publish the survey results at a conference of the Japan Geriatrics Society to be held in Yokohama on Saturday. The survey was conducted from 2011 to 2013, covering about 10,000 residents in Osaka and Nagoya aged 65 or older. The subjects underwent tests of cognitive functions including memory ability that are an international standard for simple diagnosis of dementia. Those people were then asked whether they currently continue driving cars.
Based on the scores, the test results were sorted into stages of cognitive function disorder such as a mild degree or an intermediate degree, which is equivalent to suspected dementia. In this survey, no subject who fell into the severe degree was found.
Of 162 men diagnosed with suspected dementia, 99 men, or 61 percent, continued driving. Of 130 women who were similarly diagnosed, 20 women, or 15 percent, were drivers. Of 2,431 men whose cognitive functions had slightly declined to a degree that did not interfere with their daily life, 86 percent continued driving. In the case of women, 37 percent of the 2,335 women presenting the same symptoms were drivers.
Under the current law, elderly drivers aged 75 or older are required to take cognitive tests when they renew their driverfs licenses.
However, even if a person is suspected of suffering from dementia in the tests, the person can renew the license without receiving a doctorfs diagnosis unless the person has committed certain infringements, such as ignoring a traffic light, during the past year.
In the tests in 2013, about 35,000 people were suspected to have dementia.
Hiroyuki Shimada (photo), who compiled the survey and who heads the centerfs division of preventive gerontology, said: gI was surprised to find out that the number of elderly people who continue driving even with decreased cognitive function was greater than expected. It is important to visit medical institutions when any abnormal change is recognized by an elderly person or by those around the person. Alternative means of transportation to replace driving also need to be expanded rapidly.h
Most local gov'ts reluctant to publicize info on unidentified dementia patients online
June 08, 2015
Information on only about 20 percent of unidentified dementia patients and others under protective custody by local governments has been publicized on their websites despite experts' calls for advanced information disclosure, it has been learned.
There were 346 unidentified people -- including dementia patients -- who were under protective custody by local governments across the country as of May last year, according to a survey by the Ministry of Health, Labor and Welfare. In response, the ministry launched a website showing links to all 47 prefectural governments' relevant web pages over the issue.
However, while it is estimated that there still remain around 300 such unidentified individuals under protective custody, local governments carry basic information on only 68 of them such as their gender and estimated age -- with the pictures of the unidentified attached to only 25 of them. Many local governments are apparently wary about releasing such info online out of concern for personal information protection ordinances.
"It poses no problem (to release such information) in terms of ordinances, and information should be actively publicized," said an expert.
The health ministry launched the special website in August last year under the title "For those who are looking for missing elderly with dementia and other individuals" in an effort to reconnect unidentified people under protective care with their family members. Since the end of March, the website has been showing links to all 47 prefectural governments' related web pages.
The Mainichi Shimbun queried the prefectural governments over the status of their relevant websites and the number of unidentified people under their protective care. As a result, it emerged that 23 of those 346 unidentified people had been identified by May this year, while 12 others had died without being identified. There were an additional 20 unidentified people including dementia patients, of whom seven either died or were eventually identified with the remaining 13 still unidentified. There likely remain still around 300 unidentified people under protective care across the country. The figures are limited to those available from prefectural governments.
Despite the large number of such individuals, only five prefectures have publicized on their websites basic information on all of those unidentified under their protective custody, such as their estimated age and when they came under care. Kagoshima Prefecture carries information on all of 11 such individuals on its website, followed by Shizuoka Prefecture at eight, Chiba Prefecture at two, and Kochi and Shimane prefectures at one each.
Four other prefectures are also eager to release such information online, with Kyoto Prefecture carrying on its website information on eight out of 13 such individuals under its custody, followed by Hyogo Prefecture at seven out of eight, Hiroshima Prefecture at seven out of 13, and Hokkaido at five out of six. Many other prefectures have not even made public basic information on those unidentified.
While Osaka Prefecture hosts 40 unidentified people under its protective custody, its website runs information on only two of them. Saitama Prefecture also has 23 such unidentified under its custody -- according to the health ministry survey -- but its website releases tips on only three of them. One of the 23 unidentified was eventually identified.
Furthermore, Tokyo and Kanagawa Prefecture did not even disclose to the Mainichi the number of those unidentified under their custody -- even though they had grasped the figures in the health ministry survey. Both prefectures' websites only show information on one each of such individuals.
"While it is up to each municipality that keeps unidentified people under its custody to decide whether to publicize their information online, we face the difficulty of handling private information," said an official with the Tokyo Metropolitan Government. A Kanagawa Prefectural Government official commented, "We basically do not carry information on those whose consent we can't obtain."
Many local governments that actively disclose unidentified people's information online go so far as to carry such detailed information as their physical traits and when and how they came under protective custody, after making a comprehensive decision over disclosure on people including those whose willingness cannot be easily confirmed due to ailments and other factors. However, local governments adopting similar criteria to that of Kanagawa Prefecture hardly publicize information on the unidentified, preventing their families from being reunited with them.
Japan grapples with \14.5 trillion dementia costs
May 29, 2015
The Japan Times
The cost of providing health and social care for the nationfs dementia sufferers totaled \14.5 trillion in 2014, with nearly half of the cost borne by families, a health ministry panel said Friday.
The ministry said it was the first ever detailed estimate of the cost of the condition, which affects more than 4.5 million people nationwide.
The government is encouraging a shift from institutional care to home care for elderly dementia patients as a way to curb the demand on government-run nursing care insurance, which has grown to around \10 trillion per year. But the study suggests that without strengthening home nursing care services covered by government insurance, the result will be that households are forced to assume even more of the cost and responsibility.
It is difficult to compare the situation with that in other countries because methods of measurement differ. However, dementia cost Britain around \3.9 trillion in 2013 and the United States \17.5 to \24 trillion in 2010, according to the study group at the Ministry of Health, Labor and Welfare.
The 2014 cost of \14.5 trillion in Japan is broken down into \1.9 trillion for medical services, \6.4 trillion for institutional nursing care and \6.2 trillion for care provided by family members, the study shows.
The group projects the social cost will balloon to \24.3 trillion in 2060 when the children of baby boomers are aged 85 or older.
gThe challenge is how we can improve the quality of life of patient and family members with limited financial resources,h said Keio University assistant professor Mitsuhiro Sado(photo), who chairs the group.
The ministry estimated that the number of people aged 65 or older with dementia in Japan will increase from 4.62 million in 2012 to 6.75 million to 7.3 million in 2025, which translates into roughly 1 in 5 elderly people.
The ministry study showed that the per-patient cost of care at an institution came to \3.53 million per year. At home, however, the outlays were greater, comprising \2.19 million paid to home nursing care providers and \3.82 million in an estimated value of care offered by family members.
Toshio Nakanishi, 62, who takes care of his wife Miyuki, 62, at home in Uji, Kyoto Prefecture, says that he feels the estimated bill of \3.82 billion for care by family members is not accurate.
gI feel like it is much higher,h he said.
Nakanishi says he has been looking after his wife, who was diagnosed with Alzheimerfs in April last year, almost around the clock. He only has respite three times a week, when she goes to day-care facilities.
Nakanishi, who is retired, asked the couplefs 32-year-old daughter to quit her job and join him earlier this year in caring for her mother.
For the study, the costs of medical and institutional care were calculated based on health insurance claims, while the home care figure was produced from a survey of 1,482 people through the referral of health care institutions and support groups.
They were asked about the time they spent and the type of care they engaged in during a week, and these figures were then given a monetary equivalent value.
Financial costs of providing nursing care were computed and added together, using average wages based on gender and age group.
The Ministry of Internal Affairs and Communications has estimated that 100,000 people are quitting their jobs each year to care for sick family members.
Atsushi Nishida, a researcher at the Tokyo Metropolitan Institute of Medical Science who is familiar with public dementia policies overseas, calls for new measures to enable workers to provide care without leaving their jobs.
gJapan is projected to lose working population as its birth rate is far lower than those of other countries,h he said. gUnless we take steps to make work and nursing care compatible, the countryfs economic might will further decline.h
System uses vending machines to help find elderly dementia patients
The Yomiuri Shimbun
May 28, 2015
To help elderly dementia patients in danger of wandering, a new system is being tested in Sakata, Yamagata Prefecture, that processes location information and other data picked up by vending machines and similar devices.
The system utilizes what is known as the Internet of Things (IoT, see below), and was developed in cooperation with Captain Yamagata Corp. ? a semi-public corporation based in Yamagata city that is involved in Internet-related businesses ? and the National Institute of Technology, Tsuruoka College, in Tsuruoka, Yamagata Prefecture. A rarity in Japan, the system is cost-effective compared to existing global positioning systems.
Wi-Fi devices installed around the city in stores and on vending machines pick up the signal from a device worn by an elderly person. Family members are notified of details, such as when the person passes a certain location, through automatic e-mails sent to their mobile phones.
The experiment is being conducted in an area with a radius of about 1.5 kilometers in the Yawata district in Sakata. There are Wi-Fi installations in eleven locations in the area. The smallest transmitter is about the size of a \500 coin and can be worn around the neck like a pendant. It is powered by a button cell battery that costs around \1,500 and lasts for two years. NTT East Corp. is providing free transmission.
Ten families in the area are participating in the experiment. Systems that use GPS to keep tabs on elderly people are available, but transmitters cost from \20,000-30,000 to about \100,000. Furthermore, they use batteries that need charging every two days and have monthly connection costs of approximately \10,000.
Hitomi Sato, deputy representative of the Yamagata branch of the Alzheimerfs Association Japan, emphasized potential benefits such as the small, light devices being comfortable for elderly patients to wear, and easing the psychological and financial burden on family members.
Family members often delay reporting missing elderly persons for fear of inconveniencing neighbors, according to the Health and Welfare Department of the Sakata city government. If this system becomes a reality, however, family members will be able to cope with the situation on their own.
A department official said it hoped to expand the usage area if the experiment is a success.
IoT is an abbreviation for Internet of Things. In addition to safety confirmation systems such as electric hot water systems that send usage data from the homes of elderly people to their families by e-mail, other technologies currently in development include auto-driving systems that run on a predetermined route and transmit driving status information from the vehicle. There were 3 billion IoT devices worldwide in 2013, and the number is forecast to rise to 25 billion within 20 years, according to the Economy, Trade and Industry Ministry.
National program courses help families of dementia patients cope at 150 locations
The Yomiuri Shimbun
May 25, 2015
A national research center is promoting a program to help families taking care of patients suffering from dementia.
The program, developed by the National Center for Geriatrics and Gerontology based in Obu, Aichi Prefecture, is aimed at providing a clearer picture of the disease and reducing the burden on such families.
The institutionfs center on memory disorders, which provides classes for families of dementia patients, has assessed the needs of participants since fiscal 2012, leading to establishment of the program.
The program has two courses ? a lecture-oriented introductory course for families with patients in the early stage of dementia, about three to five years after the start of symptoms, and a hands-on basic course for those with middle-stage patients, about five to seven years after the onset.
In the introductory course, medical professionals provide explanations, in line with the institution's latest findings, about the progress of the disease, types of medicine, anxiety about nursing care and other problems.
In the basic course, in which about 20 people take part, the participants learn how to cope with situations in which the symptoms of dementia patients have worsened. The course covers specific examples such as patients who dislike taking baths or who have fecal incontinence, and participants exchange opinions about looking after patients in such situations and other nursing care problems.
After studying 54 participants who completed the basic course, the center found that about half of those who were depressed or suffered from low spirits at the start had shown a significant improvement. It also found the risk of a caretaker being burned out had lessened.
The introductory coursefs contents can be downloaded as a brochure from the centerfs website (http://www.ncgg.go.jp/monowasure/index.html) beginning this month. Contents of the basic course will be compiled as a brochure later this fiscal year.
The program will be available for family members of dementia patients at various facilities, including medical centers that will be set up at 150 locations across the nation.Speech
Shiga Pref. a leader in measures for patients with early-onset dementia
May 03, 2015
For those who have been diagnosed with early-onset dementia, it's tricky to negotiate the capacity one still has for work with the insufficient support society offers for them to continue working. But various efforts are being made in Shiga Prefecture to help such men and women make full use of the skills they have and remain an active participant in society for as long as possible.
Fujimoto Clinic in the Shiga Prefecture city of Moriyama specializes in dementia and is headed by physician Naoki Fujimoto, 62 (photo)@. In 2011, one part of the clinic was turned into a dedicated work space for patients diagnosed with early-onset dementia who have quit their jobs, but still want to contribute to society. Today, 15 such patients commute to the work space to engage in simple tasks.
A rare case nationwide, Fujimoto Clinic has supported the continued employment of those diagnosed with early-onset dementia in consultation with patients' employers and occupational health physicians with the permission of the patients themselves. In addition, nurses advise patients and their employers on what type and load of work the patients should take on, and how others should approach their condition.
Still, as dementia progresses, it becomes increasingly difficult for patients to continue working for their employers, leading to their departure from their jobs. However, those who are still physically healthy feel a resistance to using nursing care services. The work space at Fujimoto Clinic was created for people in these very situations.
The work has been commissioned by three companies, and includes such tasks as processing parts for pets' toys and processing adhesive tape used in automobiles. The 15 patients participating in the program work at the clinic once a week from noon until 4 p.m., earning approximately 6,000 yen per month.
The participants take a 15-minute break for every 45 minutes of work, which they carry out with great focus. When the timer goes off to indicate that it's time to rest, a staff member invites the workers to take a break for tea, snacks and to chat.
"The work requires concentration," one male patient said. "I can't do a sloppy job, because it's work."
The tasks have been laid out by the nurses and other dementia experts to be as straightforward as possible for the patients. For example, to keep track of the number of plastic tubes that must be cut apart, the patients use ice trays. Such use of tools expands the range of tasks the patients can complete.
"In addition to being a work space, this is a place where the patients receive care," explained Noriko Okumura, a nurse at the clinic.
The clinic is a place where not only patients, but their families can receive support. A 64-year-old man who started commuting to the clinic last year grew to forget his work tools frequently at home some three years ago, when he was still a full-time company employee. When he was diagnosed with early-onset dementia, he immediately quit his job. With nowhere to go and nothing to do, he began to brood.
Once he started going to the work space at Fujimoto Clinic, however, his outgoing personality came back. "I've made friends here, and the work is fun. I'm also glad to be able to earn money," he said. His 61-year-old wife added, "Ever since he began going to the work space, he's become surprisingly positive. I think that through work, he's been able to regain some confidence."
The work space program spread to three other locations in Shiga Prefecture last year. Staff who underwent training at Fujimoto Clinic have also begun similar programs at a medical facility in Aichi Prefecture and in Nagano Prefecture.
The Shiga Prefectural Government has set up a call center where residents can consult experts about early-onset dementia, and has also created manuals and pamphlets for providing information on the condition and support to patients and their families. In 2013, it surveyed companies about early-onset dementia to identify what sorts of issues and challenges exist in the prefecture's work force.
For three years ending in fiscal 2014, Shiga Prefecture conducted an early-onset dementia community care model program centering on Fujimoto Clinic. In cooperation with medical and nursing care experts and facilities, administrative offices and corporations, the prefectural government also took part in comprehensive efforts to support patients and their families by helping patients continue working for their employers as much as possible and by creating more working opportunities for those with the condition.
Physicians with their own practices in local communities also work with experts to assist patients to continue with their jobs. Yoshimasa Fujii, a 63-year-old internist with his own clinic, examines patients he sees in his day-to-day practice with early-onset dementia.
"It's common for patients with dementia to quit their jobs right away due to their own reservations," said Fujii. "But symptoms don't progress right away, and they can still continue to do some types of work." Fujii explains early-onset dementia to employers and advises them to continue providing patients with work they can handle. He also goes to companies to offer training sessions on the condition.
According to a health ministry survey, there are an estimated 37,800 people with early-onset dementia, and the average age of onset is estimated to be 51. Because doctors are now able to diagnose the condition earlier than they had in the past, a growing number is given the diagnosis while they're still in the work force.
Reinforced measures regarding early-onset dementia is a major pillar of the government's national strategy on dementia that was announced in January of this year, called the New Orange Plan, which incorporates support for patients to continue working. However, there is little such support nationwide, and according to a survey on measures regarding early-onset dementia carried out last year by a health ministry task force, there are huge discrepancies in the assistance provided by each of the 47 prefectures.
"In Shiga Prefecture, medical practitioners, the local government and companies work together to respond to the needs of individuals to generate measures and policies concerning early-onset dementia that go beyond existing systems and roles. Such efforts are even spreading outside the prefecture. Shiga is a leader in this field," said a ministry official.
Fujimoto agrees that Shiga could be a model for the rest of Japan. "In an age where we are able to detect early-onset dementia very early, we still lack a support system for people in the early stages of the condition who do not yet require nursing care services. My hope is that Shiga's efforts will work in tandem with national policies and spread to the rest of the country."
Hibakusha: Despite dementia, A-bomb microcephaly patient remains full of memories
April 20, 2015
"Right now, I'm somewhere other than my house. Where is this? I want to go home."
Kimie Kishi, 69, who is from the city of Miyoshi in Hiroshima Prefecture and lives with a condition known as A-bomb microcephaly, suddenly telephoned me last summer after being admitted to an elderly care facility following a diagnosis of suspected dementia.
Kishi spoke in an agitated and tearful-sounding voice, and when I interjected to ask her questions, she just kept on going without answering them. Finally, she hung up.
For many years, Kishi had been living on her own. Her weight dropped from more than 40 kilograms down to 36, however, and she became unable to recall whether or not she had eaten. She repeatedly shopped for the same foods, which began piling up in her refrigerator.
Finally, a care manager who regularly visited Kishi's home recognized that something was off. Determining that it was dangerous for her to continue living alone, paperwork was filled out for her to enter the care facility.
Unable to understand what was happening, Kishi became consumed with anxiety.
On the bright side, an examination conducted in March this year did not reveal any brain atrophy. Her weight returned to what it had been before, and she appeared healthier-looking overall. Because of her exposure to the atomic bomb, she had always been prone to illness. The number of pills that she takes daily is being gradually reduced, because of the possibility that the large number that she's been taking was causing negative effects.
Kishi walked using a cane when living at home, but now she depends on a wheelchair at the care facility. While she sometimes appears upbeat, a sad expression will suddenly cloud her face.
"Even though I'm surrounded by people, I am alone," she says. "When I feel lonely, I remember things from the past."
Kishi has become unable to express herself the way she wants to, and often struggles for words while speaking. While her recent memories are somewhat fuzzy, she remains able to discuss with clarity the story that she recounts having heard from her now deceased mother regarding her hibakusha experience. "I was exposed to the atomic bomb while I was still in my mother's womb," she explains.
She also has additional memories that will likely never fade: being bullied as a result of the leg disability with which she was born due to her exposure to radiation in utero; and the grief she experienced as an adult when others told her that her head was too small.
This year marks 70 years since the atomic bombing -- and 10 years since I first began interviewing Kishi. "You've certainly done your full share of speaking up and bearing witness, haven't you?" I ask her, in response to which her feeble-sounding voice suddenly perks up.
"No, I haven't spoken up enough," she replies. "I was born with microcephaly as a result of the atomic bombing -- and I am not the only one."
Kishi used to attend gatherings of a group called The Mushroom Club for people with A-bomb microcephaly, but she's lost touch with the other members. She is unable to get back in contact with them since she has forgotten how to use a mobile phone.
"I wonder how everyone is doing?" she muses. "I want to see them, but I'm not doing so well these days."
As she speaks these words, tears glisten in her eyes. (By Hiroko Tanaka, Osaka Cultural News Department)
(This is Part 2 of a new Hibakusha series)
photo:Kimie Kishi, who suffers from A-bomb microcephaly, gets her temperature taken with the assistance of a helper at her elderly care facility in the city of Miyoshi, Hiroshima Prefecture. (Mainichi)
80% of workers with dementia under 65 get fired or quit: health ministry
Apr 18, 2015
The Japan Times
About 80 percent of dementia patients under 65 have either had to quit their jobs or been fired by their employer, a health ministry survey showed Saturday.
The finding raises doubts about whether companies are helping employees under the age of 65 with dementia to continue working, for instance by shortening their work hours or transferring them to different sections.
The average age of people who develop premature dementia is 51.3. Symptoms vary among individuals, but patients who receive proper treatment at an early stage may be able to slow the advance of the disease.
The survey by the Health, Labor and Welfare Ministry, commissioned to a dementia research center in Aichi Prefecture, was conducted between the summer and end of 2014 by mailing questionnaires to medical institutions and nursing care facilities in 15 prefectures.
It drew responses concerning 2,129 patients with dementia aged between 18 and 64, of whom 1,411 were confirmed to have held jobs prior to developing the disease.
Of the 1,411 patients, 996 decided to leave their job before the official retirement age of 60 and 119 were laid off, accounting for a combined 79 percent of the total.
The number of patients who worked until the official retirement age came to 135.
The survey also analyzed the cases of 383 patients in detail, as neither they nor their families had directly provided responses.
The number of those working at the time they developed dementia under 65 stood at 221, of whom 74 percent later quit their job or were dismissed.
About 20 percent of these 221 patients said their employers had not given them any kind of special consideration, such as allowing them to reduce their work hours.
Although patients with severe symptoms could face difficulties in the workplace, there may also be some cases in which patients could have continued to work if their companies had taken special measures.
A 2009 estimate by the health ministry put the number of people suffering from dementia under 65 about 38,000 nationwide. The disease often strikes when patients are in the prime of their working life, resulting in a financial blow to households if they lose their jobs.
Missing man with dementia found by police went untreated before death
April 08, 2015
Police and rescue workers did not take an 83-year-old dementia patient found collapsed in Tokyo's Nakano Ward to hospital, and the man died a few days later, it has been learned.
According to police and members of the man's family, he went missing from a facility in Yokohama's Tsurumi Ward on the evening of Aug. 19, 2014, and his family reported his disappearance to Kanagawa Prefectural Police that night.
At around 10:20 a.m. on Aug. 21, the man was found collapsed on a street near JR Nakano Station. A rescue team from Nakano Fire Station arrived first, followed by an officer from a police box in front of Nakano Station. The man complained that he was thirsty, and he had a temperature of 37.6 degrees Celsius, but rescue officials have said that he reportedly refused to be taken to hospital.
Rescuers had the man sign a consent form with a check next to an entry saying that he had declined to be transported to the hospital though such a response was deemed necessary, and they left the scene.
The man gave his name when asked by the police officer, but did not mention his address. He gave his birth date as Feb. 26, 1951, when in fact it was Feb. 4, 1931. The officer gave him a drink of water and took him to Momijiyama Park, which was about 300 meters away, thinking it was a safe place where he could rest. The officer then had the man sit down on a park bench and left the scene.
However, shortly after 10 p.m. the same evening, police received a report that a man was sleeping in the park, and another officer from the same police box who didn't know about the events of that morning arrived to find him sleeping on the floor of a public restroom. When the officer asked the man if he wanted an ambulance, he replied that he was all right, and he nodded when the officer then asked him if he had no home. When asked for his age, the man simply said he was "all right." When giving his name, he provided a name that was one character different from his real name. At this point the officer left the scene.
The man was found dead of suspected dehydration and malnutrition near the restroom on the morning of Aug. 23. He was finally identified in February this year, after his family found information on a police website about his appearance and belongings.
The man had given his name correctly when he was first found, but police did not look him up at the time, and they were unable to identify him after his death until his family discovered the information about him.
Just two months before the incident, the National Police Agency had sent out a notice asking police to make an effort to quickly locate missing people with dementia. When asked why police did not take the man into custody or check his identity, the Metropolitan Police Department (MPD) said that he was not injured or in danger of injuring himself. It added that his responses were clear and the officers didn't think he had dementia, and that he could not be regarded as suspicious. On the morning of Aug. 21 he was presumed to be a local who had temporarily fallen ill. In the evening, police guessed that he had recently become homeless.
A representative of the MPD's community police affairs department commented, "We offer our sincerest sympathy over this loss. It's extremely regrettable that we weren't able to quickly confirm his identity. I think it would be difficult to say that there was necessarily anything wrong with the way police handled this, but we want to put (lessons from) this incident to use in the future."
The Mainichi approached Nakano Fire Station for comment after obtaining consent from the man's family, but the station said it can't talk to third parties, citing an ordinance on the protection of private information.
Early-onset dementia isolates patients
April 04, 2015
The Yomiuri Shimbun
A 67-year-old man in Kawasaki had been an employee of a major bank, working at its overseas branches and elsewhere for about 20 years as he had a good command of languages. After retirement, he was hired at the age of 62 by a company that does business overseas on the basis of his career at the bank.
Around that time his wife, 64, began to sense something wrong with him. He began to have trouble with his translation work, and started to bring more work to do at home. When he went to a sports gym in the neighborhood, he forgot which locker he had used to store his belongings.
The man ended up quitting his new job after a year. He repeatedly caused accidents while driving.
In February 2012, after much agonizing, the couple visited the Community Consultation Center for Citizens with Mild Cognitive Impairment and Dementia at the Nippon Medical School Musashi Kosugi Hospital in Kawasaki.
People troubled by forgetfulness can visit the center free of charge. They test such things like memories of dates or days of the week using a touch panel, and patients are interviewed by a clinical psychologist based on the results. If cognitive impairment is suspected, they write up a memo to provide information on their symptoms to a doctor.
As there were indications that the man might have been suffering from dementia, he was referred to a doctor at the hospital.
The former banker scored 25 out of 30 points on a cognitive function test that indicated a possibility that he had a slight cognitive impairment. Imaging tests confirmed atrophy in the brain and hippocampus, and he was diagnosed with Alzheimerfs-type dementia.
When a person suffers from Alzheimerfs, abnormal clusters of proteins accumulate in their brain and damage its nerve cells, which causes impairment to cognitive functions such as memory. Two-thirds of dementia patients are said to suffer from this type of Alzheimerfs.
The disease is treated with drugs that suppress the dissolution of neurotransmitters related to memory, but there is no medicine to stop the accumulation of proteins and offer a permanent cure.
Early-onset dementia that affects people younger than 65, just as in the case of this Kawasaki man, accounts for only about 1 percent of all dementia cases. Therefore, it is difficult for the symptoms of early-onset dementia to be recognized by people around those suffering from the illness.
The former banker could no longer go to a barber he used to visit alone on foot, and the couple started to have more days in which they stayed at home all day long. The wife knew her husband suffered from an illness, but she could not hold back her irritation, and once brooded, gThis situation will ruin both of us.h
Since June last year, the man has attended a daycare support center where he can meet other patients suffering from early-onset dementia. Attended by nurses and physiotherapists, the patients aim to increase brain function through activities such as painting and sports.
When his wife saw the paintings her husband made at the center and came home with, she said that she felt the heavy burden on her mind lessened a little.
Utako Yoshida, head of the corporate-status nonprofit organization, Group Mugi, in the city, which operates the daycare support center, said: gPatients with early-onset dementia and their families cannot discuss their troubles with people around them, and tend to brood over problems and isolate themselves. They need a place where they can feel safe and develop trust, not take it all on themselves.hSpeech
Art therapy tours enliven dementia patients and their caregivers
Mar 11, 2015
The Japan Times
In a quiet corner of the National Museum of Western Art in Tokyo, a small group of elderly dementia patients accompanied by relatives and caregivers gathered in December in front of a work by French avant-garde painter Pierre Bonnard.
Yoko Hayashi, representative director of Arts Alive, the organizer of the event, served as guide and moderator to help stimulate conversation among the group. gWhat do you see in this one?h she asked, pointing at the portrait of a woman.
g(She) looks like a ghost,h a 62-year-old male participant with dementia replied. Hayashi prods him further: gWould you like to go on a date with someone like her?h
The group included four dementia patients and seven relatives and caregivers. Sitting in folding chairs, they spent about 20 minutes at each painting.
Hayashifs questions were aimed at stimulating the participantsf imagination, such as asking them how deep they think the pond in the painting is, or what kind of sound a musical instrument in the painting makes. She purposely left all explanation about the painterfs intentions and other information until the end.
gThe answers are in each and every personfs own heart,h Hayashi said. gWe are all equal in front of the paintings.h
The concept of art therapy tours, first developed by the Museum of Modern Art in New York, is to help improve dementia patientsf well-being by stimulating their thinking and positive feelings through appreciation and discussions of artworks in museums.
Arts Alive brought the approach to Japan in 2010. While the benefits have yet to be medically proven, Hayashi said that gin addition to expressing their emotions, listening to what other people say can also provide mental stimulation.h
Some family members and caregivers have said that sometimes the participants are more expressive when viewing art than in daily life.
Emi Masuko, who accompanied her 73-year-old husband, Kazuo, who has dementia, said: gHis response changes at each painting. Just seeing that is already a great joy for me.
gFor my husband who usually tends to be ignored even when he expresses his opinions, it is also reassuring that here he is never ever being negated,h the Yokohama resident said.
Another woman, participating in the art tour for the third time with her husband, who has Alzheimerfs, said: gI was suffering from depression as a result of taking care (of my husband), but this cheers me up. It has also made our conversation as husband and wife more lively.h
Similarly, a female caregiver accompanying a patient in the tour also lauded the approach, saying people with dementia can participate in art appreciation events without hurting their pride.
For patients who are unable to make it all the way to a museum, plans for outreach programs to be held in nursing homes and other facilities in the near future are in the making. Minato Ward in Tokyo, for example, is considering adopting this approach at existing weekly cafe-style events it hosts for residents with dementia and their family members, with expectations that the art therapy will also contribute to preventive care.
Besides museum tours, other therapy methods use art to provide mental stimulation for dementia patients, such as gclinical art.h In this approach, people with dementia are shown objects such as fruit and are free to create drawings or sculpted artworks based on what they see or touch.
Aya no Sato, a nonprofit group home and day care facility for dementia patients in Kumamoto, is one such facility that has integrated clinical art and art appreciation therapy in its dementia care, such as through creative art and art-viewing programs.
gThe fact that there are still opportunities even for those with dementia to learn new things brings hope to the patients themselves as well as to their family members,h said Nao Okamoto, vice representative at Aya no Sato.
Dementia patients worry about handling money
The Yomiuri Shimbun
March 06, 2015
More than half those suffering from dementia say they feel troubled when they fail to remember where they keep their money, a poll conducted by the International University of Japan has found.
The university, based in Niigata Prefecture, conducted the poll from October to December last year for people with dementia, asking about problems they endure in their daily lives.
A team in charge of the study says it is the countryfs first nationwide poll to ask questions of dementia patients themselves, with one team member hoping gto utilize the results to improve planning to make local communities a better place for them.h
Survey sheets were distributed via associations of dementia patientsf families, support organizations and group homes for people with dementia. Two hundred and ninety-two people answered the poll ? directly, or indirectly through interviews with their family members or certified nursing care managers.
Problems often caused by memory decline stand at the top of problems dementia sufferers feel, with 51 percent of respondents saying they hate that they forget where they keep their money.
This was followed by worries about going out ? as they get lost at stations or are unable to find bus stops (50.7 percent).
The poll also found many dementia patients have problems handling ticket vending machines and automatic ticket gates at train stations, as well as problems with using ATMs.
Japan OKs new strategy to address expected rise of dementia patients
January 27, 2015
TOKYO (Kyodo) -- The government on Tuesday adopted a new strategy to bolster measures against dementia, expecting the number of patients to reach about 7 million in Japan in 2025 as the population ages.
The government aims to provide appropriate medical care and support for patients and their families and ensure closer cooperation across government ministries and agencies.
"We will pursue a framework and make it a model for the world," Prime Minister Shinzo Abe said at a meeting of relevant Cabinet ministers where the strategy was approved, referring to dementia as a "common challenge" around the world.
In the draft state budget for fiscal 2015 starting April, the government increased its allocation for dementia measures to 16.1 billion yen, up 6.6 billion from fiscal 2014.
The government's adoption of the new framework comes as Japan deals with a growing number of dementia patients going missing or becoming victims of consumer-related fraud.
Roughly one in five elderly people aged above 65 will be affected by the progressive neurological condition in 2025, when postwar baby boomers turn 75 or older, a Ministry of Health, Labor and Welfare study team has estimated.
The number of patients aged 65 or older was estimated at 4.62 million as of 2012.
The strategy features seven pillars such as introducing dementia diagnosis training in line with the government's goal to provide suitable medical treatment and care.
Another pillar of the strategy is to research and develop ways to prevent and treat the disease. By the end of fiscal 2015, the government will establish a system for early diagnosis of the illness and begin clinical trials of a cure by around 2020.
The government also aims to introduce in fiscal 2016 a scheme to enhance cooperation among primary care doctors, specialists and those involved in nursing care to provide support for dementia patients.
The new framework, dubbed the New Orange Plan, replaces the health ministry's five-year Orange Plan on dementia care implemented from fiscal 2013.
Abe announced his plans for a revised national strategy at an international conference on dementia care in Tokyo in November.
Robots to fill role in dementia care
January 17, 2015
While the nation faces a rising number of dementia sufferers, more businesses have begun to develop products and services to help patients and their families live more comfortably. As such products and services not only benefit society but are also becoming an important industry, companies are now launching full-fledged efforts to enter the market.
gPepper, dear, when is the next time youfll visit?h
gLook over here!h
In a third-floor lounge at Nishi-Koigakubo Ninjin Home, a special elderly nursing home in Kokubunji, western Tokyo, in November, elderly dementia patients spent time with Pepper, a humanoid robot with artificial intelligence being developed by SoftBank Mobile Corp.
The worldfs first robot designed to serve people by recognizing their emotions, Pepper is set to retail for \198,000 on the consumer market in February.
A new program is now under development to enable the robot to act as a conversation partner for those suffering from dementia. During its visit that day, Pepper played a game and showed off its dancing skills, thanks to the installation of a prototype program. Seeing the elderly residents smile as they chatted with Pepper, nursing home operator Harue Ishikawa expressed high hopes, saying, gEven with a manpower shortage in the nursing care field, we can provide a higher-quality service if such robots can take over some of the work.h
The number of people suffering from or at risk of dementia is estimated to have exceeded 8 million in 2012, and the figure is expected to increase even more.
Meanwhile, the percentage of households comprising either a single person aged at least 65 or an elderly couple without younger family members is forecast to rise from 20 percent in 2010 and reach 28 percent in 2035. There also are many senior citizens who live with younger family members but stay alone at home during the daytime while the others are at work.
Kaname Hayashi, who is involved in the development of Pepper at SoftBank, said, gWe see a demand for products that will prompt communication and support everyday life by asking the elderly if they have taken their medication and other questions.h
To help prevent the condition of elderly patients from deteriorating to the point where they require nursing care, the firm hopes to give people more options than simply relying on efforts by the central and local governments.
The company plans to develop a program to provide better support for dementia patients, such as by adding a function to encourage the elderly to talk about their memories. gPepper, who is indefatigable, can always be there as a conversation partner,h Hayashi said.
In 2011, Fujitsu Laboratories Ltd. chose dementia as a research subject.
First, the laboratory staff accompanied dementia patients and their families living in Tokyo on trips to pick mandarin oranges and visit hot springs, aiming to study the kinds of difficulties such people face in their daily lives.
gProducts designed for people with dementia should be easy enough for anyone to use,h said Makoto Okada, the labfs project leader. g[The study] will enhance the value of our products and services.h
PaPeRo, a communication robot developed by NEC Corp. and others, is already taking an active role at such places as nursing care facilities. The company hopes to make it available to the average consumer for less than \20,000 a month. gThe use of products specially developed for dementia patients has been limited to such places as nursing homes,h the company said. gBut we believe that they will be soon spreading to ordinary households.h
Kao Corp., which makes daily necessities, set up a special internal team in March 2014 and began research on the disease.
gVarious companies have taken an interest in dementia in the last few years, and wefve been receiving more inquiries,h said Takenobu Inoue, director of the Assistive Technology Department at the Research Institute of the National Rehabilitation Center for Persons with Disabilities. gIf well-known makers start to sell products and services that are dementia-friendly, it could play a major role in disease prevention. Wefre willing to cooperate with companies that can disseminate information.hSpeech
Dementia patients need support over when to stop driving
January 16, 2015
Driving by people with deteriorating cognitive functions poses various risks. Being behind the wheel requires the following abilities -- cognition, prediction, judgment and steering. However, people with dementia find it difficult to drive safely when the disease starts to affect their conduct and actions.
Depending on the types of dementia, there are different characteristic symptoms that emerge during driving. In the case of Alzheimer's disease patients, the typical symptoms include forgetting their destinations during driving and becoming poor at pulling a car over to the side of the road. With regards to Pick's disease, patients tend to ignore traffic rules, suffer from inattentive driving, and shorten the distance between their car and the car ahead. In the case of vascular dementia patients, they tend to be absent-minded during driving and become slow in steering and other operations.
However, there are no global medical guidelines for whether to allow those patients to drive. Naoto Kamimura, an instructor at Kochi University Medical School who is specialized in geriatric psychiatry, said, "There are no established medical standards around the world about when to stop (dementia patients) from driving. It is not necessarily the case that dementia patients lack driving ability. Patients with mild dementia do not lag behind in their ability to drive."
Banning dementia patients from sitting behind the wheel also means their family members are deprived of their means of transport. Yukio Takahashi, a psychiatrist in Shimane Prefecture, often receives consultations from dementia patients and their family members about the issue.
"When I tell dementia patients to stop driving, some of them say, 'Are you trying to kill me?' Patients continue to go shopping and do other things in their lives even after they develop dementia. If they are to be deprived of their driver's license, they would need to find alternative means to support their daily lives and purpose in life," he said.
A manual for family caregivers in supporting dementia patients was released by a group of researchers led by Yumiko Arai, head of the Department of Gerontological Policy at the National Center for Geriatrics and Gerontology. The manual offers tips on how to respond to dementia patients when they face the issue of quitting driving.
The manual recommends that family caregivers look for someone who can drive instead of dementia patients when they become unable to get behind the wheel -- from among family members, acquaintances and friends. It also advises caregivers to consult with municipal governments over public transport systems and other transport support services available in their area.
"It is necessary for family members and others around to confirm the meaning of driving for dementia patients and then help them secure alternative means of transportation," Arai said. "There are many people who find amusement and who live to drive, rather than it being a mere means of transport. It is also important to help them find something they can enjoy even after they quit driving."
Police to push for further dementia testing for older drivers
January 15, 2015
The National Police Agency is planning to tighten the rules on dementia testing for older drivers to reduce the number of road accidents involving these drivers, agency officials said Thursday.
Under the amendment to the traffic law proposed by the agency, drivers aged 75 and over suspected of having dementia after routine testing must quickly be seen by a doctor and submit a medical certificate in order to keep their license.
Additionally, drivers would have to re-sit the tests if they commit traffic violations that could be signs of reduced cognitive function, such as driving the wrong way down streets or running red lights.
The NPA will submit the amendment during the next ordinary Diet session starting Jan. 26.
Under a 2009 revision to the traffic law, drivers aged 75 or older currently undergo cognitive tests when renewing their driving licenses every three years. Drivers diagnosed with dementia can have their licenses revoked, but those categorized by the routine tests as suspected cases are not required to see a doctor as long as they keep a clean traffic record.
In more than 10 percent of accidents caused by driving in the wrong direction, drivers have later been found to have dementia.
"We want to prevent accidents involving elderly people, which have been on the rise, by recognizing high-risk drivers in a timely fashion," the NPA said.
According to the police agency, the total number of fatal road accidents in Japan has been decreasing every year for the past 14 years, but the proportion caused by drivers aged 75 and older has risen from 5.5 percent of the total in 2003 to 11.9 percent in 2013.
Data from 2013 shows that 10.8 fatal accidents per 100,000 drivers were recorded among those 75 and older, around 2.5 times the figure for those under 75 at 4.4 fatal accidents per 100,000 drivers.
Govt to bolster aid for early-onset dementia
January 09, 2015
The Yomiuri Shimbun
The government will strengthen aid for early-stage dementia patients and those younger than 65 with the disease, for whom support has been inadequate, according to a draft of the first national strategy for dementia. The draft is expected to be officially announced soon.
By establishing a system in which nurses visit patientsf homes across the country and setting up consultation centers for dementia patients younger than 65, the government aims to ease the anxiety of such patients and their families from an early stage and realize a society where they can continue living in areas familiar to them.
Prime Minister Shinzo Abe met Health, Labor and Welfare Minister Yasuhisa Shiozaki at the Prime Ministerfs Office on Thursday and received a report on a draft of the national strategy that was jointly compiled by 12 relevant ministries and agencies, including the health ministry, the Education, Culture, Sports, Science and Technology Ministry, the National Police Agency and the Consumer Affairs Agency. Abe reiterated orders to Shiozaki to proceed with tasks required for dementia issues through a national-level approach across the different ministries and agencies.
The draft clearly stipulates the government will seamlessly provide dementia sufferers with medical treatment and nursing care depending on the status of their symptoms.
At present, there are almost no public services for dementia patients at the early stages of the disease, who do not need nursing care. Therefore, the government intends to start an intensive support team system for those at the early stage of dementia in municipalities across the nation by fiscal 2018. Under the system, nurses and public health nurses visit patientsf houses to provide care after being trained by medical specialists. Only 41 municipal governments have or will likely have such a system as of fiscal 2014.
Regarding dementia patients younger than 65, the draft points out that the disease generates huge economic problems related to labor, living expenses and educational costs for their children. Therefore, the government plans to set up facilities for such patients and their families in every prefecture by the end of fiscal 2017 to offer a wide range of information, such as how to continue employment and how to obtain an identification booklet for the handicapped.
The draft also calls for a survey to be conducted on what types of support dementia sufferers need, and how patients and their families can participate in the governmentfs process of mapping out and evaluating aid measures.
In the draft, the government plans to advance such tasks as establishing a system to help patients who go missing, promoting school education and a nationwide campaign to help deepen understanding of dementia, and supporting the development of a nursing robot.
Japan to tackle rise in dementia patients to 7 million in 2025
January 08, 2015
The Japanese government drafted a strategy to enhance anti-dementia measures Wednesday based on estimates that patients will increase to about 7 million in 2025 from some 5.2 million in 2015 with postwar baby boomers turning 75 or older.
The projection indicates that roughly one in five elderly people aged above 65 will be plagued with the age-related illness in the rapidly graying country.
The draft strategy raises the target number of primary care doctors having completed dementia diagnosis training by March 2018 to 60,000 from the present target of 50,000 to help secure early diagnosis.
A research team at the Ministry of Health, Labor and Welfare, based on a long-term tracking survey in Fukuoka Prefecture, projected the number of dementia patients to reach 5.17 million in 2015, 6.75 million in 2025 and 8.50 million in 2060 if the dementia rate remains unchanged.
If the rate rises, the number is estimated to expand to 5.25 million in 2015, 7.30 million in 2025 and 11.54 million in 2060.
The number of patients aged 65 or older had been estimated at 4.62 million as of 2012 by another ministry study team.
The draft strategy also seeks that early intensive support teams for dementia patients be put in all of Japan's more than 1,700 municipalities from fiscal 2018, against only 41 in fiscal 2014 ending in March, and consultants to address young dementia patients aged below 65 appointed in all 47 prefectures by March 2018.
As Prime Minister Shinzo Abe pledged at an international conference on dementia in Tokyo last November, the government will shortly finalize the strategy, dubbed New Orange Plan, replacing the present five-year Orange Plan through March 2018.
Number of dementia patients to reach around 7 million in Japan in 2025
Jan 8, 2015
The Japan Times
One in five elderly people in Japan will have dementia in 2025, according to the governmentfs new estimate released Wednesday.
The number of dementia patients in Japan will reach between 6.75 million and 7.3 million in 2025 when postwar baby boomers turn 75 or older, the health ministry said in a projection.
A research team at the Ministry of Health, Labor and Welfare put the estimated number of dementia patients at 65 or older in 2012 at around 4.62 million.
The new projection was included in the ministryfs draft national strategy for enhancing dementia measures that was disclosed at a meeting of the Liberal Democratic Party. The government will shortly finalize the strategy, made up of seven major policies including measures focusing on the needs of the patients and their families.
At an international conference on dementia in Tokyo last November, Prime Minister Shinzo Abe vowed to devise a national strategy for tackling the age-linked illness in the rapidly graying country.
From fiscal 2016, the government plans to launch a long-term study of 10,000 patients across the country to investigate the mechanism through which the illness develops.
The degenerative disease often starts as memory lapses, then progresses to more severe impediments such as losing track of time and place, and loss of mobility.
According to the 2013 health ministry study, Alzheimerfs is the most prevalent type of dementia, affecting two thirds of the patients. Nearly 20 percent have vascular dementia, caused by strokes. The third most common type is Lewy body dementia, which plagues 4.3 percent of all patients, and is closely associated with Parkinsonfs disease.
The study also found women were more susceptible, particularly those aged 85 and above.
Dementia in Japana 2010`2014