DEMENTIA IN JAPAN
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.
Bank Tellers Serve as Dementia Care Givers in Aging Japan
Dec 26, 2014
They would enter the bank and ask for their cash. Yuriko Asahara, behind the counter, would check where they would stash it -- in the side pocket of a handbag or perhaps deep down in a shoulder bag.
Asahara wasnft spying. She knew shefd have to remind them within an hour or two. Many of her clients suffered from dementia, and over two decades the bank manager became a self-taught expert in the disease.
Globally, an estimated 44.4 million people suffer from dementia and the figure is projected to triple to 135.5 million in 2050 as the population ages, Alzheimerfs Disease International estimates. Nowhere is the problem more acute than in Japan, where an estimated 8 million people have dementia or show signs of developing it. By 2060, 40 percent of Japanese will be over 65, up from 24 percent today, according to National Institute of Population and Social Security Research.
gAt first I didnft understand why they would lose things so many times in a day and I got frustrated,h said Asahara, a former branch manager at Japan Post Holdings Co., the countryfs biggest holder of bank deposits. gGradually, I learned to look them in the eyes and to be sensitive about what could be occupying their minds.h
The Japanese government, faced with record debt, is raising premiums and reducing access to state-funded nursing homes. With about 520,000 elderly on waiting lists for placement, many spend their days wandering in shopping malls and making trips to their banks to check their savings.
Companies are encouraging workers like Asahara, 64, who retired this year, to help forgetful elderly navigate their stores. The push stems partly from a sense of civic duty. Itfs also a realization that helping seniors is good for business. The market for goods and services purchased by seniors reached 100 trillion yen ($830 billion) in 2012, according to NLI Research Institute in Tokyo.
Corporations targeting elderly business is part a nationwide phenomenon to reckon with a graying Japan. About 5.4 million people, from apartment managers to bank employees, retailers and even children, have taken a government-funded course to learn about dementia and how best to behave with people who show signs of the disease.
Aeon Co. (8267)fs program, which began in 2007, has trained about 10 percent of the retailerfs 400,000 employees. Clerks who once scolded customers for opening food packages and for eating without paying are learning to show more empathy, said Haruko Kanamaru, general manager of social affairs at Aeon.
The focus on seniors is ga large portion of our business strategy,h Kanamaru said. gWe are improving services handling troubled elderly customers.h
Japanfs government-backed training program has inspired the U.K. to pursue a similar tack, said Jeremy Hughes, chief executive of Alzheimerfs Society, a London-based charity group. Although a leader in dementia treatment, the U.K. began an educational program called gdementia friendsh only last year, aiming for 1 million people by 2015.
While the U.S. has no national plan to educate citizens, some communities are running local programs. In Watertown, Wisconsin, the gDementia Friendly Campaignh started last year gives free educational session to residents and business owners. In Minnesota, a state-wide advocacy group, Act on Alzheimerfs, created toolkits to guide communities to become dementia friendly.
Many developed countriesf leaders have pledged to combat dementia, emphasizing community-based care. In December last year, the Group of Eight nations set a goal of finding a cure for dementia or a way of modifying the diseasefs course by 2025.
gTherefs an understanding that we shouldnft lock people up,h said Marc Wortmann, executive director at Alzheimerfs Disease International. Instead, communities should gtry to integrate them and keep them in societies.h
More than a dozen customers needed extensive assistance at Asaharafs bank branch, the former manager said. She and five colleagues learned to be patient and to listen.
They spent hours helping those clients find lost passbooks, reset PINs for ATMs, and understand their utility bills. Many elderly clients were obsessed with money, Asahara said. One woman, now in her 80s, constantly lost track of withdrawals from the time Asahara took the job 20 years ago.
When the national program, called Dementia Support Caravan, began in 2005, apartment managers were the first to join. They were dealing with tenants who complained about elderly neighbors banging the wrong doors, failing to sort bins, stealing newspapers and rubbing human waste on communal walls, said Hiroko Sugawara, who runs the program. Now demand is rising across corporate Japan.
gCompanies are proactive because they are desperate to learn ways to respond,h Sugawara said.
The branch Asahara oversaw is in the heart of Nagabusa, outside of Tokyo city center and representative of many of the countryfs suburban, aging cities. The area is filled with rows of industrial looking apartments for more than 3,000 households. Built in the 1960s and 1970s, they hosted young families when Tokyo hosted the summer Olympics in 1964 and Japanfs economy boomed.
Fifty years later, the residents have aged and their children have moved out. Seniors over 65 made up about 29 percent of the areafs population in 2011, above the national average, according government data.
Asahara, who took over the job from her mother, saw the neighborhood change over the years.
gLittle did I imagine that it would be this way when I started,h she said. gBut itfs the reality of an aging nation.h
Asahara helped confused customers and, when necessary, reported serious cases to families and social workers. There were people who wore sweaters on hot days, or frothed at the mouth from dehydration, or looked emaciated. When she spotted her customers lost on streets after grocery shopping, she drove them home.
She arranged to replace house keys three times for a woman suffering from dementia. One morning, the woman said she had spent the night at another elderly womanfs house after losing her keys again. The other woman, a stranger she had met in the streets, also had dementia, Asahara said.
Some of the people she has helped over the years have families who live too far away to notice their loved onesf mental health deteriorating. Others are too scared to share problems with relatives, Asahara said.
gWe see their decline closely and perhaps knew more about them than their relatives,h she said. gI canft ignore them because one day we all get older and can suffer from dementia.h
Now that Asahara has retired, her son Takushi Asahara, 36, who joined Japan Post a couple years ago, has taken over her position. Eight months into the job, he said the extent of aging in the community exceeded what he had imagined.
Takushi said he is impressed by how the branchfs veteran workers handle elderly customers.
gAt first I used to think the branch should focus on expanding the business, rather than spend so much time dealing with the elderly with troubles,h he said. gI learned I was wrong. We must take a good care of them for our survival.h
To contact the reporter on this story: Kanoko Matsuyama in Tokyo at email@example.com
To contact the editors responsible for this story: Rick Schine at firstname.lastname@example.org Cecile Daurat
Capacity of Tokyofs elderly care homes to be boosted
Dec 26, 2014
The Tokyo Metropolitan Government said Thursday it plans to boost the capacity of nursing care facilities in the capital.
Ahead of the 2020 Olympics in Tokyo, the metropolitan government will take steps to make the capital more friendly to foreign visitors, it also said in a report on its long-term vision.
By the end of fiscal 2025, the total capacity of special nursing care facilities for elderly people with severe disabilities will reach 60,000 tenants, 1.5 times the level at the end of fiscal 2013, which ended last March, according to the report.
In calendar 2025, a quarter of all Tokyo residents will be 65 or older, the report said, calling for boosting the capacity of group homes for elderly dementia sufferers 2.3-fold to 20,000 tenants and doubling the capacity of serviced apartments for the elderly to 28,000 tenants.
The metropolitan government will provide subsidies to those opening child care centers, aiming to raise the capacity for such facilities by 40,000 children to 275,000 to eliminate waiting lists for such centers.
The metropolitan government also aims to increase the annual number of foreign tourists to 18 million by 2024 from 6.81 million last year. Free Wi-Fi will be made available at a larger number of places, according to the report.
The metropolitan government will create a so-called English village for elementary through high school children in fiscal 2018 to give people the opportunity to spend time in an English-language environment.
Govt outlines 7-pillar strategy to deal with dementia
December 21, 2014
The Yomiuri Shimbun
The Japan News
As measures to help the estimated 8 million people in the nation with dementia or incipient dementia, the government intends to establish seven pillars, including the promotion of greater public awareness of the disease, according to a draft outline of the governmentfs first national strategy to tackle the issue.
The strategy, dubbed the gNew Orange Plan,h is aimed at creating a society in which people with dementia can continue to live in the areas they are accustomed to. The seven pillars listed in the draft outline also include the creation of regional areas prepared to deal with such issues as missing persons, development of preventive measures and treatment, and emphasis on the point of view of people with dementia, it was learned Friday.
The government is expected to officially decide on the plan by mid-January next year.
Prime Minister Shinzo Abe announced the governmentfs intention to devise the plan at a conference on dementia in Tokyo in November. Led by the Health, Labor and Welfare Ministry, a total of 12 ministries and agencies jointly compiled the plan, which contains measures the entire country should tackle by 2025, when members of the baby boom generation will be 75 or older.
According to the draft, the government will introduce a program to provide interaction with dementia sufferers and others at schools, to deepen understanding of the condition across generations. It will also launch a national campaign in which people with dementia talk about their feelings.
A watch system will be established to find and protect people who go missing as a result of dementia-related wandering. The government will work to create regions where people can continue to live comfortably even after developing dementia, through such steps as supporting their employment and participation in society.
To ascertain what kind of help is needed in the early stages of dementia, before services are required under the nursing care insurance system, the government will investigate patientsf needs. It will promote policies based on the opinions of people with dementia and their families, for such purposes as strengthening support for families caring for people with dementia.
The government will conduct a large-scale public survey as part of research into prevention and treatment, including blood tests and genetic analysis. It will also develop robots that can assist with care, and equipment utilizing information and communications technology.
Emergency rooms struggling to treat people with dementia: poll
NOV 27, 2014
Hospitals with emergency departments are having difficulty caring for people with dementia, a survey led by the National Center for Geriatrics and Gerontology says.
About 94 percent of the hospitals that replied said it was difficult to provide care to people with dementia when they are rushed in to treat injuries or illness, citing the risk of patients falling, miscommunicating or failing to cooperate on checkups and treatment.
The results ? to be presented at an academic conference on dementia starting Saturday in Yokohama ? are likely to raise concern that such patients may not get sufficient medical treatment when in need of urgent care.
Dementia is a pressing issue in Japan, where roughly 8.62 million people ? or about 25 percent of the population above age 65 ? either live with illness or are at risk of developing one. This number is expected to continue rising with the aging of the postwar baby boomers in a country with one of the longest life expectancies in the world.
Dementia, caused by the death of brain cells, leads to memory and language impairments that are severe enough to interfere with everyday activities.
Difficulty communicating with such patients was the main problem cited by hospitals that participated in the survey. In fiscal 2013, questionnaires were sent to 3,679 hospitals throughout Japan with emergency care departments and 589 provided valid responses.
More than 70 percent said they had to physically restrain patients with dementia, even though that is only allowed for gemergency or unavoidable casesh when providing nursing care.
The use of restraints and sedatives is under review in various countries.
The survey found that Japanese hospitals said they take such action to ensure gthe safety of patients.h
With the cooperation of the Alzheimerfs Association Japan, the survey included responses to questionnaires sent to 500 people with dementia.
Of the approximately 300 who sought treatment by going to the emergency ward, 6.9 percent said they were not medically examined or had been refused hospitalization.
In the comments space, one person wrote he or she was told a family member had to be present round the clock in order to be admitted.
Another wrote of having difficulty walking after being physically restrained for two months by the hospital.
Team unveils blood test regimen to detect Alzheimerfs before symptoms appear
NOV 11, 2014
THE JAPAN TIMES
A group of Japanese experts announced Tuesday that they have developed a blood test measure to detect signs of Alzheimerfs disease before patients show symptoms.
The discovery by a team led by Koichi Tanaka, a Nobel Prize in chemistry laureate and a senior fellow of Kyoto-based Shimazu Corp., and Aichi-based National Center for Geriatrics and Gerontology, was revealed in a magazine issued on the day by the Japan Academy.
One of the causes of Alzheimerfs disease is abnormal accumulation of the protein amyloid beta inside brains. With the newly developed test, the team will examine how the protein builds up and how it harms a suffererfs cognitive functions, as there are some people who accumulate the protein but do not suffer from the disease.
gThe accumulation of amyloid beta is the start of Alzheimerfs disease. So wefd like to develop medicines or treatment to deal with it,h said Katsuhiko Yanagisawa, vice director of the center.
The team is monitoring the brain conditions of 62 male and female examinees aged 65 to 85 by using positron emission tomography (PET). They analyzed their blood after confirming that their amyloid beta had accumulated.
Using a device for quality and quantity analysis developed by Tanaka and other experts, the team can detect small amounts of a protein related to amyloid beta that had never been detected before.
They are able to judge with high accuracy whether amyloid beta is accumulating by checking the ratio of this related protein as well as another type of related protein.
In the past, the only way to check if amyloid beta had built up was via PET, which is costly, or an examination of cerebrospinal fluid taken from a patientfs spinal cord. gThe amount of blood necessary for a test is just 0.5 cc. Wefd like to make it one of the options attached to regular health checks in the future,h Tanaka said.
Japan to adopt new strategy on dementia care: Abe
TOKYO (Kyodo) -- Prime Minister Shinzo Abe said Thursday at an international conference on dementia care in Tokyo that Japan will work out a new national strategy to boost measures dealing with the age-linked illness in the rapidly graying country.
"By enhancing our nation's measures regarding dementia, not only the Ministry of Health, Labor and Welfare but the entire government will work together to support the lives" of people suffering from dementia, Abe said on the final day of the two-day event that saw experts from around the world discuss prevention and treatment of the progressive neurological condition.
The new framework will involve revising the health ministry's five-year plan on dementia care implemented from April last year and enhancing cooperation across government agencies.
The ministry said it plans to conduct from fiscal 2016 its first ever nationwide study into the mechanisms of dementia development and prevention, following 100,000 men and women over the age of 40 without dementia.
The study will document their daily habits, including diet, exercise and whether they smoke, and record data collected in blood tests, such as genotype and changes in blood-sugar level, to gauge possible links to the disease.
The government hopes to draft the new strategy by year-end to secure necessary funding in its draft national budget for fiscal 2015 starting April.
The strategy will also call for increased professional and nonprofessional support across the country for dementia sufferers and their families, making it easier for individuals with dementia to receive care in their own communities.
"Building a society where people with dementia feel at ease is a common challenge for the world. As the country with the fastest-aging population, it is our responsibility to become a model for tackling the matter," Abe said.
But whether his government can resolve issues including funding and address the actual needs of dementia sufferers and their families remains to be seen, experts say.
Dementia is a pressing issue in Japan, where roughly 8.62 million people -- around 25 percent of the population above 65 years old -- either live with the illness or are at risk of developing it. The number is expected to continue rising as the country's postwar baby boomers get older.
Britain, which hosted the dementia summit meeting of Group of Eight nations last December, adopted a national strategy on dementia care in 2009.
The event in Tokyo attended by about 300 people was one of several following up the summit in London. The World Health Organization will host a meeting of health ministers in March to spread awareness of the disease among other countries.
November 07, 2014
Dementia survey to cover 10,000 people
Prime Minister Shinzo Abe announced Thursday that the government will map out a new national strategy to address dementia in which all ministries and agencies jointly tackle issues related to the disease and also conduct a nationwide survey targeting 10,000 people to help develop effective treatments.
gWe will map out a new strategy to accelerate the nationfs measures to deal with dementia,h Abe said during an international conference on dementia in Tokyo. gThe government will work as one to support the lives [of dementia patients and their families].h
During the three-day Group of Seven meeting on the disease, which ends Friday, Abe said the government gwill conduct a nationwide follow-up survey on residents to promote the study of dementia and help develop treatments.h
Abe added that the government plans to start the survey, which will cover about 10,000 people nationwide, from fiscal 2016.
As part of measures to address dementia, the Health, Labor and Welfare Ministry launched a five-year plan in fiscal 2013 dubbed the gOrange Planh to help dementia patients live in the community.
About one out of four elderly people in the country is suffering from dementia or incipient dementia. Given the circumstances, a wide range of issues need to be addressed with regard to the disease.
In addition to medical and nursing care, the Consumer Affairs Agency, for example, needs to draw up measures to deal with illegal business practices and the National Police Agency needs to take measures when dementia patients go missing.
The Education, Culture, Sports, Science and Technology Ministry, meanwhile, needs to raise awareness of the disease at school.
Therefore, there have been increasing calls for the government to unite to tackle those issues.
Britain and the Netherlands have national strategies to address dementia.
The nationwide survey under Japanfs envisioned national strategy will also cover nondementia patients and continuously examine their lifestyle and blood chemistry.
The government is also considering analyzing genetic information of the people surveyed.
The planned survey is aimed at identifying factors that may cause dementia and utilizing data obtained for the prevention and study of the disease. The survey will likely be conducted every year from fiscal 2016 to fiscal 2020.Speech
November 07, 2014
The Yomiuri Shimbun
As I See It: All society must cooperate to protect wandering dementia patients
The issue of people with dementia wandering, going missing or even being killed in accidents, has garnered much public attention recently. The problem's rising profile is due in great part to incidents such as these being reported in the media, and to news of a court ruling that the widow of a man with dementia hit and killed by a train in Nagoya must pay damages to the railway company for lost operating profit.
Families of dementia patients who have been in accidents struggle with the guilt of having left their ailing family member unsupervised. However, families alone cannot protect dementia patients who have a tendency to wander. Understanding and cooperation from communities and society are indispensable. I am certain of this as someone who has cared for a 75-year-old mother with Alzheimer's who wanders.
My family and I live in Kyoto. My mother was diagnosed with dementia four years ago, and currently has a care-needs certification of five -- the highest level. She cannot do most things by herself.
She began wandering around two years ago, mostly inside the house. Eventually, she came to wander constantly except at meal times and when she slept, and frequently left the house without telling anyone. At first, she often walked to the area around a nearby supermarket that she used to frequent, then returned home. At one point, however, a relative found her 1.5 kilometers away from home. To get where she'd gone, she'd had to cross at least two very busy roads. I was relieved that she was safe, but horrified by the thought of what could've happened.
Along with my 83-year-old father, my wife and I, who live next door to my parents, cared for my mother. Woken by my mother numerous times at night, however, my father began to fall asleep during the day. And that was when my mother would wander outside. On numerous occasions, neighbors guided my mother home or staff at a senior daycare facility that my mother used to go to escorted her home.
Many families struggle with wandering loved ones. According to a survey conducted in fiscal 2010 by the Alzheimer's Association of Japan (AAJ), an organization for families of those with Alzheimer's, around 20 percent of families with dementia patients said they had trouble dealing with fire safety and wandering, while some 40 percent said they were overwhelmed with having to constantly supervise their ill family members.
Science has not yet been able to fully explain why dementia leads to wandering. A research team at the Ministry of Health, Labor and Welfare has been analyzing the problem from various angles, including who does or does not wander, what kind of care those people are receiving, and how much their brain has atrophied. Takao Suzuki, who heads the research team and is director of the research institute at the National Center of Geriatrics and Gerontology, says, "We don't even have a set definition for wandering. Research has only just begun."
This spring, my mother was placed in a group home where dementia patients live together. I'm disappointed that we couldn't keep caring for her at home, but at least we've been freed from the fear that she might be in a serious accident. I believe that my mother had remained safe for as long as she did because she lived in the same community for a long time and was supported by those who knew her. But I doubt this is the case in larger cities where people tend not to have strong personal ties with their neighbors.
Knowing what my father experienced, I think there's only so much care an elderly person can provide another elderly person. We live in a time, however, where it's possible that those with dementia will have to care for each other.
In the case of a 91-year-old dementia patient who was killed by a train, the Nagoya High Court in April ordered the man's then 85-year-old wife to pay damages to the railway company for lost earnings for failing to supervise her husband. It is unrealistic, however, for an elderly spouse to constantly stand guard over a dementia patient. And for many, it is not economically feasible to hire homecare specialists around the clock.
Nationwide, there are an estimated 4.62 million people with dementia aged 65 and older, and another 4 million are likely to develop dementia -- a total equal to about one in four people in that age group. This figure is sure to increase with the aging of the Japanese population.
Please do not think of accidents involving wandering as something that does not concern you. AAJ President Kunio Takami believes it's an issue that society must tackle as a whole.
"If an accident occurs, a family cannot object to accusations of insufficient supervision. But no matter how hard a family tries, they cannot prevent wandering. Accidents can happen to anyone," he says.
My wish is for the establishment of a permanent forum where patients and their families, communities and various levels of government join police and public transport to understand the current state of affairs and take ownership of the problems stemming from them. To deepen understanding among local residents, communities can hold training programs on how to protect dementia patients who wander, as does the Fukuoka Prefecture city of Omuta.
There are steps each of us can take in our everyday lives. If we see an elderly person who appears to be at a loss, we can approach them to see if they need help. And if we have family members with dementia, we must not hide it or try to shoulder the burden all alone.
The Alzheimer's Disease International organization has designated Sept. 21 World Alzheimer's Day. This year, focus was placed on the need to form bonds between residents when communities make the effort to protect those with dementia. I sincerely hope that the recent rise in reports relating to dementia and the resulting public interest in the issue serve as an opportunity for us to think about how to create a society in which both patients and their families can live with peace of mind. (By Takuto Imanishi, Osaka City News Department)
September 27, 2014(Mainichi Japan)
3 women arrested over alleged theft from elderly woman with dementia
Three Tokyo women were arrested on Sept. 23 on suspicion of stealing money from the bank accounts of a 90-year-old dementia patient, police said.
The Metropolitan Police Department has arrested 64-year-old health care worker Momoyo Yamagata, Keiko Makishima, 75, and a 78-year-old woman who lives in the same apartment complex as the victim.
Yamagata is suspected to have fraudulently withdrawn a total of 2 million yen on three separate occasions from late October to mid-December last year by using the victim's cash card and personal seal that Yamagata had stolen from the victim's home.
The other two suspects, meanwhile, are alleged to have taken 1.5 million yen out from the woman's account at a credit union in early December last year by pretending to be the victim.
According to police, the 78-year-old suspect lived in a room next to the victim and introduced Yamagata and Makishima to the woman. The group had hung around at the woman's house since around July 2012, claiming that they were taking care of her.
A judicial scrivener, who acts as a legal guardian of the woman, notified Shitaya Police Station in March this year after discovering that a large sum of money had been withdrawn from the woman's accounts. The woman suffers from severe dementia and cannot even remember her own home address.
Police suspect that the three stole over 10 million yen from the woman. Yamagata and the other suspects have denied the allegations, saying that they were asked to withdraw the money from the accounts.
September 24, 2014(Mainichi Japan)
Certain foods linked to reduced incidence of dementia
July 27, 2014
FUKUOKA -- An ongoing epidemiological study conducted in a small town in Fukuoka Prefecture has shown certain dietary patterns to be associated with reduced risk of dementia.
For about the last half century, residents' ages and occupations in the town of Hisayama (pop. 8,339 as of July 1), located to the east of the city of Fukuoka, have remained about the same as the national average. For this reason, Kyushu University set up a research lab in town and began conducting an epidemiological study of its population starting in 1961, under the belief that results would reflect the general Japanese population.
Researchers began studying dementia in Hisayama in 1985. According to an analysis of data collected from 1,193 residents aged 60 and older over a period of 17 years, the rate by which seniors developed dementia in their lifetime was found to be about 55 percent.
For 17 years, the research team tracked the diets of 1,006 people aged 60 to 80 who did not show symptoms of dementia at the beginning of the study. Of these subjects, 271 developed dementia -- of which 144 had Alzheimer's and 88 had vascular dementia. Kyushu University researcher Mio Ozawa looked into the links between the onset of dementia and the amount of foods such as rice, bread, noodles, potatoes, soybeans and miso that was consumed.
Ozawa and her team found that a diet abundant in vegetables, dairy and soybean products and low on rice was associated with a reduced incidence of dementia. Researchers also indicated numerically the impact that certain foods have on dementia prevention. The figures show that it is better to cut back on rice, but a study of rice on its own does not show any links between the food itself and the onset of dementia.
"When one eats more rice within a diet that can only contain so many calories, the more rice one eats, the less vegetables and other foods one can fit," Ozawa explained, "which may be why increased rice consumption is linked with an increased likelihood of developing dementia."
As for milk and other dairy products, which made the list of foods whose intake should be increased, the researchers found that the calcium and magnesium found in dairy products were effective in preventing dementia. Dairy also contains an abundance of vitamin B12, which has the effect of reducing homocysteine levels, which are believed to raise the risk of Alzheimer's; consumption of dairy reduced the incidence of dementia, including Alzheimer's, the researchers said.
"There are no established treatments for dementia, nor are there any preventative drugs for dementia," said Yutaka Kiyohara, head researcher of the Hisayama Study. "We hope to help prevent the disease by understanding the reality of dementia through epidemiological research and shedding light on the risk factors.
Epidemiological studies rely on statistics to identify the relationships between the causes and outbreaks of disease. Hisayama residents 40 years old and older are eligible for Kyushu University's Hisayama Study, which is carried out as a collaborative effort between Kyushu University and local doctors, and at least 80 percent comply. With the help of the municipal government, researchers continue to seek the cooperation of those who have moved outside the town's borders, with about 99 percent success. Some 80 percent of residents agree to autopsies, allowing researchers to identify diseases and causes of death. As a result, the study is considered unparalleled around the world. Specialists make diagnoses in the case of dementia, too, and autopsies confirm dementia in many cases.
DEALING WITH DEMENTIA@B
Assistance for vulnerable elderly on the rise
Communities practice to prevent confused seniors from vanishing
by Mami Maruko
Jul 4, 2014
Last in a three-part series
The growing issue of people with dementia getting lost and failing to return home ? sometimes for years on end ? is pushing more municipalities to support the elderly at the community level.
According to the National Police Agency, 10,322 elderly people with dementia were reported missing in 2013, up from 9,607 in 2012.
The problem stirred public interest when it was reported in May that a 67-year-old woman who had gone missing in Tokyo since 2007 was reunited with her family at a nursing home in Gunma Prefecture.
The woman went unidentified for seven years because police could not figure out her name, address or other basic information.
Kumiko Nagata, a manager at the Dementia Care Research and Training Center in Tokyo, said itfs important for people to carry basic identification once they get older, even if they donft have dementia. She said itfs also a good idea to prepare a list of places that seniors or their kin visit on a daily basis to help find them in case they get lost, sick or have an accident of some sort.
Although this is simple to do, Nagata said many adults may not find the idea appealing. She suggests they carry basic ID in a nice key holder or other object that suits their tastes.
She believes that dealing with the issue of seniors with dementia disappearing should be tackled at the national, local, and family levels.
The Health, Labor and Welfare Ministry announced June 10 that they will begin studying the behavioral patterns of elderly who get lost starting this summer. It plans to ask each prefecture to look into the routes on which the incidents occur, and to keep track of what kind of psychological state each person was in at the time.
It has also asked each prefecture to tally the number of people who have vanished and the number of unidentified elderly they have found who are now being cared for in local nursing homes. They have also been asked to report the level of nursing care that their seniors receive.
On a municipal level, many prefectures are tackling the problem with help from their communities.
For example, the city of Omuta, Fukuoka Prefecture, has created several programs over the past decade that match the needs of the elderly and their families, aiming to turn the city into a place gwhere the elderly can feel at ease to wander around.h
In Omuta, where nearly a third of the residents are 65 or older, annual training sessions have been held since 2004 to help people deal with confused seniors who are apparently lost. Even elementary school and junior high school students participate in the program, local officials said.
The sessions involve residents holding role-playing scenarios in pairs, with one member acting as the lost person. The participants practice such approach phrases as gAre you having some kind of problem?h or gAre you OK?h while speaking in a soft voice. The drills also show them how to report missing persons.
gIt all started from the residentsf side, in which the Hayame South Humanity Network, one of the co-ops in Omuta, had a strong desire to prevent isolated deaths from occurring among the cityfs elderly,h said Seigo Nitta of the Omuta Municipal Government.
The project has expanded to more than 2,000 residents, with the sessions now held by the municipal office, he said.
gWe need to think why wefre holding these sessions. When some elderly gets lost in the local community, of course itfs important to seek out those who are missing,h he said. gBut whatfs equally important is the preliminary step, where we need to make a community or a system that works, where we can watch over and cooperate with people with dementia and their families.h
To this end, the local municipal office has created a network that includes the police, fire department, post office and local companies.
The city of Matsudo, Chiba Prefecture, has a similar program. An official in the senior citizens support section of the Matsudo Municipal Government said continuing such programs is important because gthe more eyes there are that look out for the elderly in town, the more likely it is that the community will find out when something unusual, such as an elderly person wandering around, is happening.h
In the Matsudo workshop, volunteers learn what dementia is and how they can help those with the disease, through a nonprofit organization called Caravan Mate, which holds workshops to train volunteers.
In May 2014, 2,096 people signed up to become members of Orange Koekake Tai (which roughly means Units That Call Out to the Elderly), where they voluntarily speak up whenever they see an elderly person wandering around town.
gItfs very important to raise public awareness, but more importantly, we should increase the number of supporters who help the elderly and who have correct knowledge about dementia,h the official said.
Nagata points out that itfs also vital for the elderly themselves to make an effort to connect with the community.
gThey donft have to do anything special. These days there are a wide range of social activities organized by local governments, and they can learn about them in their local paper or by word of mouth,h she said.
gBeing an elderly or a dementia patient spans a long time, so therefs a limit to relying on just the family or experts,h Nagata said. gItfs important to start early, even before you get dementia, to find places and people that you can spend fun time with and talk about the small things that worry you.h
People should make an effort gto make as many ties as possible in the local community, so that youfre not alone when you grow old,h she said.
DEALING WITH DEMENTIA@A
Early onset dementia poses special problems
Families, officials alike hampered by poor grasp of the malady
by Tomohiro Osaki
Jul 3, 2014
Second in a three-part series
Whenever her dementia-afflicted husband went to bed, Reiko Ozawa would sigh in relief and sometimes wish he would never wake up.
That was because once he did, a living nightmare would await her, as her husband, Kunio, would tend to wander off, rant at her and even suffer hallucinations.
gMy marriage with you was the biggest mistake of my life,h Kunio, who passed away six years ago at age 64, once shouted at Ozawa in one of his worst outbursts. It didnft take long before he reverted to what appeared to be a childhood mentality, calling Ozawa gmom.h
So far, so typical for dementia patients and the people who look after them.
Except that by the time all these symptoms came to light, Kunio was still in his late 50s, four years after he was first diagnosed with Alzheimerfs at age 54 in 1998.
gWe were all shocked, because back then, being diagnosed with dementia at such a young age was utterly inconceivable,h said Ozawa, 66, who now heads a self-help organization called Hoshi no Kai (roughly Group of Reshining Stars) for early onset dementia patients and their families.
Early onset dementia affects people younger than 65, but experts say the belief that dementia only strikes seniors remains pervasive, obfuscating the plight being suffered by the conditionfs younger patients.
Going by the numbers only, there are few patients with early onset dementia. A 2009 Health, Labor and Welfare Ministry survey found an estimated 37,000 such patients, with some as young as 18. In contrast, the number of dementia patients older than 64 hit 4.6 million nationwide in 2012, when the ministry last ran a survey.
Like their older counterparts, victims of early onset dementia show such symptoms as uncharacteristic irascibility, memory loss and an inability to communicate verbally. Most typically, early onset dementia begins in their 50s.
No fundamental cure or prevention measures exist. Studies suggest men are slightly more susceptible than women, in contrast to dementia patients in the 70s and older, among whom women have been shown to be more vulnerable.
The government set up a call center in 2009 geared toward families of early onset patients and made it easier for the patients to use the government-run nursing insurance system.
One of the biggest problems facing people with early onset dementia is that severe memory loss will force almost all of them to leave their jobs.
Because the majority of early onset patients are male and in many cases the household breadwinner, Ozawa says member wives in her organization often speak of the looming financial woes stemming from the sudden loss of income.
Ozawa said she herself lived with the fear of poverty when her husband, who was formerly employed by a foreign-owned pharmaceutical company, was pressured into quitting when he started showing symptoms.
Without any other sources of income, the Ozawas ended up selling the house they had built just five years before because they couldnft afford the mortgage.
Another difficulty typical of early onset patients has to do with their relative youth and physical strength. Families and experts point out that senior care facilities often refuse to admit early onset patients out of fear they will be aggressive toward nurses and fellow residents.
In one case, 64-year-old Emiko Takahashi, who heads a self-help group called Chiisana Tabibito Tachi no Kai (A Group for Small Travelers), said her husband, Akito, diagnosed with Alzheimerfs at 57, was kicked out of a nursing home after accidentally knocking down more senior residents.
According to Yukiko Komai, head of a Tokyo-based public support center for early onset patients, these facilities think of seniors in their 80s or 90s as their primary patrons, so their services often fail to cater to younger people like Akito.
gA man in his 50s, for example, would no doubt feel uncomfortable being forced to sing nursery rhymes and do origami (with other residents). But the reality is that few of these nursery facilities have expert knowledge about how else to entertain and accommodate him,h Komai said.
Both Ozawa and Takahashi agree that early onset patients are so socially stigmatized that their family members often recoil from publicly talking about what they are going through.
Ozawa admits that she tried to keep her husbandfs dementia secret for a long time by lying to her neighbors and saying every sign of his senility stemmed from a stroke he had earlier.
Her coverup came to a miserable end when her husband one day woke up hallucinating and began to shout profanities from a window ? with a frying pan in his hand ? at an imaginary ggroup of thievesh he said were lurking outside. Only after that incident did Ozawa accept that she could hide the truth no longer.
gThe way people see it, dementia is something that only concerns much older people. So I was afraid if we came out, people would start speculating that Ifm somehow responsible for what happened to my husband, thinking, perhaps, I must have done something really evil ? like poisoning his food or something ? to bring such a peculiar illness to him,h Ozawa said.
Takahashi agrees. gEven if we come out, people wouldnft be able to think of anything else to say other than some banal words of consolation,h let alone give her constructive medical tips, she said, gbecause they just donft know about this disease.h
Lack of knowledge on early onset dementia plagues local bureaucrats as well, said Akihiko Takahashi, a colleague of Emiko Takahashi at the Nakano Ward Office who co-heads her group.
There are a batch of public assistance programs that early-onset patients could qualify for, including a disability pension. But Akihiko said local officials sometimes mishandle or possibly even trivialize family inquiries in a misguided belief that there are no public welfare services they can refer them to, and turn them away.
gItfs sometimes the case, though, that officials are wrongfully denying the families access to public aid they actually qualify for because of their poor knowledge,h the ward official said.
Having co-headed Takahashifs group for the past year, Akihiko said that he realized early onset patients, for all their disabilities and deteriorating mental capacities, are not entirely incompetent and can be entrusted with certain undemanding job responsibilities.
gBusiness managers tend to think the moment their employee is diagnosed with dementia, that person is so far gone he would never be able to function normally. But if only they manage to get past certain inconveniences that the condition poses, Ifm sure theyfll agree hefs still capable,h Akihiko said.
Ozawa echoes this view. At no time in her 11 years of tending to her husband did it ever cross her mind that he became someone else or disintegrated into anything less human, Ozawa confidently said.
gLooking back, I remember there were always those brief moments when he suddenly turned lucid and joked around like usual. I took it as evidence that somewhere deep down in his mind, his true self was always there, unhurt, no matter how incapable he became of expressing himself on the surface.h
DEALING WITH DEMENTIA @
Dementia burden weighing on more families
by Tomoko Otake
Jul 2, 2014
First in a three-part series
Life was relaxing and peaceful for Shigeru Suzuki until six years ago, when he realized that Hiroko, his wife of more than 30 years, was having problems doing simple chores.
The 77-year-old former employee of a major civil engineering firm recalls that, at first, he couldnft understand why Hiroko couldnft sort clothes as told. One day, he got irritated and snapped at her, pressing her to explain why she couldnft just remember to put the clothes away. Hiroko then tearfully replied: gItfs not like I want to be forgetful.h
Suspecting something was wrong, Shigeru took her to a neurologist, who said she was experiencing the early stages of Alzheimerfs disease. Little did he know back then that her condition would soon deteriorate to a point where he would have to do everything around the house, as well as attending to her daily needs, including dressing, feeding and bathing her.
gI was a typical husband (in Japan), having delegated all of the household duties to my wife,h Suzuki said recently at their home in Kitaurawa, Saitama Prefecture. gBut little by little, I found myself having to take over, as her condition worsened.h
Stories like Suzukifs are not uncommon in a country with a rapidly graying population, where 1 in 4 people aged 65 or over has some form of dementia. An estimated 4.62 million people in Japan are suffering from the degenerative disease, while 4 million others have gmild cognitive impairment,h a condition likely to progress to full-blown dementia, according to a 2013 study commissioned by the Health, Labor and Welfare Ministry.
Recent high-profile cases show that, despite government efforts to improve the lives of people with dementia, the illness ? which often starts as memory lapses and then progresses to more severe impediments such as losing track of time and place, and loss of mobility ? takes a heavy toll on patients and those who care for them. With no miracle treatments in sight, and with good specialist doctors in short supply, the burden of care falls primarily on family members, many of whom are often aging and saddled with their own health concerns.
According to the 2013 health ministry study, Alzheimerfs is the most prevalent type of dementia, affecting 67.2 percent of 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. In fact, among 100-year-old women, the likelihood of dementia is nearly 100 percent, said Dr. Yuichi Sugai, a dementia specialist at the psychiatry division of Yokufukai Hospital in Tokyo.
gWhat it all means is, in the aging society, men (husbands) would be most often taking care of women (wives),h he said. gIn clinical settings, too, I see many men who are doing the housework and taking care of their wives.h
Sugai added that, while research into understanding dementia has made great advances in recent years, treatment options are limited. Currently there are only four kinds of medication available worldwide, Sugai said, noting that none is effective enough to stem the progress of dementia.
gThey are not drugs to cure dementia,h he said. gThey are known to be 30 percent effective, meaning that they can only slow its progress.h
In addition, attempts by pharmaceutical companies over the past decade to develop vaccines for Alzheimerfs have hit a snag, due either to side effects or limited effectiveness, he said.
gMedicine has come closer to nailing the mechanism of dementia, and many molecular-level studies are being done,h he said. gBut treatments are needed right now.h
The shortage of medical experts is also a big concern in Japan. Some of the most troubling symptoms of dementia, such as aggressive behavior, hallucinations, agitation and wandering off, are noncognitive problems known as BPSD, short for gbehavioral and psychological symptoms of dementia.h Patients with BPSD often undergo a sudden change of personality, becoming abusive and even violent.
These symptoms, which vary widely among individuals, can be controlled with certain psychoactive drugs, but the dosages and combinations must be carefully monitored and adjusted, Sugai said. To make matters worse there are only 1,200 dementia specialists nationwide, not nearly enough to cope with all the patients, he added.
The issue of patients wandering off and getting lost came to the fore last month when NHK reported on a 67-year-old woman in an advance stage of dementia. Police found her roaming in Gunma Prefecture in 2007. They were unable to identify her, and she was then placed in a nursing home in the area.
Her husband contacted the broadcaster the day after the program aired, and was reunited with her for the first time since she vanished from their home in Tokyofs Asakusa district.
Had police not mixed up her name, she could have been located much sooner. According to NHK, the womanfs name, Mieko Yanagida, was written on her underwear. But police identified her as gEmikoh in notices sent out to other departments in an effort to find out where she had come from.
It would not be surprising if more cases like Yanagidafs come to light. The National Police Agency said last month that 10,332 dementia patients were reported as missing in 2013, up 715 from the year before.
Shigeru Suzuki confides that the roughest part about caring for his wife is having to constantly monitor her toilet needs. When he doesnft take her to the toilet at the right time and she ends up soiling her diaper, he has to clean her by bathing her, which is a physically and mentally taxing task.
gIfve become very sensitive to odors,h he says, noting that he is on the lookout for signs of trouble. gI wish some company would come up with an odor sensor-equipped alarm.h
Still, he says he is fortunate because Hiroko, 72, has stayed calm despite the disease and happily eats everything he prepares for her.
Shigeru, who doesnft depend on any of his three grown-up children for support, says he keeps his sanity by occasionally turning to outside help. He asks staff from nearby day care facilities to pick her up and take care of her three times a week, and uses gshort-stayh overnight services once a month. That way, when Hiroko is in the hands of professionals he has time for himself, to get together with old friends or go on fishing trips. Such services are covered by the public nursing insurance plan and partially subsidized by the government.
Still, the list of what she can no longer do grows daily. Hiroko, who used to love golfing and would often drive on her own to golf courses, now must use a wheelchair.
On a recent visit, she was reticent, her expression mostly blank, and she often dozed off while Shigeru was talking. But when her husband was away, she became visibly nervous, her eyes darting around in search of him. Shigeru would try to quell her anxiety by telling her to wait, before leaving her, even for a second.
Even so, Shigeru seems to be taking the progression of her illness in stride, and, for now at least, he himself remains in good health.
gWhat truly amazes me is that, we can still communicate, and she understands my jokes,h he said. gWhen we go shopping for groceries, and when I try to buy beefsteaks, she asks me, eIs it OK to buy that much?f So I tell her, eOh, this morning I had a dream about having a mint of money.f Then she laughs.
gShe misses me when Ifm away, and she is happy when I touch her. So I try to hug her when we are watching TV together. In a sense we are more affectionate to each other now. We still have emotional bonds. Itfs not like Ifm living with a doll.h
Test offers promise for early Alzheimer's detection, but debate remains over use
Advances in Alzheimer's disease diagnosis technology have led to developments in detecting signs of the disease before symptoms appear, but with the presence of false detections and the lack of a cure, there is debate over how widely to use the new test when it could just cause patients stress.
In Alzheimer's disease, substances including a kind of protein known as beta amyloid build up in the brain and cause the death of nerve cells, lowering cognitive functions and affecting one's ability to get by in daily life. These changes in the brain begin before the onset of disease symptoms like forgetfulness.
The diagnosis technology allows the buildup of beta amyloid to be viewed through brain imaging called beta amyloid positron emission tomography (PET), but medical facilities have only been able to use this technology for research or clinical tests. The reason is that even if a developing case of Alzheimer's can be seen from the imaging, currently there is no way to stop the disease or completely treat it -- the best that can be done is to slow its onset.
The Japanese Society of Neurology, the Japan Society for Dementia Research and the Japanese Society of Nuclear Medicine, however, aiming for the use of the tomography in diagnoses, have jointly created guidelines for determining the appropriate times to use the technology, as well as doctor qualifications for making the decision of whether to do a test and for examining the results.
Under the guidelines, cases classified as appropriate for beta amyloid PET testing include those where it would be useful for differentiating between a possible case of Alzheimer's versus a possible case of a similar disease, and when there is a possibility of Alzheimer's in a relatively young patient. In either case, however, it would be after Alzheimer's symptoms had already appeared.
Meanwhile, the guidelines say that cases with unresolvable ethical issues -- such as no treatment being available or the patient or their family being unable to accept the test results -- or where the test results would not help with treatment are inappropriate.
Research section leader Kenji Ishii of the Tokyo Metropolitan Institute of Gerontology, who served as managing chairman for putting together the guidelines, said, "The (beta amyloid PET) images will be the deciding factor for diagnoses," but also said, "With no fully effective medicine existing, what we must debate from here on is whether an early diagnosis will allow effective treatment and better prognosis through lifestyle changes. Since the diagnoses could instead cause unnecessary anxiety or be used under incorrect circumstances, a careful decision on this matter is needed."
A different doctor, however, advocates actively using beta amyloid PET images: Shizuo Hatashita, vice head of Shonan-atsugi Hospital in Kanagawa Prefecture, says, "Beta amyloid PET is necessary to offer our diagnoses responsibly as doctors."
Since 2007, the hospital has been offering, under the name of research, beta amyloid PET testing to patients who want to use it. There have been cases, they say, where beta amyloid PET testing has overturned diagnoses of Alzheimer's that had been made based on symptoms or brain shrinkage. Among people the hospital has given the tests to who were not already aware of Alzheimer's symptoms, around 20 percent have shown a buildup of beta amyloid in their brains. Around half of those people with the buildup have gone on to develop mild cognitive impairment (MCI), the precursor to Alzheimer's, within five to six years of the test.
The hospital explains the content and purpose of the test to the patients and their families before conducting it, and they share all the results with them. For people who show beta amyloid buildup, the hospital has them begin regular hospital visits so they can be monitored. They help with guidance on diet and lifestyle, and advise patients to stretch, take walks, and keep up their hobbies and increased interaction with others.
Hatashita says, "If we can make a relationship of trust with the patient, we can avoid giving them only anxiety (with the tests). If people know about the possibility of getting Alzheimer's beforehand, they can become aware and work to stop it."
One 74-year-old man living in Atsugi, Kanagawa Prefecture, who was diagnosed with MCI after a beta amyloid PET test in 2007, says, "I'm glad I learned ahead of time I might get dementia. I want to recommend (beta amyloid PET) to my friends." At first he was reluctant to take the test, only doing so because his daughter convinced him to, but he now says, "When they show a color picture that even an amateur like me can easily understand, you can't help but accept the results. It gives you resolve."
Since his diagnosis, the man writes down important things on memo notes or on his calendar so he doesn't forget. He also stays active together with his wife by taking walks or small trips. His wife, who has noticed the progression of his symptoms over time, says, "We've managed to get by so far, and I think we will cope with whatever is to come. We had more time to prepare ourselves mentally than if we had suddenly been told he had dementia, and were able to have the confidence to take the situation positively."
In a 2004 poll by the National Center for Geriatrics and Gerontology, over 80 percent of respondents said they would prefer to be told if they were going to get dementia in the future. These days, one in four people 65 or over are said to have dementia or MCI, and the national government puts early detection and early response at the center of its policy on dementia. Still, the debate on when is the best time for patients to receive their diagnosis has only just begun.
June 14, 2014(Mainichi Japan)
Elderly with dementia increasingly targeted in consumer fraud
JUN 8, 2014
Elderly people with dementia or diminished mental capacity are increasingly being targeted in consumer fraud and related complaints nearly doubled in the decade through fiscal 2013, officials of the National Consumer Affairs Center reported.
The number of such complaints handled by consumer centers nationwide came to around 10,600 in the previous fiscal year, which ended in March, including instances of investment fraud and unauthorized delivery of expensive items, the officials said Saturday.
The figure almost doubled from the roughly 5,800 cases reported in fiscal 2003. By contrast, similar fraud cases involving people of any age declined to about 920,000 from 1.51 million over the same period.
In graying Japan, the population of elderly with dementia who require care increased to more than 3 million in 2012 against 1.49 million in 2002. The figure is projected to exceed 4 million in 2020, according to the government.
Even if family members discover such scams in progress, it is difficult to recover the loss because dementia often prevents patients from explaining or recalling how the contract was sealed, according to Kenji Ota, a lawyer specializing in consumer fraud cases.
Gov't mulling new information-sharing measures to help ID lost dementia patients
The government is considering introducing new information-sharing measures to respond to the continuing problem of dementia patients getting lost and spending years away from their families without being identified, it has been learned.
The Ministry of Health, Labor and Welfare hopes to introduce a system that will allow municipalities to share information with each other and with police, but officials have not yet settled on the specifics.
"We must create a system that effectively matches missing people, when they are discovered, with the names of those who are being searched for in other municipalities," Health, Labor and Welfare Minister Norihisa Tamura (photo) said at a news conference on June 6.
Some prefectural governments have already started independent investigations into missing dementia patients in their care, but the ministry plans to send requests for such investigations to prefectural governments anyway sometime next week. It will base its new system on their responses to questions.
Between April and June this year, three missing people with dementia were identified after their images were carried by newspapers and on television. The time they spent in care away from their families ranged from two to 18 years.
The families of the three had filed missing person's reports with police. One of the three, a woman, had her name written on her underwear. One more had provided his name. Had local governments, care facilities and police shared the right information with each other, it is highly likely these two people would have been quickly identified.
On June 5, the National Police Agency sent out a notice urging prefectural and municipal governments and care facilities to contact police whenever they received information that could help with the identification of missing dementia patients in their care.
June 07, 2014(Mainichi Japan)
Police agency: 258 dementia patients missing nationwide
June 06, 2014
The Yomiuri Shimbun
The whereabouts of 258 dementia patients who went missing in 2012 and 2013 had not been confirmed as of the end of April, according to the National Police Agency.
Last year 10,322 dementia patients went missing across the nation, but 10,088 of them, or 98 percent, were found by police and others over the same year.
However, 151 people were still unaccounted for as of the end of April. The whereabouts are also unknown of 107 of the 9,607 dementia patients who went missing in 2012.
Authorities began compiling statistics on missing dementia patients in 2012.
Police mainly search for missing people with dementia after receiving missing persons reports from families and others. Among the people whose whereabouts were confirmed last year, 9,949 were found within one week of police receiving the reports, and 6,443 were found on the same day.
Eleven people were found one or two years after families and others alerted police, while 32 people were found after two years or more. Of the total, 9,509 were found alive and 388 had died.
The rest of the patients were found not to have gone missing, as they had visited their relativesf houses or other places. Among those who went missing last year, 5,747 were men and 4,575 were women. Osaka Prefecture topped the list with 2,114, followed by Hyogo Prefecture at 1,308.
The number of missing dementia patients in Tokyo remained relatively small because prefectural police have different ways to handle cases in which a missing person is found before their family submits a missing-persons report to police. Some ask families to submit reports on such cases after the fact and others do not, according to the NPA.
Photos to be released
The NPA on Thursday instructed relevant prefectural police to introduce a system under which photos of people taken into protective custody are kept by police, to be made available to families and others. The measure was taken following a recent series of cases in which elderly people with dementia were identified after being missing for many years.
If such elderly people with dementia cannot be identified, the law stipulates that they be put in the care of the municipalities where they were found and moved into nursing care facilities and other facilities. Last year, 157 people were handed over to municipalities and 13 were still unidentified as of the end of May.
To identify such individuals, the police will seek photographs from municipalities and others, and allow families to examine them at police stations and other places. Given that people with dementia may move from prefecture to prefecture, the NPA will make such photos available not only at police stations in areas where they were taken into protective custody but also across police stations in neighboring prefectures.
Police typically check for the identities of dementia patients taken into protective custody by running their names through a database search. But they will now enable clothes and other information to be used as search criteria.
gWe urge families to take measures such as writing the name of a family member with dementia on their clothes,h cautioned an NPA official.
Unidentified dementia patient found 18 years ago may be missing Tokyo man
An unidentified man is seen at a special nursing home in Sayama, Saitama Prefecture, on May 28, 2014. (Mainichi)
SAITAMA -- An unidentified dementia patient found wandering in Sayama, Saitama Prefecture, 18 years ago and taken into protective custody may be a missing man from Tokyo's Shibuya Ward, the Mainichi Shimbun has learned.
The Saitama Prefectural Government released the details of the unidentified man's case on May 27, and has received over 30 inquiries since. One of those was from a person claiming to be family of one Shokichi Nomura, a Shibuya Ward resident who went missing in October 1996 -- around the same time the unidentified man was found in Sayama.
According to the Saitama prefectural and Sayama municipal governments, this is their most promising lead so far, as the unidentified man -- now living in a special nursing home in Sayama -- identified himself once as "Shokichi Nomura" when he was found. Local government officials are working on setting up opportunities for the man and his potential family member to meet.
Officials of the Saitama Prefectural Government's department of senior citizens and nursing care said they will work carefully on identifying the man in cooperation with the Sayama Municipal Government while respecting the opinions of those who may be his family.
June 03, 2014(Mainichi Japan)
Tokyo gov't sitting on personal info of unidentified dementia patients
The Tokyo Metropolitan Government has withheld details on three suspected dementia patients in protective custody that could help identify them, because it considers the information personal, it has been learned.
The metropolitan government announced on May 30 that three people whose identities were unknown remained in protective custody in Tokyo. But it did not provide any information on the three beside their gender, the year and month they had been taken into custody, and the fact that all of them were hospitalized.
"We cannot decide at this point whether the metropolitan government can go ahead and unilaterally decide to release personal information that the local bodies which took the people into custody have not made public," a metropolitan government representative explained.
The Mainichi Shimbun, however, has already reported on two of the three people, providing the names of the wards that had taken them into custody in coverage during April.
The metropolitan government's stance contrasts with that of the Saitama Prefectural Government, which announced the results of an independent probe on May 27 giving details of two people in protective custody in the prefecture. The details included the circumstances at the time of their discovery, and their approximate ages. Reporters also interviewed them and their photos were taken.
Saitama Gov. Kiyoshi Ueda criticized the overly protective stance of government offices, saying they were "becoming too uptight" about protecting personal information.
"There are some public officials who use that as an excuse not to do work," he said. "If it's hard for the section in charge to make a decision, they should seek a decision from the top."
"There is no problem from the perspective of protecting personal information if it is beneficial, helping to save those involved," he said.
June 02, 2014
Only 57% of prefectures have conducted unidentified dementia patient surveys
Less than 60 percent of the 47 prefectures across Japan have investigated suspected dementia patients and others who have been taken into protective custody by local authorities and whose identities remain unknown, a Mainichi Shimbun survey has found, highlighting the need to conduct an urgent study on such cases.
The survey, conducted May 28 through 30, asked the 47 prefectures whether they have inquired with municipalities within their jurisdiction about the number and status of people whose identities are unknown who have come under protective custody. As a result, 27 prefectures -- 57 percent of all prefectures -- were found to have carried out such surveys, revealing a total of six such cases.
An earlier survey conducted by the Mainichi Shimbun through April covering 74 municipalities had found that there were five such cases, with many of them coinciding with the cases found in the latest survey. Experts are calling for prompt investigations and verifications to grasp the overall picture.
The issue of unidentified dementia patients came to the surface after the Mainichi reported on a man who was taken into protective custody by the city of Osaka and had spent more than two years under a pseudonym as he didn't know his name. He was later identified as a 74-year-old man from Hyogo Prefecture and was reunited with his family. The case was followed by the revelation that a woman who was taken into protective custody in the Gunma Prefecture city of Tatebayashi seven years ago was actually a 67-year-old resident of Tokyo's Taito Ward.
These reports prompted the Saitama Prefectural Government to check with its municipalities and announce on May 27 that a male dementia patient who was taken into protective custody in the prefectural city of Sayama 18 years ago, as well as a female generalized amnesia patient who was taken into protective custody in the prefectural city of Hidaka nine years ago, remain unidentified.
Following the move, the Mainichi conducted the latest survey and found that seven prefectures -- Tochigi, Saitama, Niigata, Ishikawa, Mie, Shimane and Kochi -- had already carried out such surveys and that other than Saitama, none found any unidentified dementia patients and other patients.
Twenty other prefectures -- Hokkaido, Aomori, Yamagata, Fukushima, Ibaraki, Gunma, Chiba, Tokyo, Kanagawa, Toyama, Yamanashi, Gifu, Shizuoka, Aichi, Nara, Wakayama, Hiroshima, Fukuoka, Kumamoto and Oita -- are currently conducting such surveys. Hiroshima Prefecture asked its municipalities whether there are unidentified people in protective custody regardless of whether they are suffering from dementia or not, while Fukuoka Prefecture checked not only with its municipalities but also with elderly facilities in the prefecture.
Meanwhile, 20 other prefectures had never conducted such surveys, though Kyoto and Iwate prefectures said they were planning to carry out similar investigations shortly. Akita, Fukui and Tottori prefectures haven't inquired with their municipalities but maintained that they have no such cases after examining welfare and other benefits forked out from prefectural coffers. At least one prefecture hadn't even decided which department handles such cases.
The Tokyo Metropolitan Government and the Kanagawa Prefectural Government have found three cases and one such case, respectively. The Kanagawa case and two of the Tokyo cases were already reported on by the Mainichi in April. Separate from these cases, the Tokyo government announced on May 30 that there is an unidentified man who was taken into protective custody in Tokyo in February. Tokyo and Kanagawa Prefecture are looking into the possibility of other similar cases.
June 02, 2014(Mainichi Japan)
eDementia Cafef opens doors to sufferers, families
May 26, 2014
The Yomiuri Shimbun
A cafe-style project for dementia sufferers and their families to come together and talk has opened its doors in Itabashi Ward, Tokyo, with particular emphasis on helping support the families of sufferers, who often find themselves isolated in society.
The idea for the project was suggested when Hidamari, a local organization of families of dementia sufferers, began working with similar organizations based elsewhere to set up a common network in May last year. At a meeting of organizers of such groups, it was proposed that a space be created so affected families could meet.
The program will function as monthly gatherings called Carersf Cafe Orange, held on the fourth Tuesday of the month from 1:30 p.m. to 3:30 p.m. Eight groups led by sufferersf families and associated supporters will take turns organizing the event on a volunteer basis.
To hold the event, the Pia cafe JHC will be made available free of charge, thanks to the good offices of the ward government. The cafe is operated by JHC Itabashi-kai, an organization that helps the mentally disabled in finding work.
Its inaugural event on April 22 was attended by about 20 people. A woman, who has taken care of her 79-year-old husband at home for 17 years, attended the event with him and talked about how hard caring for him can sometimes be.
Miyoko Matsumura, 72, representative of Hidamari and a member of the project organizing committee, said: gSome people begin talking as if they are bursting out of their shell. I hope their burden will be eased a little bit by asking advice and sharing their hardships with others.h
Hospital uses experts to deal with rise in elderly dementia patients
KYOTO -- A hospital here is employing experts to help it manage elderly patients with dementia, whose symptoms can otherwise interfere with treatment.
Patients with dementia can become excitable or wander from their hospital rooms, and many regular hospitals refuse to accept them because of this. To avoid this problem, Kyoto Min-iren Chuo Hospital in Kyoto has been employing a team of experts since last fall, a "dementia care team" of seven specialists including a neurologist, psychiatrist, operational therapist, nurse and nutritionist who respond to requests from the hospital's wards with their variety of expertise.
A doctor in charge of one 101-year-old patient at the hospital who was to receive hernia surgery asked for help from a member of the team, Michiko Hasegawa, 32. The patient had Alzheimer's disease, and couldn't remember anything even when given explanations about her surgery. The anxiety caused from not knowing why she was in the hospital or why she needed surgery could cause the patient to experience delirium, which can in turn worsen dementia symptoms. The patient's family worried that after getting out of the hospital, if her dementia had worsened she might no longer be able to eat or use the bathroom without help.
Before the hernia surgery, Hasegawa met with the patient four times. At first, the patient denied needing surgery, but over the course of the meetings, she became more receptive to the idea. Hasegawa reassured her, "You have the ability to recover because you have a strong heart." The patient responded, "That's because I run in the neighborhood sports festival. Do you want to run with me?"
Hasegawa felt from this exchange that the patient had accepted the idea of surgery. She says, "Dementia patients are not completely unaware. It is important to talk to them until you get their understanding."
Although the patient removed her IV during the surgery at one point, there were no major complications, and after three weeks she was discharged from the hospital.
Early this month, the specialist team responded to a request for aid with one 77-year-old patient who was suffering from acute cardiac insufficiency and Alzheimer's disease. The previous night, the patient had been awake all night and barged into other patients' rooms. Hasegawa spoke with the patient, but whatever she asked him, he only responded, "I don't know." She kept at it, however, and finally the man, when told he was going to get out of the hospital the next week, smiled and said, "Next week? Good. It's all thanks to you."
After the talk with the patient, the team met and had a discussion. They agreed that even though the man may have already forgotten what he was told about being able to go home, the happiness from when he heard the news might be lingering and making him restless.
Hospital workers had been considering using medicine to make the patient sleep, but Hasegawa said at the team meeting, "While keeping in mind that the night hospital staff had a hard time (dealing with the patient), let's give them a method to handle the patient without using medicine." Everyone in the team nodded their agreement.
The hospital has over 350 patients staying in its rooms, and around half of them are 75 or over. Some 60 to 70 percent of them have some kind of mental impairment diagnosed, so for the hospital, knowledge about how to deal with dementia patients is necessary. For the past year, however, the specialist team has only treated around 20 patients. The hospital has 400 nurses, but getting them all to perform their duties with respect for the opinions of dementia patients is difficult.
The hospital has held conferences in each of its wards to consider methods for how to keep hospital workers from tying down dementia patients, and has begun classes to teach nurses how to care for the patients.
"Tying down patients is bad for the patient. I want nurses to know that it causes dementia symptoms to worsen and delays recovery," says Hasegawa.
Besides Kyoto Min-iren Chuo Hospital, another institution, the National Cancer Center Hospital East in Kashiwa, Chiba Prefecture, has also adopted efforts to better treat patients with dementia. It is training all of its nurses to better understand delirium symptoms and last fall adopted checklists for new patients to check for risk factors suggesting susceptibility to delirium. Delirium is similar to dementia but can be prevented or its symptoms reduced by treating physical ailments or stopping the use of triggering medicines. The checklist risk factors include being 70 or over and having been diagnosed with dementia.
Asao Ogawa, head of the hospital's psychiatric and cancer treatment section, says, "At emergency hospitals, often patients come in without their dementia being noticed, and hospital workers are unable to effectively respond to their dementia symptoms," adding, "It is important to differentiate between dementia and delirium and respond appropriately to patients with each ailment."
Meanwhile, last fiscal year the Ministry of Health, Labor and Welfare started training doctors and nurses and regular hospitals on how to handle dementia patients. In preparation for growth in the number of dementia patients as the population ages, it aims to have over 80,000 people take the training by fiscal 2017.
May 23, 2014(Mainichi Japan)
Japan's dementia epidemic prompts calls to improve missing persons network
May 23, 2014
Nearly 5 million people in Japan live with dementia and thousands are going missing from their homes and carers every month.
In Japan's second biggest city, Osaka, Atsuko Hajihata is frantically looking for her missing grandfather Akinori Matsuyama.
For the last several months she has been handing out leaflets on street corners and train stations, asking people to contact her if they see her grandfather.
He walked out of the family home in January and has not been seen since. Ms Hajihata says she is nervous because she thinks he has dementia.
"I still have hope of finding him but I've heard that bodies of drowned people have been found," she said.
"But maybe he's being looked after by people."
Some of the missing turn up in mental institutions or aged care homes.
One unidentified man has been living in a nursing home in Osaka since being rescued from a busy highway two years ago.
He has severe dementia and does not know his name or where he came from. There is no information that can help identify him.
His carer asks "can you remember anything?", but the man does not reply.
The staff at the nursing home have given him the name Taro so he can receive welfare benefits.
They believe he is about 70 and have even given him a fictitious date of birth so they can celebrate his birthday.
"Taro is not his real name so staff have mixed feelings about doing this," his carer said.
"[It is] painful to think he'll die without ever being identified."
But tragically many of the missing are found dead.
Kenzo Yohizawa left his home while his wife was preparing dinner. She wrote his name and address on his shoes but Kenzo left in his sandals.
Three weeks later he was found frozen to death beside a river just 500 metres from his home. His wife believed he would return.
"I never imagined it and didn't think that he would die. I have regret and feel sorry that I wasn't able to find him," she said.
Ageing population means dementia problem will grow
It is hard to obtain exact figures of how many people with dementia go missing, but police estimates for 2012 are about 10,000.
Kumiko Nagata works at one of Tokyo's oldest and biggest aged care facilities, and says the problem is going to get much worse.
"In Japan, people over 65 exceed 25 per cent so the number of people missing with dementia will increase rapidly," she said.
"These days old people aren't living with their families; they often live alone or as elderly couples where both might have dementia. So they don't realise if one goes missing."
There is a network for missing persons but only 10 per cent of local governments are using it.
Most want a new system with much greater co-operation between police and government agencies.
In the meantime, communities are taking matters into their own hands, setting up non-profit groups like Missing Person Search (MPS) on the outskirts of Tokyo.
MPS is run by Hiroshi Tahara, an ex-police officer of 25 years.
"Everybody thinks if you report to the police they will actively search but they only really get involved if there has been an unusual death," he says.
Mr Tahara says the government should develop better registration systems and look at practical ways to stop the crisis.
He wants all dementia sufferers to wear shoes with a GPS function so they can be found quickly.
Police database error may have led to dementia patient's 7-year separation from family
A woman with dementia who was taken into protective custody in 2007 had been filed under the wrong name in a police missing persons' database, possibly delaying her reunion with family members.
According to several sources including the Gunma Prefectural Police and the Tatebayashi Municipal Government in the prefecture, 67-year-old Mieko Yanagida of Tokyo's Taito Ward was taken into protective custody near the Tobu Isesaki Line's Tatebayashi Station in Tatebayashi in the predawn hours of Oct. 30, 2007. Because she was unable to tell police her name or address, she was placed in a private nursing care facility in Tatebayashi.
The municipal government and officials at the care facility say that the socks and underwear Yanagida was wearing at the time were labeled "Yanagida" and "Mieko," respectively. However, when entering data on the woman into an online missing persons' database, prefectural police mistakenly wrote that her underwear had been labeled "Emiko," and failed to note the name "Yanagida." Police said that they didn't know about the "Yanagida" label until December last year.
Because Yanagida initially said her name was Kumiko -- which is actually her daughter's name -- she was called Kumiko Yanagida at the care facility.
The Metropolitan Police Department's Asakusa Police Station received a missing persons' report from Yanagida's family on Oct. 31, 2007, two days after she went missing. Police entered information on Yanagida including her full name in kanji, the reading of her name, as well as her height and body type into the online database. Her family also submitted photos of her to police.
An official with the Metropolitan Police Department searched the system for Yanagida, but because her name had been erroneously input by Gunma police as "Emiko" and with no surname, a match failed to come up.
Flyers asking for information on Yanagida were distributed to police boxes in six Kanto region prefectures. But it was the tips sent in by viewers of a television program that aired on May 11, in which Yanagida was introduced as an unidentified woman living in a care facility, that led to her reunion with her family. Yanagida's husband visited the facility the following day, where they saw each other for the first time in seven years. It also happened to be their wedding anniversary.
An official at the care facility where Yanagida has been living said, "We even wondered if Yanagida had been abandoned on the Tobu Isesaki Line. Couldn't she have been reunited with her family sooner?"
According to the community safety planning division of the Gunma Prefectural Police, records from when Yanagida was taken into protective custody no longer exist.
"We will interview those who were involved in the case to find out the details of what happened," an official said.
The Mainichi Shimbun reported April 19 on an elderly man with dementia who had been taken into protective custody after being discovered on the street in Osaka in March 2012. His family notified police after seeing the news report, leading to the man's identification as a 74-year-old from neighboring Hyogo Prefecture.
The man's name had been completely unknown to authorities until his family came forward. The missing persons' report compiled by the Hyogo Prefectural Police included a photo, but no match appears to have come up when police went through the missing persons' database.
May 14, 2014(Mainichi Japan)
Court considers hardship of caring for senile in lawsuit over rail death
April 27, 2014
The Yomiuri Shimbun
Last weekfs ruling by the Nagoya High Court posed a weighty question: How can we establish a system that will enable people to live at home after developing senile dementia?
The case, which was sent to the court on appeal, involves a suit filed by the Central Japan Railway Co. (JR Tokai) seeking compensation from the bereaved family of a man with senile dementia who died after being struck by a train?an accident the railway company claims caused damage because it delayed the train schedule. The high court ordered the manfs wife, who was caring for her husband at home, to pay compensation.
There have been a considerable number of cases in which elderly people with dementia have wandered away from their home and become involved in train accidents. The issue is something people providing nursing care for family members can relate to.
The accident occurred when the man wandered out and entered the train tracks after his wife had briefly dozed off.
In the first trial at the Nagoya District Court, the presiding judge said that the danger of the man being involved in an accident, if he went out, was predictable and that gthe wife was at fault for neglecting her duty to constantly watch over him.h
The high court, on the other hand, ruled that such an accident had not been predictable. The court also rejected the claim that she was at fault for neglect, which constitutes illegal behavior, by taking into account the fact that the wife was trying hard to nurse him. But it still acknowledged her responsibility of paying compensation as the person obliged to supervise her husband since he could not be legally held accountable.
24-hour watch impossible
It is virtually impossible for family members to watch sufferers of senile dementia they care for around the clock. If family members are made to shoulder excessive burdens, more and more people will have second thoughts about caring for such patients at home.
The fact that the high court halved the amount of compensation the family has to pay in this case indicates it took into consideration the hardship of nursing care givers.
Furthermore, the high court pointed out a blunder on the part of JR Tokai, saying, gIt can be presumed that the accident could have been preventedh if the railway company had locked an opening in a fence, from which the man is believed to have entered the tracks.
The court also said, gIt is the social responsibility of public transportation entities to improve safetyh by paying consideration to people unable to understand the danger of accidents. We hope all railway companies will take this point seriously.
At a time when the number of senile dementia patients has surged in recent years to 4.6 million, and there are long waiting lists to enter special nursing homes for the elderly, it is difficult to care for senile dementia sufferers at nursing facilities alone.
In 2012, about 9,500 went missing because of senile dementia, of which 359 people were later found dead. It is essential to expand and improve the system for supporting nursing care at home in addition to coming up with measures to prevent accidents involving elderly people who wander away.
The government, for its part, should establish around-the-clock visiting nursing care services as well as medical institutions that would dispatch a doctor to the home of a patient whose symptoms have worsened.
It is indispensable to involve community members in countermeasures. The city of Omuta, Fukuoka Prefecture, which sends e-mail alerts to citizens whenever a senile dementia sufferer goes missing, can be a good example for other local governments.
It will also be necessary to study the advisability of establishing an insurance system that would compensate railway companies for accidents involving senile persons.
Now is the time to research Alzheimerfs
Apr 19, 2014
The Japan Times
by Rowan Hooper
The team leader at the Laboratory for Proteolytic Neuroscience at Rikenfs Brain Science Institute is not a man usually given to making apocalyptic statements.
Yet when I asked him whether Japan should be investing more money in Alzheimerfs research, he responded with more than the usual academic plea for more money. gAlzheimerfs disease,h said Takaomi Saido, gwill destroy Japanfs social-welfare mechanisms in the near future.h
Saido, based in Wako, Saitama, is on a twin social and scientific mission: to protect Japanese society from the ravages of Alzheimerfs disease, and to uncover the secrets of how the brain ages.
Itfs interesting that he emphasizes that his mission is about protecting society. Alzheimerfs is already one of the most expensive diseases in developed countries. In the United States, it costs more than $100 billion a year. Saido is only too aware of how this will increase.
gMy social mission is to protect social-welfare mechanisms,h he told me, gbecause the socioeconomical cost of Alzheimerfs disease will be greater than the governmentfs annual income by 2050 unless the disease becomes preventable.h
That sounds like a lot of money. But the estimate for the financial burden caused by Alzheimerfs in Japan by 2050 is $500 billion a year, which is about the same as the governmentfs annual revenues. Why is the cost going to increase so much?
gPeople will be receiving much less pension after retirement and paying more taxes and hospital costs,h Saido said. So the government should invest now to save in the future. If we can find a way to treat or prevent Alzheimerfs, the number of people who suffer from dementia and the burden on caregivers will be smaller.
gAlzheimerfs research is much more cost-effective than any other research field, including stem-cell research,h Saido assured me.
As an example, Saido offered his new mice. Years in the making, these are no ordinary mice. The Riken team thinks it may revolutionize research into Alzheimerfs, and this is the scientific part of Saidofs twin mission. gMy scientific mission is to uncover the essence of brain aging, one manifestation of which leads to Alzheimerfs disease development.h
Much of the research conducted into Alzheimerfs uses mice as gmodelsh of humans. Scientists use strains of mice that have a genetic propensity to develop Alzheimerfs-like symptoms, and it might go without saying, but mice are not the same as people, and the models are not perfect.
In particular, the strain of mouse commonly used in Alzheimerfs research makes too much of a particular protein, known as amyloid precursor protein. This APP leads to the production of amyloid deposits, which are thought to cause the breakdown of neurons in the brain and which are the hallmarks of Alzheimerfs disease.
But since the mouse makes too much APP, Saido thinks much of the work done on that mouse strain ? and there has been a lot ? is flawed, and wonft help our understanding of the disease in humans. The new mouse model is a strain that produces APP and the subsequent amyloid deposits in a way that is more realistic for the actual human disease. The details have just been published in the journal Nature Neuroscience.
gThe generation of appropriate mouse models will be a major breakthrough for understanding the mechanism of the disease,h said Saido, gwhich will lead to the establishment of presymptomatic diagnosis, prevention and treatment of the disease.h
I asked Saido for any preventative advice. gTo my knowledge, the only scientifically proven measure is a daily exercise, like one hour of walking,h he said.
Much remains to be discovered about this insidious disease. But there is hope. Two recent papers in the British journal the Lancet show that in the U.K. and Denmark there is a decrease in the number of people getting Alzheimerfs disease.
The first paper shows details of two surveys of people with Alzheimerfs in the U.K., one in 1994 and the other in 2014. The researchers expected that the second survey would show more people with Alzheimerfs, since the average age of the population had increased over the intervening 20 years.
But the numbers came up some 200,000 short. The evidence suggests that people are developing Alzheimerfs at an increased age. Something appears to be delaying the onset of the disease. (The DOI reference for this paper is 10.1016/S0140-6736(13)61570-6.)
The Danish study shows that people in their 90s born in 1915 were healthier and smarter ? they performed better on cognitive tests ? than people in their 90s born in 1905. So something improved in the lifestyle or diet of people born in 1915 that seems to have protected them. (The DOI reference for this paper is 10.1016/S0140-6736(13)60777-1.)
What are we to make of this? Some might say that it shows, for developed countries at least, that better nutrition, fitness and education may be helping to reduce the reach of Alzheimerfs. Maybe thatfs true ? but only slightly. gTo conquer Alzheimerfs disease, it is essential to establish presymptomatic diagnosis and preventive medicine,h said Saido.
He also suggests that the apparent decrease in Alzheimerfs seen in the U.K. may be due to a decrease in the consumption of fish and chips. Thatfs not as glib as it might seem, as an improved diet could reduce vascular forms of dementia, which would also reduce Alzheimerfs.
But even if you doubt that the fabric of society is at risk ? or that fish and chips have much to do with it ? hefs right that we need to conquer the disease.
Rowan Hooper (@rowhoop on Twitter) is the news editor of New Scientist magazine. The second volume of Natural Selections columns translated into Japanese is published by Shinchosha at \1,500. The title is gHito wa Ima mo Shinka Shiteru (The Evolving Human).h
Osaka dementia patient remains unidentified 2 years after he was found on street
OSAKA -- An elderly man was taken into a protective custody two years ago when he was found on a street here. He suffered from severe dementia and couldn't recall his name, address or age at the time he was found by police. There were also no reports of missing persons that matched his description. While he now lives at a nursing home in the city, no one knows his true identity.
The Mainichi Shimbun visited the man at the nursing home earlier this month. When we asked him how he was doing, the man nodded and smiled. According to judicial scrivener Tetsuo Yamauchi and other people who have been named as the man's guardians by the mayor of Osaka, the man is at stage-three nursing care level (of a one to five level based on assessed care needs). He has difficulty speaking and needs assistance when using the bathroom, but he can walk by himself.
The Osaka Municipal Government named the man Taro and gave him a last name that relates to the name of the place he was found as he needed a name to register for welfare services. The local government also decided his birth year and day, judging by his appearance that he was about 70 years old. The man is now 72, according to his official documents, but some of the nursing home staff say he might be younger.
On March 11, 2012, police took the man into custody after finding him sitting on a street in the city's residential area. The man was wearing a light blue down jacket, grey sweatpants and black sneakers. He appeared to be clean. He did not have any cash or belongings and told police that he didn't know his name.
When he was found, the man was wearing an adult diaper, hinting that he might have been taken care of by someone. Nursing home staff say that he was not at a stage where he could have lived without any assistance.
The Osaka Municipal Government issued an emergency temporary protection order on March 11 and the man then entered a protection shelter. He remained unidentified after 14 days of the designated period for protection and entered the nursing home at the end of the month.
Nursing homes typically offer care for the elderly with dementia based on their background, medical history and makeup of family members. For instance, if a nursing home resident wanders about daily late in the afternoon, care workers assume that the person is trying to go home to cook dinner and work to relieve their anxiety. In the Osaka man's case, however, care workers do not have any information on the man to establish a care program for him. Yamauchi said the man had been turned down by around 30 nursing homes before finding the one where he currently lives.
Kumiko Nagata of the Dementia Care Information Network Tokyo Center said she is certain that similar cases are on the rise. "I have met people like the Osaka man, but no process has been made to understand the reality of these people. It's high time the national and local governments worked on establishing measures to tackle these problems so that people like the Osaka man can retrieve their names and go home," Nagata commented.
April 19, 2014(Mainichi Japan)
Dementia patient unidentified for 2 years spends birthday with family
OSAKA -- A patient with dementia who lived with his identity unknown for over two years in an Osaka care facility celebrated his real birthday with his family on April 30.
During the family visit, which the Mainichi received permission to watch, the 74-year-old man returned a smile to his family, something he hadn't been able to do during their first visit because he had been asleep with a fever. He was only identified by his family on April 27 after having gone missing from their care and had been taken into custody by authorities as an unidentified person about two years earlier.
A male employee at the care facility where the man is staying said, "He has a calmer expression than usual. He knows it is his family here. I sense his family filling a role that employees cannot."
The man had been given a temporary name and temporary birthday while his identity was unknown, and the facility held a "birthday" celebration for him in January. Now that his real birthday is known, however, the facility employees decided to give him another celebration and presented him with a flower bouquet and a necklace of colored paper on the day of the family's second visit.
The Mainichi reported on the man, who was still unidentified at the time, on April 19. A family member said that when they went to a police station and saw a photo of the man on the Mainichi's website for the first time, they were "around 80 percent sure" it was him.
May 01, 2014(Mainichi Japan)
Stroke prevention drug found to slow mild dementia
OSAKA (Kyodo) -- Researchers have found that a drug used in the prevention of strokes, cilostazol, is effective in slowing the progression of mild dementia, according to a study published Thursday in the U.S. online science journal Plos One.
The team including Masafumi Ihara, chief physician at the National Cerebral and Cardiovascular Center, said that the drug seems to improve the excretion of waste products in the brain that cause dementia.
Four million people in Japan are believed to have mild cognitive impairment, or MCI, and a half of them are set to develop dementia-related illnesses such as Alzheimer's disease within five years, according to one estimate.
The study was based on an analysis of the medical records of Alzheimer's patients who were given the drug and those who were not administered it.
The team plans to start clinical research with MCI patients this fall with Mie University, Kyoto University and Kobe University.
Dementia patients often develop vascular diseases and the team has noted that cilostazol enlarges the blood vessels to improve blood flow in the brain.
The team carried out a survey to check whether taking cilostazol in addition to dementia medications made any difference in the decline of cognitive functions in Alzheimer's patients, assigning scores on a 30-point scale.
Among those who can barely manage a social life, 36 people who were not taking cilostazol saw their scores fall by an average of 2.2 points over a year, compared with a 0.5 drop in 34 people who were taking the medicine. Improvements were even reported in some areas, but no effect was seen in patients with advanced conditions, the study said.
The team has discovered that cilostazol promotes excretion of waste products in the brain in mice with symptoms of Alzheimer's disease.
Other participants in the latest study include a research institute at the Kobe-based Foundation for Biomedical Research and Innovation.
February 27, 2014(Mainichi Japan)
Early stage dementia sufferers among the disappeared and the dead
More than 500 people with diagnosed or suspected dementia went missing in 2012 and were later found dead, or not found at all. Some people with dementia, however, have disappeared despite showing such mild symptoms of cognitive impairment that their families had yet to notice anything was wrong.
According to research in Hokkaido's Kushiro region by disabled senior support NGO "Tanpopo no kai," in partnership with the Dementia Care Research and Training Center in Tokyo, some 20 percent of those with dementia who went missing had "early stage" symptoms so mild their families hadn't noticed their condition.
"At the onset of the illness, it's hard for even those closest to the patient to notice anything has changed. It's even hard for the patients themselves to tell," said Kumiko Nagata, head researcher at the dementia care research and training center. "I hope anyone who notices something unusual, even something very small, will consult about it with those around them."
In the early evening of Jan. 30, 2012, 84-year-old Sadao Murakami told his wife Kimiko he was heading from the post office -- about 800 meters from their home in Osaka's Naniwa Ward -- to water the plants at their old residence, also nearby. "I'll be back in a little bit," he told Kimiko, 83. She watched him pedal away on his bicycle, looking just as he always did. Kimiko did not sense anything abnormal about her husband. Sadao, however, didn't come home that night.
A week later, on Feb. 6, a passer-by found Sadao in a ditch in Hirano Ward, some 9 kilometers from his house. He was dead, his bicycle lying abandoned a short distance away. Authorities believe Sadao, lost and exhausted, succumbed to hypothermia. His body was partly wedged in the approximately 30-centimeter-wide gutter, as though he'd been trying to get out of the midwinter wind.
"What was he feeling as he was riding along on his bicycle?" Kimiko wonders. "He can't have been in a normal state of mind."
Since a month or two before he disappeared, Sadao had sometimes forgotten that he'd eaten. There were other small incidents; misplacing his room key at a hot spring resort, and losing his way on the road home. Worried, Kimiko suggested her husband visit the hospital, but he never followed her advice.
"The possibility he had dementia never really occurred to me, and I wouldn't have known which hospital to take him to anyway," she says.
"People with cognitive impairment tend to simply keep moving forward, making it hard for them to return home when out on a bicycle. You have to be careful about that," the Murakamis' family doctor told Kimiko, after she'd lost Sadao.
"Sadao hadn't noticed he was sick. I should have had him checked out as soon as I could and been more careful about him," Kimiko laments, adding that she feels regret every day. Now, with no one to share a meal with, she says she can no longer summon the will to cook for herself. "I get so lonely in the late afternoons and evenings, because I'm all by myself now," she says, adding that she hasn't yet been able to cry over the loss of her husband, not even once.
According to research by "Tanpopo no kai" and the Dementia Care Research and Training Center, there were 129 missing person cases from 1994 to 2003 in Hokkaido's Kushiro region where dementia symptoms could be confirmed in the missing, and where their families were able to say whether they'd noticed those symptoms. Of that number, 20.2 percent of the missing persons had very early stage symptoms that had gone unnoticed by their families. Another 43.4 percent had early symptoms that manifest daily, but not to the point that their families believed they could go missing.
"Pointing out symptoms of very early stage dementia can sometimes make family relations difficult," says Nagata. "It's important for the families to seek advice and cooperation from those close to the person and local support centers." Furthermore, "the patient will have their own reasons for wanting to go out. Seeing that as a problem and locking them indoors will only worsen their condition," Nagata continued. "Families can't handle this situation on their own. They need local support, and everyone from neighbors, local kids and students, to workers at shops, restaurants and public transport systems can be a big help."
February 04, 2014(Mainichi Japan)
Japan to estimate dementia's costs to society
By Peter Levring and Christian Wienberg, Bloomberg News
January 31, 2014
TOKYO _Japan's health ministry plans to estimate the overall societal cost of dementia, including direct medical costs and the burden that providing care puts on the families of people with the condition, by the end of fiscal 2014, according to sources.
The move is aimed at helping the government make better funding plans, cut wasteful spending related to dementia and devise measures to alleviate the burden placed on families.
The Health, Labor and Welfare Ministry intends to estimate the total amount of direct expenditures for dementia-related treatment, nursing care and the indirect costs of unpaid, informal care by the families of people with dementia.
Government data, including surveys on patients and nursing care insurance payments, can be used to determine direct medical costs, but there are currently no statistics concerning the economic impact on the families of dementia patients.
The ministry's task team plans to ask about 1,000 people nationwide to record details of the care they provide over a week to family members with the condition, including the amount of time they spend watching such relatives, feeding them and assisting them in using the bathroom. The value of such unpaid care by families will then be estimated based on nursing care workers' standard wages.
Based on the existing data, dementia treatment costs are expected to total hundreds of billions of yen, while nursing care expenditures are expected to reach up to 7 trillion yen ($68 billion). If the level of dementia-related societal costs in Japan is on par with that in Britain, which has already estimated such costs, Japan's total societal costs from dementia are likely to top 10 trillion yen.
In 2012, the World Health Organization estimated the global societal costs of dementia at $604 billion and warned of a rapid increase in the future.
Last year, the United States estimated its costs in 2010 at $215 billion (about 22 trillion yen). Denmark and Sweden also have made similar estimates and reflected them in their policy measures.
Mitsuhiro Sado, a Keio University assistant professor and expert in neuropsychiatry who leads the ministry's research team, said: "The economic impact survey isn't simply aimed at cutting costs. It's important to explore effective ways to use limited resources through such measures as reinforcing support for the families of affected people."
578 dementia sufferers died or remained unaccounted for in 2012 after going missing: survey
A total of 578 people, who had been diagnosed with dementia or were suspected of suffering from the disease, were confirmed dead or remained unaccounted for in 2012 after going missing, according to a nationwide survey conducted by the Mainichi Shimbun.
Of the 578 people, 359 were confirmed dead and 219 others were unaccounted for in 2012, according to the Mainichi survey based on data from prefectural police headquarters across the country and other sources. The findings underscore the gravity of the situation involving dementia sufferers in Japan.
The National Police Agency (NPA) has released data on the number of dementia sufferers who were registered as missing, starting with statistics for 2012, which stood at 9,607. But it also emerged that procedures leading up to the registration of missing people vary from police headquarters to police headquarters throughout the country. Because some dementia sufferers were found and placed under police protection or died before they were officially registered as missing, the actual number of people who went missing is likely to be far greater, and the number of dementia sufferers who died after going missing could also rise accordingly.
The 359 people (including those who were reported missing before 2012), who were confirmed dead, were found in forests, rivers, irrigation channels as well as in the gardens of empty houses, roads and elsewhere. Prefectural police headquarters concerned have listed the status of the 219 missing people as of the end of 2012 as "statistically unknown."
Of the 9,607 people registered as missing, Osaka Prefecture accounts for the greatest number at 2,076, followed by Hyogo Prefecture at 1,146. The two prefectures reported such large numbers, however, because their respective police headquarters have been actively urging the families of missing dementia sufferers to formally register them in writing as missing. It is part of police efforts to help determine whether there are any links to incidents or help with their own investigations.
In Kanagawa, Chiba and Saitama prefectures, meanwhile, there is a system in which police authorities list missing people as "temporarily unaccounted for" immediately after receiving reports from their families or other sources by phone or other means. Sometimes people are found at this stage, in which case they may never be officially registered as missing.
In Kanagawa Prefecture, 262 people were registered as missing, compared to 232 people in Chiba Prefecture and 146 people in Saitama Prefecture. The Metropolitan Police Department (MPD) does not have such a system, but there are cases in which it found missing people before they were formally registered as missing because searches were launched before official reports were lodged. In 2012, 350 people were formally registered as missing in Tokyo.
Elsewhere, Aichi Prefecture had 735 people who were formally registered as missing, Kyoto Prefecture 371 people, Fukuoka Prefecture 357 people and Ibaraki Prefecture 317 people. As for the number of deaths by prefecture, Osaka Prefecture had 26 people, Aichi Prefecture 19, Kagoshima Prefecture 17, Tokyo 16, Ibaraki Prefecture 15, and Hokkaido, Fukushima, Nagano and Hyogo prefectures had 14 people each.
The Mainichi survey found that there were cases in which dementia sufferers traveled far from their homes. According to the Osaka Prefectural Police, a 75-year-old man from the Osaka Prefecture city of Kadoma was found at a port in Matsuyama, Ehime Prefecture, a day after he was registered as missing in August 2012. An 83-year-old man who was living alone in the city of Osaka was taken into protective custody after straying into a pachinko parlor in Hakodate, Hokkaido, 22 days after he was registered as missing in January 2013. It is not clear how the two men got to Shikoku and Hokkaido, respectively, and how they spent their time.
While the number of people in each age bracket 70 and under who have been registered as missing has declined or remained roughly unchanged in recent years, the number of those aged 70 or older who have been registered as missing has been increasing sharply. Of the 81,111 people who were registered as missing in 2012, the number of those aged 70 or older stood at 14,228, an increase of 3,521 (33 percent) from five years earlier. The sharp increase is believed to reflect a rise in the number of dementia sufferers.
January 29, 2014(Mainichi Japan)
Family still hunting for Alzheimer's patient missing for over a year
It has been learned that in 2012 alone, over 500 people with dementia went missing -- and were later found dead or not found at all.
The families of the missing do all they can to look for their loved ones, but in some cases even very long searches have provided no answers, no confirmation of their fates. This leaves many such families despairing that they did not do enough to protect their relatives, and waiting hopefully for the happy day when the disappeared return home.
"It's been like a nightmare. Why did this have to happen?" says 73-year-old Yae Tanaka of Kishiwada, Osaka Prefecture. It is Jan. 25, and Takaaki, Yae's husband of some 50 years, has been missing for exactly one year. On this day in 2013, at just past 9 p.m., Takaaki got out of the bath, put on his pajamas, got on his bicycle and rode into the night. He left his GPS tracking device-equipped mobile phone at home.
Takaaki, now 76, was diagnosed with Alzheimer's disease in 2003. As his symptoms worsened, he began having trouble finding his way back home when he went out, and was taken into the care of the police on several occasions. Yae and Takaaki were a household of two, and she says she stayed close and watched over him not just when they were out shopping or walking the dog, but around the house as well.
When Takaaki disappeared, every member of the Tanaka family in the area joined the search. They checked empty houses, parks, and even followed a path all the way to the mountains of neighboring Wakayama Prefecture. They walked around handing out leaflets with Takaaki's picture on it. At the beginning of February, an acquaintance of Takaaki's said she'd talked to him on Jan. 31, near a hospital a little less than a kilometer from the Tanaka home. The woman did not know he had been reported missing, and said that he told her, "It seems my dog's disappeared."
In March that year, Takaaki's bicycle was found about 5 kilometers away at a social welfare facility in Kaizuka, Osaka Prefecture. An employee said that the bike had been there "probably since the beginning of February." Police officers and dogs searched the area for some sign of where Takaaki had gone, but turned up no other clues. His family continues the search to this day, heading out to personally check on new information that might be connected to Takaaki's whereabouts.
Yae and Takaaki's children say they've never seen their parents fight and, unusual for Japan, the elder Tanakas always called each other by their first names. Takaaki's Alzheimer's may have advanced in recent years, but he joined Yae in her hobbies like tai chi and singing in a chorus group, and he was often seen with a smile on his face.
"I've lost a great treasure," Yae says, tears in her eyes. "I'm the one at fault, because I couldn't look after him. If I see him again, I want to tell him, 'I'm sorry.'"
The couple's 41-year-old son Masao, who lives in the neighborhood, added, "My dad's probably scared and lonely. I should have been more careful. I want him to come home safe and sound. If he can't do that, I just want him to come back no matter what's become of him."
More local governments are now instituting measures to help track down dementia patients who go missing, including search drills and setting up systems to send emails to registered users, with a description of the patient including a photo and their name and address.
"This could happen to anybody," says Masao. "I'd very much like to see this problem dealt with on a national scale."
January 29, 2014(Mainichi Japan)
Govt must promote healthy lifestyle from young age to ward off dementia
The number of elderly Japanese people suffering from dementia is increasing much faster than predicted. The government must devise measures to prevent and treat the condition as quickly as possible.
According to an estimate by a research team of the Health, Labor and Welfare Ministry, the number of elderly people diagnosed with dementia has reached 4.62 million. Research results by Kyushu University indicate the number is six times the level 20 years ago.
It must be noted that an increase in people suffering from diabetes, along with the quickly aging population, has boosted the number of dementia patients. Domestic and overseas research has found that diabetics are about twice as likely as those without diabetes to develop Alzheimerfs-type dementia.
Alzheimerfs-type dementia develops as a result of the accumulation of abnormal protein in the brain. People are more likely to develop this type of dementia if they become diabetic and a large amount of insulin is produced in their bodies, because insulin, which lowers blood sugar levels, also interrupts the dissolution of the protein and thus promotes its accumulation.
Major causes for diabetes are overeating and obesity resulting from insufficient exercise. According to some data, people who pay attention to their lifestyles by exercising regularly and eating Japanese and other healthy foods are less likely to develop diabetes or dementia.
The health ministry should publicize such information, which could help people prevent these health problems by paying attention to their lifestyles from a young age.
As many as 4 million people are said to suffer from gmild cognitive impairment,h believed to be a stage before dementia. Symptoms include impaired memory and judgment. If treated at an early stage, however, it can likely be prevented from progressing to dementia, doctors say. We hope measures to prevent the condition will be established as soon as possible.
Dementia could be controlled
It is still important to diagnose dementia as early as possible, even if a patient has already developed symptoms. If treated properly, dementia patients could recover in cases where the formation of a hematoma in the brain due to a blow to the head caused it, for instance.
However, the conditions of many patients deteriorate if left undiagnosed. It is necessary to develop a system that can render an accurate diagnosis by increasing expert-staffed outpatient gforgetfulh clinics around the country.
If diagnosed early, it might be possible for people with dementia to continue their family life and jobs longer with the understanding and cooperation of their families and people around them.
Developing measures to deal with dementia is a common concern among advanced countries, whose populations are aging quickly.
Japan, the United States and six other advanced countries held the first G-8 Dementia Summit last month in London. They agreed to drastically increase research funds for dementia and share research data with the aim of establishing treatment methods by 2025.
International cooperation is essential to study dementia, which still has many unexplained elements. We think Japan, whose population is aging the fastest in the world, should lead the research. The government should play a leading role and mobilize all Japanese researchers in this field to tackle the issue.
(From The Yomiuri Shimbun, Jan. 17, 2014)
Editorial: Regional cooperation needed to care for people with dementia
Many members of the public are obviously worried that they or their parents living apart from them may suffer from dementia in the future. More hospitals and nursing care facilities for elderly people suffering from dementia may become necessary. Actually, however, many patients with dementia are living in their own homes without inflicting too much of a burden on their families. Dementia tends to be misunderstood. Members of the public need to have the correct knowledge about dementia before becoming worried about the disease.
People tend to associate dementia with delusions and wandering around, but not all patients with the disease show these symptoms. There are many people with dementia who are working or involved in volunteer activities. In recent years, some people suffering from dementia even delivered speeches and are engaged in other awareness-raising campaigns about the illness.
Delusions and wandering about are believed to be secondary symptoms caused by interactions between dementia and social factors such as patients' living environments and the quality of nursing care they receive, rather than symptoms particular to dementia. In many cases, even specialized nursing care facilities cannot look after patients and end up transferring them to mental hospitals. As such, approximately 50,000 people suffering from the disease are hospitalized at such medical institutions.
A survey conducted by a Health, Labor and Welfare Ministry study group on about 5,000 inpatients with dementia shows that the largest number of patients were hospitalized because their mental conditions had worsened. The fatigue of family members looking after the patients and difficulties in looking after them in their regional communities or at care facilities were also cited in many other cases.
At the same time, there are many cases where the secondary mental symptoms of many patients have drastically improved after only small amounts of pharmaceutical products were administered to them. Experts say that respecting patients' pride and creating a comfortable living environment for them are effective measures in improving their conditions. There are many patients with medium-degree cognitive functions who show symptoms such as suffering from delusions and wandering about, and experts say the conditions of these patients often worsen after being hospitalized.
Hideki Ueno, a doctor living in Asahi, Chiba Prefecture, has examined more than 900 patients with dementia who have shown psychiatric symptoms, but less than 40 of them needed to be admitted to mental hospitals. "Dementia needs less medication than schizophrenia and other ordinary mental disorders. Therefore, patients don't necessarily need to be hospitalized, and can be treated by doctors in their neighborhoods who have undergone certain training," Ueno says.
People tend to fear that if patients with dementia live in their own homes, they will force a heavy burden on their families. However, 56 patients with dementia were living alone in Kunitachi, western Tokyo, as of November 2013. According to a report that Kunio Nitta, a doctor in Kunitachi, has submitted to the ministry's study group, one of these patients often calls their daughter with delusions that a thief breaks into their home, one is visually impaired, another has handicapped legs and one other is forgetful. Still, their families visit them only on weekends or call them only in the morning or evening, and nursing care services at facilities or at their homes support the patients' self-reliance, along with short stays at care facilities and food delivery services.
The Kunitachi Municipal Government has worked closely with local communities to provide regional comprehensive care for dementia patients through cooperation between medical and care workers, by securing doctors in each community who can treat sufferers and through mutual assistance between neighbors in supporting the patients. The city did not allocate a massive amount of taxpayers' money from its budget to support hospitals looking after patients. Such being the case, local governments can change the current situation in which many people are forced to quit their jobs to look after senile family members and exhausted family members have no choice but to rely on mental hospitals for caring for senile people.
January 14, 2014 (Mainichi Japan)
56-year-old dementia patient expresses agony of memory loss
"Nouns are disappearing from the world I live in." So said a 56-year-old dementia patient in the Kansai region recently in his journal to the Mainichi. As the brain disorder slowly eats away at his memory, the man writes to express his agony and anxiety.
"The world is filled with nouns. A doctor told me I had dementia. Forgetting things has become a serious illness," the man wrote after he was diagnosed with the disease in May last year. He went to see a neurosurgeon as he had become forgetful and after taking several tests, his doctor told him that he had dementia.
"A storm of anxiety flooded into me, but there was nothing I could do. I had dementia," sighed the man.
He had thought that the illness was something that only affects the elderly. He had thought dementia patients would soon start wandering about and having delusions. He was in shock and cried for three days after he was diagnosed. His wife lamented that dementia was worse than cancer and told the man not to tell others about his condition.
Fearing that he would not be able to write anything once words slip from his mind, the man started to write about his experiences and feelings. He wrote many entries in his computer in the two to three months after the diagnosis.
"I tend to forget people's names, so I take notes on my iPhone every time I succeed in remembering them. This works well. I now can remember over a dozen names of people and places I once forgot. I'm happy about that. But more than anything, nouns are disappearing from my world. Nouns like 'mug' keeps slipping out of my mind. It's quite tiring to spend each day with the fear of forgetting words."
The man became psychologically stable after seeing experts on early-onset dementia. Being able to write made him confident and, though just for a short period of time a day, he continues working. Nevertheless, the man struggles with small things like being unable to find the TV remote control or his watch.
"People tend to think that dementia patients forget the feeling of suffering, but I hope they understand that we struggle from the agony of memory loss," the man wrote.
"Dementia patients have a difficult time living in this complex society where speed is required. I hope that society becomes patient with people who forget and lose their ways," the man added.
The man concluded his journal entry in June last year, about a month after he was diagnosed, saying, "The world often disappears from my sight, but I will work my best. I ask for people's support."
January 14, 2014(Mainichi Japan)
Railway accidents involving dementia patients a serious issue in aging society
At least 149 railway accidents involving dementia patients or those suspected of having dementia claimed the lives of 115 people in the eight-year period ending in fiscal 2012, underscoring the need for prompt measures in a rapidly aging society.
Railway companies are required to report accidents to the Ministry of Land, Infrastructure, Transport and Tourism, which the ministry compiles into official records. Through a freedom-of-information request, the Mainichi Shimbun obtained the ministry's records and police reports from fiscal 2005 on -- when the Long-Term Care Insurance Act was revised -- and found that because many accident reports did not note that those involved had dementia, the actual number of dementia patients in railway accidents may be even greater.
Many of the accidents are believed to have occurred due to wandering dementia patients entering dangerous areas that were not fenced off, or ducking under crossing bars, because they were unable to recognize the dangers of doing so. Some were found walking on tracks for several hundred meters, while others were hit by trains as they walked on bridges and in tunnels.
A 73-year-old woman who was killed in an accident in Osaka in January 2008 is believed to have climbed onto the tracks through an iron fence door located at the end of the station platform for railway staff. In other cases, people were killed as others were searching for them using information transmitted from their GPS systems.
In August 2013, the Nagoya District Court ordered the family of a dementia patient killed in a railway accident to pay approximately 7.2 million yen in damages to Central Japan Railway Co. (JR Tokai), siding with the company's claim that the family had neglected its responsibility to look after the victim. The family has since appealed the ruling.
Members of an association of families of people with dementia said it was impossible to watch dementia patients every single minute of the day, and expressed concern that being held to such heavy responsibility would stop many families from taking care of those with dementia in their own homes. In 2012, there were an estimated 8.62 million dementia patients -- including around 4 million people with mild cognitive disorders -- or about one in every four senior citizens.
The Mainichi Shimbun spoke with the bereaved families and other insiders whose names and addresses could be identified in 10 accidents involving nine railway companies, including the abovementioned case with JR Tokai.
According to the families, in addition to the ongoing JR Tokai case, Tobu Railway Corp. in two cases, and Kintetsu Corp. and the Nagoya Railroad Co. in one case each, had demanded bereaved families pay between approximately 160,000 and 1.37 million yen in damages. The company that demanded some 1.37 million sought damages for overtime wages paid to employees and the cost of alternative transport as a result of the accident. In this and another case, the amounts were reduced over the course of deliberations, but in all four cases, the bereaved families paid damages.
No compensation was demanded in the five other cases involving Hokkaido Railway Co. (JR Hokkaido), East Japan Railway Co. (JR East), West Japan Railway Co. (JR West), Kyushu Railway Co. (JR Kyushu) and Nankai Electric Railway Co. According to the bereaved families, JR East said that it would "not demand compensation because it was confirmed the person in question had dementia," and Nankai said, "While we suffered a loss of approximately 1.3 million yen, we will not demand compensation."
JR East said that it did not communicate its intentions to the family in those terms, but that it was true that the company had deliberated the case and based on the facts, decided not to demand compensation. Nankai, meanwhile, said it would refrain from commenting on the case.
While there is a trend among JR companies not to claim damages in such accidents, it is not uncommon for other railway companies to demand compensation as a rule.
According to the General Insurance Association of Japan (SONPO), personal liability insurance may cover damages caused by railway accidents. Such insurance is usually a special provision of auto and fire insurance policies, and premiums run around several thousand yen annually. But because railway accidents are not always interpreted as being subject to such insurance policies, SONPO urges consumers to confirm eligibility with insurance companies.
In fiscal 2012, 295 people died in railway accidents. Suicides, meanwhile, whose data are separated from non-suicide railway accidents, numbered at 631.
January 13, 2014(Mainichi Japan)
Researchers to track 10,000 elderly to study effects of exercise on dementia prevention
A team of researchers will initiate a study on the effects of exercise in preventing dementia, keeping track of roughly 10,000 elderly people across Japan for four years, it has been learned.
The team -- comprised of researchers from at least 10 universities, medical institutions and local governments -- will embark on the large-scale study in fiscal 2014 and will compile a report one year after wrapping up the four-year survey. The study will look into the relationship between exercise and the incidence of dementia.
It has been generally known that exercise contributes to dementia prevention, but this will be the largest verification study of its kind in Japan. If exercise does prove to be effective in warding off dementia, the Ministry of Health, Labor and Welfare will incorporate the study results into a project to lessen the need for nursing care.
According to the team's interim plan submitted to the ministry at the end of last year, the study will cover 10,000 selected people aged 65 or older who are healthy and not forgetful. The subjects will be divided into two 5,000-member groups, with both participating in a four-year study program including classroom lectures on how to use computers, while the first group will also undergo exercise programs during the first year.
All participants will be required to carry pedometers with them to gauge their day-to-day exercise situations and the frequency of their social activities. After they complete all programs, the research team will compare the difference in the two groups, such as the incidence of dementia.
January 01, 2014(Mainichi Japan)
Movie offers heartwarming look at son caring for mom with dementia
November 16, 2013The Asahi Shimbun
By HARUKO ISHII/ Staff Writer
With Japan's rapidly aging population, manga artist Yuichi Okano wants to help people like himself who are being increasingly tasked with taking care of an elderly, impaired parent.
Okano's manga gPecoross no Haha ni Aini-ikuh (Visiting Pecorossf mother), about his daily life with his mother, who is suffering from dementia, has been made into a film that will be released nationwide on Nov. 16.
gAfter watching this movie, people of my generation who have nursed or will nurse their parents will think that they have to have a relaxed state of mind," said Okano, 63. "I also want young people to see it.h
The movie of the same title is filled with humorous scenes of a middle-aged man taking care of his mother, while taking up serious issues, such as the progression of her condition and placing her in a facility for elderly people with dementia.
The movie shows Okano's belief that forgetting things is not necessarily bad.
Okano, whose nickname is "Pecoross," taken from a small onion called "pecorosu," which his bald head looks like, divorced at age 40 in 1990 while working in Tokyo. Along with his 3-year-old son, he returned to his parentsf home in Nagasaki. Ten years later, his father died. Then, his mother, Mitsue, now 90, began to suffer from dementia.
Her symptoms progressed. She began to wander around. In addition, she would stuff her unwashed underwear into a drawer. After agonizing over what to do, Okano decided to put his mother into a facility in which elderly people suffering from dementia live in a group, along with caregivers.
In the film, a scene symbolizes the relationship between Okano and his mother. Patients with dementia often are in an unstable state of mind and, as a result, may shout abusive language.
On a train station platform, Okano is pushing his mother along in a wheelchair. Then, she suddenly shouts at him, gHey, you thief!h She also shouts, gYoufre a bad man!h
Okano immediately takes off his cap and shows his bald head. Then, she says with a smile, gOh, youfre Yuichi. What a nice bald head you have!h
In addition to this and other episodes that were described in the manga, the movie also depicts his motherfs childhood when an atomic bomb was dropped on Nagasaki near the end of World War II, and her memories of marriage and her child-rearing days.
The last scene of the movie is set at the Nagasaki Lantern Festival, in which her thoughts come and go between the past and the present.
The last scene gives power to Okanofs words: gWhen seeing my mother, I feel that forgetting things is not necessarily bad.h
In the movie, Okano is played by actor Ryo Iwamatsu, while his mother is played by actress Harue Akagi. Iwamatsu, 61, and Akagi, 89, are almost from the same generations as those of Okano and his mother.
According to Akagi, she especially empathizes with the scene in which Okano feels a sense of guilt when he puts his mother into a facility for dementia patients. Akagi also has experienced putting her dementia-stricken mother into a similar facility before she died at the age of 85.
g(A day before putting my mother into the facility), I felt depressed because I was not able to take care of my mother. I covered myself with futon (Japanese-style mattress) and wept,h Akagi recalled.
gBut when I saw my mother smiling in the facility, I thought that I should have put her into the facility earlier,h she added.
Akagi said that she wants people to feel the deep affection between a mother and her child from watching the movie.
At present, Okanofs bedridden mother is not in a state in which she can understand the movie. However, he plans to show it to her in a DVD.
gEven if she cannot understand the move, I want her to watch it,h he said.
The movie was directed by Azuma Morisaki, who is called a master of comedies. The manga gPecoross no Haha ni Aini-iku,h was published by The Nishinippon Shimbun Co., based in Fukuoka, in July 2012. It has sold about 160,000 copies partly from becoming a well-discussed topic on Facebook and other social networking services. It won an award from the Japan Cartoonists Association in fiscal 2013.
Hunt stepped up for Alzheimerfs cure
November 4, 2013
The Yomiuri Shimbun(The JapanNews)
A health ministry study group will begin a research project on Alzheimerfs disease this month, aimed at prevention and developing fundamental medicines for the condition.
Joining an international research partnership called Dominantly Inherited Alzheimer Network (DIAN), the group plans to survey patients with familial Alzheimerfs, a condition that inevitably leads to dementia, and their families. The effort is expected to help develop medicines and identify the mechanism that causes the onset of the disease.
An estimated 4.62 million elderly people in Japan have dementia, of which there are several types. Alzheimerfs dementia, which mainly causes memory problems, accounts for 70 percent of all dementia patients.
According to an overseas study, almost everyone who carries the gene for familial Alzheimerfs develops dementia, many while in their 40s and 50s. About 520 family lines with the gene have been found around the world, but the situation in Japan remains unclear.
Headed by Prof. Hiroshi Mori of Osaka City University(photo), the ministry group plans to send questionnaires to about 6,000 medical specialists in dementia and 235 medical centers for the treatment of dementia across the nation.
The surveys will examine such points as the results of medical examinations of people who are likely to have developed the disease and their families; whether the causal gene was identified; and their living situations and issues that need to be addressed.
While concealing individualsf identities, the group also plans to send questionnaires to regional chapters of Alzheimerfs Association Japan, and to interview patients and their families who are believed to belong to a few dozen family lines with Alzheimerfs in Japan.
The survey is expected to be concluded within this fiscal year. The group will clarify concerns in patientsf everyday lives and areas where they need additional help, and utilize the results to establish a support system.
Also, the group aims to participate in DIAN with Japanese family lines with the Alzheimer gene. Though it is difficult to determine when a person will develop dementia, a person with the familial Alzheimerfs gene usually develops the condition at about the same age that their parents displayed symptoms.
Therefore, the group aims to identify the mechanism for developing the disease by conducting follow-up checks on people with the familial Alzheimerfs gene, including diagnostic imaging.
DIAN began its research study of people with the gene responsible for familial Alzheimerfs in 2008, mainly led by Washington University in St. Louis. The study currently involves four nations, including Germany and Britain, and this year it began a clinical trial to administer experimental drugs and placebos to people who carry the gene but have not yet developed symptoms.
The study by the health ministry group may help develop methods of prevention or fundamental medicines by one day conducting its own clinical tests with experimental drugs and placebos on people before they develop the disease.
As the causative agents for dementia are believed to be same for familial Alzheimer and for other general types of Alzheimerfs, the study results of familial Alzheimerfs are expected to help people suffering from general Alzheimerfs as well.
VOX POPULI: Court ruling in Nagoya too harsh for family of dementia patient
September 28, 2013
The Asahi Shimbun.
I find works by mystery writer Hideo Yokoyama uniformly good, but the short story gDokih (Motive) is an absolute gem. It is an account of an incident in which a large number of police officer IDs go missing. What gives a human touch to the tense story is the relationship between the protagonist and his father.
The son is a police officer and so was his father. After his mother dies, his father becomes mentally ill. Having lost both speech and the ability to express himself, the father becomes like ga lump of earthh and lives in an isolated ward. When the son visits him, the father lets out a yelp to a nurse. gYa!h The nurse answers him: gI know. You must be very happy.h
The son is baffled at the nursefs gfree translationh that his father is happy to see him. While the nurse understands the old manfs feelings, the son, who rarely visits him, cannot. The difficulty and pain of staying close to elderly people who are suffering from emotional disorders touch the readersf hearts. It must be all the more difficult in real life for people who look after such elderly relatives at home that their agony is beyond description.
Last month, a harsh ruling was handed down in a case concerning home nursing care. A 91-year-old man in Aichi Prefecture suffering from dementia wandered onto a railway track and was killed by a train. The train schedule was disrupted on account of the accident, causing financial damage to Central Japan Railway Co. The Nagoya District Court held the manfs wife, who was looking after him, and his son responsible and ordered them to pay 7.2 million yen ($73,000) to the railway company.
The story was reported on the lifestyle page of the Tokyo and other editions of The Asahi Shimbun dated Sept. 27. The man managed to leave the house after the wife and daughter-in-law let him out of their sight for just a very short time. The ruling determined that they failed to keep an eye on him. But no one can be watchful all the time. Isnft the responsibility the court expects them to shoulder too heavy?
At the end of gDoki,h the protagonist tells his wife that gYa!h means gIfm happy.h The wife says she knew that for a long time. At least in the story, there is hope.
Vox Populi, Vox Dei is a popular daily column that takes up a wide range of topics, including culture, arts and social trends and developments. Written by veteran Asahi Shimbun writers, the column provides useful perspectives on and insights into contemporary Japan and its culture.
Alzheimer's brain scan detects tau protein
By James Gallagher Health and science reporter
19 September 2013
Pioneering brain imaging that can detect the build-up of destructive proteins linked to Alzheimer's has been developed by Japanese scientists.
It could lead to new ways of diagnosing the condition and of testing the effectiveness of new drugs.
The technology, reported in the journal Neuron, can identify inside a living brain clumps of a protein called tau that is closely linked to the disease.
Alzheimer's Research UK said it was promising work.
Alzheimer's disease is a problem for researchers trying to come up with a cure. The brain starts to die years before any symptoms are detected, which means drugs are probably given too late.
A diagnosis of Alzheimer's cannot be made with absolute certainty until a patient has died and their brain is examined. It is also not 100% clear what is the cause of the dementia and what are just symptoms.
One protein, called tau, is very closely linked to the disease, with tangles of tau thought to be one way in which brain cells are killed.
The team, lead by the National Institute of Radiological Sciences in Chiba, used positron emission tomography to build a 3D picture of tau in the brain.
They developed a chemical that could bind to tau and then be detected during a brain scan.
Tests on mice and people with suspected Alzheimer's showed the technology could detect tau. Dr Makoto Higuchi (photo), from the National Institute of Radiological Sciences in Japan, said: "Positron emission tomography images of tau accumulation... provide robust information on brain regions developing or at risk for tau-induced neuronal death."
The research is at an early stage, but it could eventually lead to an actual test for Alzheimer's disease.
It might also allow researchers to closely follow the impact drugs that affect tau have on the brain.
Another protein - beta amyloid - is also linked to Alzheimer's and can be detected in similar tests.
Dr Eric Karran, director of research at Alzheimer's Research UK, said: "This promising early study highlights a potential new method for detecting tau - a key player in both Alzheimer's and frontotemporal dementia - in the living brain.
"With new drugs in development designed to target tau, scans capable of visualising the protein inside the brain could be important for assessing whether treatments in clinical trials are hitting their target.
"If this method is shown to be effective, such a scan could also be a useful aid for providing people with an accurate diagnosis, as well as for monitoring disease progression."
Report: Imaging of Tau Pathology in a Tauopathy Mouse Model and in Alzheimer Patients Compared to Normal controls@Neuron, Volume 79, Issue 6, 1094-1108, 18 September 2013
Govt to help dementia sufferers
August 28, 2013
The Japan News
The Yomiuri Shimbun
The government will establish a liaison council in September tasked with eliminating boundaries between ministries and agencies in order to create a society friendly to those suffering from dementia, it has been learned.
Coming at a time when the number of elderly people suffering from dementia is growing rapidly, the initiative is aimed at making society safer for dementia victims.
The government will set up a liaison council comprising representatives from 11 relevant government bodies, and its first meeting is expected to be held in September, according to sources.
Because issues related to dementia range widely from medical and nursing care services to consumer protection and public transportation systems, the government aims to have ministries and agencies share information beyond organizational boundaries to facilitate a comprehensive approach to the problem.
According to an estimate by a study group of the Health, Labor and Welfare Ministry, there were 4.62 million people aged 65 or older suffering from dementia in the nation as of 2012, and an additional 4 million people are predicted to develop dementia in the not-distant future as baby boomers age.
Although the welfare ministry introduced, from this fiscal year, measures to enable dementia patients to live at home, it is difficult for a single ministry to create a society that can comprehensively deal with sufferers of dementia.
For example, because the number of car accidents involving elderly people suspected to be suffering from dementia has increased, the National Policy Agency should consider how to handle license renewal for the elderly. The Land, Infrastructure, Transport and Tourism Ministry also should consider improving public transportation systems, which would make it easier for dementia patients to live without driving a car.
Consumer protection is another issue that requires attention, including vicious home-visit sales scams that target the elderly, a problem that the Consumer Affairs Agency should handle.
Furthermore, the adult guardianship system, which is aimed at protecting assets of vulnerable people and is overseen by the Justice Ministry, has not been fully implemented.
Efforts to promote the understanding of dementia at schools and through lifelong education are also necessary, a problem that comes under the purview of the Education, Culture, Sports, Science and Technology Ministry.
At the first meeting of the liaison council, officials from the Cabinet Office and 10 ministries and agencies will explain measures and policies currently undertaken by each, and exchange opinions.
The welfare ministry and the Cabinet Office, which is in charge of overall policies related to the elderly, will play leading roles in council discussions to be held regularly, according to the sources.
Because the government currently lacks such a forum for comprehensive discussions about dementia, the council is expected to make substantial contributions to the promotion of various measures to improve conditions for dementia victims.
But it remains to be seen how enthusiastic ministries and agencies will be about overcoming sectionalism and cooperating with each other, observers said.
Grandma on Feeding Tube Without Consent Symbolizes Japan
Feeding tubes are so common in Japan that my family wasnft initially consulted about the procedure, which is effectively irreversible. When my mother walked into Grandmafs room the next morning and saw a tube, she dropped to her knees by the bedside and stayed there for hours, crying.
gI am sorry. I didnft mean to do this to you,h my mom repeated over and over.
As medical science becomes more sophisticated, wefre finding new ways to prolong life. When my grandma, Hisako Miyake, was born in 1916, life expectancy in Japan was around 43 years; now it is 83, the longest in the world.
When it comes to death, Japan doesnft score so well. In 2010, the Economist Intelligence Unit ranked 40 developed and developing countries on gquality of death,h based on criteria such as end-of-life cost and care and, more broadly, how well societies faced issues of death. Japan was 23.
In Japan, therefs not much talk about death. Living wills, or even discussions about end-of-life decisions, are rare. Historically, hospitals focused on extending lives of patients with little chance of recovery, said Tetsuo Kashiwagi, president of Japanfs Hospice Palliative Care Foundation.
gThatfs still the mainstream,h he said.
The use of feeding tubes at the end of life, which is not conventional practice in the western world, is a way of life in Japan. Twelve percent of patients who get the procedure are fed this way for five years or more, according to a survey conducted in 2011 by Japanfs hospital association.
When my grandma -- or obaachan, as I call her in Japanese - - was born, one out of 20 Japanese was over 65. Now it is one in four. By 2060, the proportion will swell to 40 percent.
The aging population has the potential to bankrupt Japan, now the worldfs third-largest economy after being surpassed by China in 2010. As the proportion of the working population declines, Japan, also the second most-indebted economy, has fewer salary-earning taxpayers to foot the bill for dependent seniors, especially because the birth rate is low and society doesnft encourage immigrant workers.
Born in 1916
Grandma spoke often of her own determination to live to 100. She was born on Dec. 27, 1916, about 18 months after World War I broke out and the same year Woodrow Wilson was re-elected president in the U.S. She grew up in a wealthy household -- her family was the dominant rice wholesaler in the historic city of Nara, Japanfs capital 1,300 years ago. The area, called Naramachi, retains many relics from its past, including wooden residences called Machiya, long, skinny buildings that doubled as shops.
When I was a teenager, she told me how shefd bump along the road in a rickshaw to the station where she took the train to Osaka to attend college. That would have been in the 1930s, when few Japanese women were getting higher education. She also told me how her pocket money was enough to buy western pastries and candies.
Grandmafs two-floor Machiya, under a pagoda-style tiled roof, was a wonderland to me. The complex, built in the early 1800s, is set inside a 700-square-meter (7,500-square-foot) plot surrounded by a mud wall. At the entrance, there was a telephone box, one of Narafs first. Its many rooms, chambers, staircases, passageways and doors were perfect for hide-and-seek.
The other attraction of visits to Grandma was her fondness for indulging my sister, brother and me with sweets.
Life as Grandma knew it came to an abrupt end during World War II, when the government instituted food rationing and took control of rice distribution, effectively closing the familyfs business. Over generations, rice traders plowed their profit back into buying land. When the U.S. occupation forces moved in, the farmland was taken away and redistributed to growers in 1947.
My grandma used to say that she and her friends would complain that they couldnft find anyone to marry because all the bachelors were at war. Women stitched notes with their names and addresses inside good-luck charms dispatched to soldiers.
My grandfather received one from Grandma when he was stationed in Manchuria, China. Sumio Miyake was a graduate of the Imperial Japanese Army Academy in Tokyo. He was an ambitious colonel who specialized in working out complicated mathematical equations used to predict the trajectory of a bomb. Grandpa was not only an elite officer, he also came from a higher class -- a descendant of a samurai family with acclaimed archery skills.
When he returned to his military training in Osaka, he traveled about 30 kilometers (19 miles) to Nara to thank her. They fell in love. They ultimately had three children; my father, Takashi, was the oldest.
During and after the war, the familyfs fortune was dissolved by the government.
gWe became poor all at once,h my grandma said in an interview with a magazine called Sun in 1998. That wasnft her familyfs only wartime tragedy: Grandma also lost her only brother, Hiroshi, who was sent to Manchuria to fight. His body was never found. He was declared dead in 1946, when he would have been 20.
Steak for Breakfast
After the war, a dozen of Grandmafs relatives lived in the family home. Grandma ran the household for the first time without servants, and she struggled. Still, she insisted her children enjoy English tea for breakfast, meat and Western-style meals on some occasions. When her second son, Tsutomu, brought his university friends to the house in the 1960s, she cooked them steak for breakfast.
gShe once told me she knew she had to buy cheaper meat,h my mom said, gbut her mouth instinctively told the meat shop the opposite.h
She probably kept the standard high so as not to lose face.
When I think of her, I picture her standing in her kitchen. She always wore an apron tied around her abundant waist while working in the home and liked to prepare extra food, which she gave as sacraments to the gods and spirits of ancestors she worshiped every day. She also insisted on giving expensive foods and delicacies as gifts to her extended family.
My grandpa died of a heart attack in 1984. My grandma lived alone in her home until 11 years ago, when she started to lose control of her bladder. At the age of 85, she moved in with my parents.
She took only a few things with her. Among them: the postcard Hiroshi had received from the army in Osaka advising the date he was to be interviewed for military service.
Three years after she moved in with my parents, she had a compression fracture of her spine, possibly compounded by her weight -- 60 kilograms (133 pounds) on a 1.58-meter (5-foot-2) frame. She was hospitalized for three months. Her decline hastened after that. She became frail, walked around the house with a stick and used a day-care service twice a week for bathing, which my mom wasnft strong enough to help her do.
She became fully dependent on my parents, especially my mom, her daughter-in-law. Each time I went back to see my parents in Nara -- Ifd visit every few months -- Grandma had regressed physically a little more.
Fed With Spoon
She stopped eating. She said she didnft want to use her chopsticks, so my mom started to feed her with a spoon. It sometimes took more than an hour because she chewed so much.
gI remember she said it would be so easy if she could hop to the afterlife instantly,h my mom said. gI told her that the human body isnft designed to go on for more than 90 years -- thatfs why her body canft function the way she wants it to. Her deterioration is natural.h
Still, perhaps because her decline was happening in slow motion, no one thought to ask if she had any end-of-life wishes. None of us even imagined tube-feeding.
Discussion about death within Japanese families may be difficult in part because Japanese arenft very verbal. They tend to use more ambiguous, less direct speech, said Kashiwagi, president of the Hospice Palliative Care Foundation.
eHonne and Tatemaef
Thatfs because Japanese tend to protect other peoplefs feelings to avoid conflict and enjoy harmony. Itfs the base of the concept called gHonne and Tatemaeh in Japanese: the difference between personal feelings and what people express publicly.
Views on life and death also changed over the past several decades because Japan focused on economic growth, which is materialistic, said Yoshinori Hiroi, a professor of health-care public policy at Chiba University.
gJapanese used to understand the world of life and death through Shintoism and Buddhism,h said Hiroi. Focus on economic growth after the war prevented Japanese from accepting aging and death, he said.
Grandmafs mind started to fail. She often saw dead relatives, my mom said, and her memory started to go.
gShe probably realized death is nearing when she felt so tired and began to have delusions,h my mom said one afternoon in May. gShe must have been terrified.h
Last December, nine days before Grandmafs 96th birthday, my mom sent me a text message saying Grandma had been rushed to the hospital in an ambulance. Her temperature had soared to 40 degrees Celsius (104 Fahrenheit) and she was drowsy.
She was admitted to the same hospital where her husband died. My 66-year-old father saw that as a bad omen. Grandma fought on, and began eating again when my mom fed her mushy food, slowly. I rushed from Tokyo to see her and by the time I arrived, her condition was stabilizing.
Shefd developed aspiration pneumonia and had a urinary tract infection that had caused a kidney complication called pyelonephritis. Her recovery was a matter of time, the doctor said.
One afternoon, my parents cut short their visit while Grandma slept peacefully. When my mom returned the next morning, she was shocked to find a tube had been inserted into Grandmafs stomach through her nose. My mom was furious. Someone outside the family -- a nurse -- had made a decision that, as my mother saw it, could keep Grandma alive in an unnatural way for years.
My parents werenft prepared for this.
Choked on Dinner
Mom stormed off to find the nurse responsible for the tube and chided her for not trying hard enough to feed Grandma. Grandma had choked on her dinner the previous evening, the nurse responded.
The next day, the color had returned to my grandmafs face and she was more responsive, shouting gcoldh when the family touched her with cold hands. She also smiled more frequently when the family talked about her past and mumbled words as if to join the conversation.
gWe were so surprised,h Mom said. gShe was probably getting more energy from the drip than from the mushy food she was getting though the mouth.h
The family decided it would be best to replace the nasal tube with one inserted directly into her abdomen because breathing was uncomfortable for her.
On Feb. 1, she was moved to another hospital, near my parentsf house, for the surgery. Three days later, she had an endoscopy, in which a tiny camera is inserted through the mouth to peer inside the esophagus and stomach, to monitor the operation. The procedure took less than an hour and showed a perfectly functioning upper gastrointestinal tract.
With the stomach tube, she may keep going for months, if not years, while her organs continue to absorb the nutrients they need to sustain her.
Of the quarter-million patients in Japan estimated to be fed through a tube like Grandmafs, more than 90 percent are bedbound, according to the survey by Japanfs hospital association. They are, on average, 81 years old and nourished via tube for 2.3 years.
In the U.S., feeding tubes are more commonly used in patients with swallowing difficulties, such as those with neurologic conditions after a stroke, or people treated for cancer of the oral cavity or esophagus, according to the American College of Gastroenterology. For late-stage dementia patients, who have lost their ability to swallow, the intervention is controversial, the group says. It recommends assessing life expectancy and quality of life before making a decision.
Quality of Life
The American Academy of Hospice and Palliative Medicine and the American Geriatric Society recommend severely demented patients be fed by mouth. In Japan, the Geriatrics Society published guidelines in June 2012 that gave doctors leeway to reduce nutrients and remove feeding tubes with consent of the patient or the family, responding to public concern about quality of life.
A Japanese study that tracked the prognosis of 931 geriatric patients with a tube inserted directly to their abdomen said about 60 percent died of pneumonia, 14 percent from cardiac failure, 3 percent from cancer and 22 percent from other reasons.
More than 70 percent of Japanese said theyfd prefer not to be fed through a tube into the stomach if they suffered from terminal cancer or severe dementia, according to a survey by the health ministry in March. Although about 70 percent supported preparing living wills, only 3.2 percent did the work, it said.
My grandmafs doctor said he would refuse to remove the tube even if my family asked that Grandma be fed orally.
gOnce itfs in -- whether itfs through nose or direct into the stomach -- you canft remove it,h my father said in May as we chatted beside Grandmafs bed. gItfs too late to make a call even if you want to.h
Japanese doctors are reluctant to stop life support on terminal sufferers because they could be prosecuted for killing patients. Doctors at Imizu City Hospital in Toyama, central Japan, were investigated for murder after the hospital found in 2006 that they had removed respirators of terminally ill patients, which led to more public discussion about setting rules for death with dignity.
gJapanese elderly are forced to live longer, and that is an abuse of medical care,h said Kanao Tsuji, director of Suidobashi Higashiguchi Clinic in Tokyo. gDoctors are making decisions based on their values, which are different by doctor. Japan needs to create an institution with specialists that can document wishes for patients and a law that protects the elderlyfs dignity.h
My grandmafs cousin, Hiroko Matsuyama, died three years ago at age 96. She had cancer removed from her stomach to relieve pain shortly before her death.
gI donft know how the family and the doctor concluded that it was better to operate on her,h my father told me. gI wondered if there was a way to palliate her instead. Surgery seemed too much at such age.h
In the U.S., an average of $69,947 was spent on chronically ill Medicare patients in their last two years of life in 2010, according to the Dartmouth Institute for Health Policy and Clinical Practice. Expenditures were the highest in Los Angeles, with $112,263. Caring for patients with chronic illness in their last 24 months accounts for almost a third of total Medicare spending, the institute found.
My grandmafs monthly out-of-pocket cost was about 100,000 yen ($1,005) for the first five months of her hospitalization, including consumables such as diapers and food. Thatfs 10 percent of the bill. The government picked up the remaining 90 percent through a universal health-insurance plan that sets price limits on fees and services.
Japan introduced an affordable health system in the 1960s to broaden access to acute care when tuberculosis was the nationfs top killer. Cancer and cardiovascular disease now are the most common causes of death. Those are more complicated to treat, so the system is overloaded with patients and the cost to the government is escalating.
In May, the out-of-pocket cost for Grandmafs care increased by 65,000 yen to 165,000 yen a month, reflecting a reduction in the reimbursement the hospital gets from the government for patients in long-term care. The bill exceeds Grandmafs government pension, which is like Social Security in the U.S., so my father picks up the 20,000 yen-a-month difference.
I am 33 years old and deeply respectful of my elders, so many of whom built modern Japan and continue to be vital and productive. One study, in the U.K., found that seniors contribute more to society than they cost. The charity group Royal Voluntary Service in Cardiff reported in March 2011 that people older than 65 made a net contribution of 40 billion pounds ($61 billion) to the U.K. economy in 2010 through taxes, spending, providing care and volunteering, and that the contribution will grow 93 percent to 77 billion pounds by 2030.
I donft want Grandma to die. Shefs comfortable and still seems to have some connection with her shrinking world. And her children -- my father Takashi, my uncle Tsutomu and my aunt Megumi -- look so happy to see her during their frequent visits.
But Japan -- which spent the equivalent of 9.6 percent of its gross domestic product on health care in 2011, about half the 18 percent spent in the U.S. -- wonft be able to afford to give me the same level of care. Japanese born in 1955 and after will get fewer benefits -- pension, health care and elderly care -- than they have paid in taxes and contributions, according to a study by the Cabinet Officefs Economic and Social Research Institute in January 2012.
Caring for Grandma the past 11 years has taken its toll on my 61-year-old mom, Ritsuko, who weighs 90 pounds and is barely over 5 feet tall. She would run her errands, help Grandma to the toilet, sponge bathe her and change her adult nappies.
My mom was diagnosed with early-stage breast cancer in January. She had a lumpectomy, followed by radiation, and has taken on female-hormone-suppression therapy to prevent recurrence. Already a slender woman, she lost weight after the surgery and a blood test showed elevated levels of liver enzymes and bad cholesterol.
Because her first doctors didnft treat her immediately, she switched physicians late last month and was hospitalized to cure the liver damage. She has been in the hospital for more than three weeks now and is expected to be discharged once the liver enzymes drop to the normal level.
Talking About Aging
My mom and I have been discussing aging, dying and the impact on our economy over the years, and a lot more recently. My grandma and her peers lived much longer than anyone could have been expected at the time of their birth, so no one was prepared to look after them for so long, Mom said.
My mom and dadfs generation, who took care of their parents and witnessed the burden it created, think differently, she said. Their dream is gpinpin korori,h or PPK, which means to live long, healthy lives and to die naturally without suffering from illness.
gLooking at how they lived to be so old, as well as their deaths, makes us think we need to do better so as not to burden the future generations,h she said.
I visited Grandma recently at her hospital bed in Nara, a mile from where she grew up. She was curled up like a baby under a blanket.
Her creaseless face belies her 96 years. Nurses turn her over every hour or two to prevent bed sores. She weighs 90 pounds because her overall intake is about 600 calories per day, equivalent of two McDonaldfs cheeseburgers.
She shares the room with an 83-year-old woman who talks to herself and sings songs, and an 88-year-old woman who says very little. Her second roommate wears cotton gloves that are tied to her bedframe so that she canft pull out the feeding tube inserted in her nose.
Outside, nurses in light-pink, blue and white uniforms bustle along a dimly lit hallway carrying diapers, trays of tea and medications. Hints of sweat and excrement pervade the air.
Grandmafs diaper is changed every few hours by one of the nurses in a light-blue tunic. Another periodically dabs her toothless gums with a moistened sponge attached to something resembling scissors. She is bathed on Mondays and sponged on Thursdays.
Her hands are closed and tense, making it difficult for me to hold them.
When I said Ifd clean her eyes with wet cotton, she replied gthank you.h She smiled when my aunt Kazuko and I talked about her memories. She mumbled something, but the only word we could catch was Chieko. That was the name of her youngest sister, who died six years ago.
Three times a day -- at 9 a.m., 1 p.m. and 4:30 p.m. -- the nurse who does her gums feeds her. That is, she replaces the bottle that drains a 160 milliliter nutrient-rich white liquid through a tube inserted into her stomach.
When liquid food is administered to her, I see Grandma munching her empty mouth as if shefs chewing food. She mostly breathes through her mouth, and seems perpetually parched. When we press a wet wad of gauze to her lips, Grandma sucks on it as if it were nectar.
For a woman who asked everyone to chew 30 times at dinner because she believes itfs good for health, nothing -- neither solid nor liquid -- has passed her lips in seven months. Most probably, nothing ever will.
To contact the reporter on this story: Kanoko Matsuyama in Tokyo at email@example.com
To contact the editors responsible for this story: John Brecher at firstname.lastname@example.org; Jason Gale at email@example.com
Jul 24, 2013
By Kanoko Matsuyama
The lessons Japan has for the UK on dementia
As the UK population ages, our politicians are looking at the policies of a country where one in four people is over 65
by Mayumi Hayashi
11 June 2013
Jeremy Hunt's recent visit to Japan passed almost unnoticed in Britain. Yet the issues he discussed with Shinzo Abe, the Japanese prime minister, and the health minister, Norihisa Tamura, touched on a problem that is likely to dominate social policy in the next decade: dementia care. One in four of the Japanese population is over 65. By 2050, the proportion will be 40%. There are already 4.6 million people with dementia in Japan. Britain, with 10 million people over 65, has 800,000 people living with dementia, at an annual direct cost to the Treasury of more than ?10.2bn pounds. By 2050, Britain is expected to have around 1.7 million dementia sufferers.
Not surprisingly, the condition has been a prominent concern to past and current policymakers. In 2009, the Labour government unveiled an ambitious dementia strategy, which aimed to improve the quality of life for people with dementia and their carers through greater understanding within society and improved services. Last year, the coalition government also emphasised the need to improve dementia care, with David Cameron launching his "challenge on dementia", which identified three major goals: better health and care, fostering "dementia-friendly" communities, and improved research.
Initial successes included a substantial increase in primary care trust funding for dementia care, but subsequent cuts in government spending resulted in reduced funding for the condition (although involving less reliance on the controversial use of antipsychotic drugs). Discussions in Whitehall about finding new, yet cost-effective, initiatives have been informed by Japan's experience. There, politicians and policymakers have focused on educating the public (even the term "dementia" was outlawed) by recruiting and mobilising volunteer dementia "supporters", and implementing a new national compulsory long-term care insurance system, offering enhanced services for people with dementia.
In Japan, within seven years of its inception in 2005, nearly 4 million people had already completed training as volunteer supporters for the country's dementia-affected population. The aim is to have 6 million supporters by 2017.
The long-term care insurance system introduced in 2000 attempted to cater for as many people with dementia as possible, with the aim of meeting their social as much as their medical needs. Ringfenced additional funding for the new system ? from taxation and insurance contributions ? was intended to guarantee improved, and theoretically fairer, access to care for eligible dementia patients, who pay a flat-rate 10% user fee. So-called group homes, seen as promoting active living in a supported environment ? similar to an extended family ? are common. Pivotal to this system is the "care navigator", who is responsible for co-ordinating integrated health and social care, and for ensuring access to round-the-clock home care, nursing visits, day centres, group homes, respite care and rehabilitation. Reinforcing the entire system is a well-developed network of day centres (the world's best per capita provision), including dedicated facilities for dementia care.
Both Labour and the coalition government have attempted to borrow aspects of Japan's approach. The search for a cheap means of buttressing dementia care has arguably been the greatest attraction of Cameron's "befriending" scheme ? clearly modelled on the Japanese dementia supporters. Unveiled last February, the scheme aims to recruit 1 million volunteer "dementia friends" by 2015. Himself an early volunteer, Cameron sees the initiative as being at the heart of "dementia-friendly communities", one of the three pillars of his dementia challenge.
But professionals question how relevant volunteer "friends" are to British needs. Many prefer the existing system of Admiral nurses (analogous to Macmillan nurses specialising in cancer care), who give specialist care to dementia sufferers and back-up to their carers. Highly trained, and so relatively expensive, these nurses are employed by the NHS, but their numbers have been affected by public spending cuts.
Assumptions that Japan can provide a model for Britain in managing the dementia timebomb may be misplaced. Crucially, Japan has not evolved a robust system of evaluating the quality of care. In contrast, Britain's approach has emphasised rigorous inspection. Organisations such as Dementia UK and the Carers Trust repeatedly stress the need for adequate support for dementia carers in order to guarantee a good quality of life for patients. Significantly, Japan has not yet produced any comparable networks of support for carers.
On the other hand, the Japanese voter typically expresses mature views on how care should be funded. The assumption is that high-quality services must be paid for. The high degree of consensus on this question is reflected in widespread support for the mandatory insurance system. But in Britain, successive governments have avoided increases in direct taxation to fund the social elements that form such an important part of care for dementia sufferers. Equally, it is taken as read in Japan that the entire system of accessible care should be properly funded and the cost shared between government (through taxation) and society at large (through insurance contributions). It is a lesson that Britain might usefully consider.
Mayumi Hayashi (photo) is a Leverhulme early career fellow at King's College London
Number of elderly with dementia in Japan reaches 4.62 mil.
TOKYO (Kyodo) -- The number of people aged 65 or older with dementia in Japan is estimated to have reached 4.62 million in 2012, accounting for about 15 percent of the total elderly population, a health ministry survey has shown.
A study group of the Health, Labor and Welfare Ministry also estimated that another 4 million elderly people in Japan suffered from mild cognitive impairment, which could evolve into dementia, in 2012, up from 3.8 million in 2010, based on a research conducted between fiscal 2009 and 2012 across Japan.
When the estimated numbers of the elderly with dementia and mild cognitive impairment are put together, the combined figure suggests one in four people aged 65 or older in Japan suffer from these symptoms.
Takashi Asada, a University of Tsukuba professor (photo) specialized in dementia, and other members of the study group collected data on 5,386 senior citizens in eight municipalities across Japan by interviewing them and their families for diagnosis.
As a result of the research, the researchers projected that 15 percent of the overall population aged 65 or older in Japan -- or 4.62 million of the 30.79 million people in that age bracket in 2012 -- have developed dementia.
As of 2010, the number of people aged 65 or older with dementia10+ in Japan was estimated at 4.39 million, of whom 2.7 million lived at home -- including about 430,000 who lived alone.
By age, the percentage with dementia among people aged 74 or younger stood at 10 percent or lower, but the ratio surpassed 40 percent among people aged 85 or older. In most age groups, more women developed dementia than men.
The health ministry had estimated last year that the number of elderly people with dementia in Japan reached 2.8 million in 2010 and 3.05 million in 2012, based on data collected on those in need of state-backed nursing care services.
The latest projections far exceed those estimates, underlining that many senior citizens with dementia do not use services provided under the public nursing care insurance scheme.
(June 02, 2013 Mainichi Japan)
Dementia Friendly Fujinomiya
Chief Executive at Alzheimer's Society
In the shadow of iconic snow-capped Mount Fuji, a group of five shopkeepers meet to discuss how best to keep their town centre alive in the face of competition from out of town shopping malls and the buying power - and prices - the national chains can command that the local stores simply can't match.
That first meeting was over 10 years ago and the fact that I could join their meeting in April 2013 shows that they must have found a formula that keeps them in business, if not prosperous. The answer lies in valuing their customers. As Mrs Masula, chair of the Association explained, their customers are very local and elderly. They used to be supported by extended families across two or three generations, but all too often the elderly are now alone as children and grandchildren move away.
On June 16 2000, they held a one-off open day where the shop keepers came together to promote their stores and provide information and support for their customers. That one-off event has now become a monthly fixture on the 16th of each month. With around two-thirds of their customers over 60, the shopkeepers association have also seen the effect of dementia on everyday lives. So for the last three years they've been holding workshops to learn about how best to support people with dementia. It's their part of the Japanese version of England's 'Dementia Friends' programme where information sessions help everyone be understanding to those with dementia living alongside them. In Japan over 4million people have attended these sessions over the last eight years. In Fujinomiya, the shopkeepers have helped their neighbours with dementia carry on living in their own homes and the monthly shopper days include dementia information stalls. Stores display in their window a sticker that shows they are 'elderly and dementia friendly'. In some cases they have even been the first stage in getting people with Alzheimer's and other forms of dementia diagnosed, signposting their customers to professional help.
For now, there is a comforting programme of mutual benefit between the storekeepers and their customers who have dementia. But tough financial times and changing shopping habits make it increasingly hard to keep the small stores going. Part of the success of the Dementia Friends programme is that the big stores are now also realising that it's good business to be dementia friendly. Aeon, Japan's Tesco, have signed up to the programme and just out of Fujinomiya there's a big franchise drug store who have also signed up to be dementia friendly. The Manageress told me the company give time off to attend the information sessions. Small but important changes have now taken place in store. If a person with dementia is taking a long time at the checkout, then another till will be opened so the queue of potentially irritated customers is moved. The store also picks up on people who might have dementia buying abnormal drug supplies.
As in England, becoming dementia friendly is catching on across government, businesses and wider society. That's good news for people with dementia and their carers. On home turf, the Dementia Friends initiative inspired by the pioneering work in Japan is gaining speed. Our ambition is for a million people to attend an awareness session and take action on dementia. In three months from launch almost 9,000 people have already signed up.
Defeating dementia won't just happen in a lab or in a care setting. We need a step change in the way people think, talk and act about the condition and all of society has a role to play. Find out how you can get involved by visiting dementiafriends.org.uk
Ryuta Kawashima: The devil who cracked the dementia code
27 May 2013
He is the brains behind ? and face of ? a series of zany video puzzle games that keep millions of Japanese people entertained. Could they also bring back lost memories?
Ryuta Kawashima is used to children pointing at him on the street. They often shout gKawashima Devil!h Itfs the price the neuroscientist pays for being the famous face of a lucrative series of brain puzzles that he developed for Nintendo.
Kawashima appears in the videos as a disembodied, floating head with horns and a bright red face, asking gdevilishlyh hard maths and memory questions. Millions of games have been sold, earning him royalties of over $30m. But, he says, his games are more than just a fun way to learn: they could, in fact, provide a revolutionary new way to treat dementia.
The 54-year-old refused to keep the money he made from the brain puzzle series, ploughing much of it into a research centre in Japanfs Tohoku University, attached to the Institute of Development, Aging and Cancer. Kawashimafs 40-strong team of young scientists spends their days working on ways to train our working memory and stimulate the prefrontal cortex, the area of the brain that deals with problem-solving and personality. Brain exercises have been shown to expand the cortex of healthy young people, he says, gSo why not the old?h
That question animates a remarkable new documentary on Kawashimafs work. In Do You Know What My Name Is? pensioners with severe dementia at a care home in the US state of Cleveland, Ohio, are seen recovering the use of their memories after using a six-month programme of learning therapy he designed. Some are almost literally brought back to life, transformed from depressed, hollow shells slipping inexorably toward death back into sociable, happy people.
gWe neuroscientists knew that brain plasticity exists in young subjects. The new point is that we now know it exists even in the brains of dementia sufferers,h Kawashima explains.
He says stimulating the frontal cortex clearly improves memory and brainpower: gWe found that the best candidate for training working memory in people with dementia is reading aloud and performing simple arithmetic.h
Kawashima claims his own tests show an improvement in up to six out of 10 dementia sufferers, and he thinks that this can be bettered.
Dementia, a catch-all term for symptoms that include loss of memory and cognitive function, afflicts about 800,0000 people in the UK, according to the Alzheimerfs Society. The symptoms are progressive, robbing victims of memory, confidence, personality and, eventually, life as they slowly fade away. The condition costs the UK economy an estimated ?23bn a year, says the Society, and there is no known cure or preventative ? only the use of expensive drugs to delay the onset.
With the number of sufferers expected to treble worldwide from 36 million to 115 million by 2050, according to the World Health Organisation, scientists are increasingly turning to non-drug treatment.
A paper this month in the Proceedings of the National Academy of Sciences says a simple, cheap prescription of vitamins B6 and B12, and folic acid can slow the decline of grey matter. Nurses at care homes around the world use approaches such as music, art therapy and card games in an attempt to keep older brains stimulated and alive.
Japan is a test case for dementia because it is the worldfs fastest-ageing society, with nearly a quarter of the population aged 65 or older. For about a decade, thousands of private nursing homes across the country have been using Kawashimafs learning therapy, essentially a series of 30-minute brain exercises done every day, five days a week. The method has spread through word of mouth, after nurses and strapped local governments almost universally reported a slowing or even reversal of cognitive decline in subjects.
So far, however, Japanfs powerful Ministry of Health has so far refused to fund large-scale clinical trials, Kawashima laments. He believes he knows why: gMany doctors are not happy with our results because if they use our method they canft sell drugs. This is a very big market in Japan and theyfre losing a lot of money.h
Because his approach is marketed via a private company called Kumon Institute of Education, he insists he doesnft, in any case, need government help. The Ministry of Health declined to comment on his method.
As Kawashimafs fame has grown, so has interest in his work ? along with criticism. Some scientists have branded him a charlatan who has made a lot of money selling crank theories. Others say the jury is still out.
gI think he is a compelling character, and has some excellent ideas,h says Professor Clive Ballard, a researcher on dementia with University College London. gThey arenft yet well supported though by research evidence,h he adds.
The problem, Kawashima admits, is the dearth of large-scale clinical trials on his work. However, that may be changing soon. The Cleveland experiment is expected to spread elsewhere in the US and further afield too: Finlandfs government is launching a bid to translate his learning therapy into the local language and culture.
gHis work has a promise big enough to invest in a really big trial,h says Dr Juha Teperi, who is organising what he says will be a randomized sample of between 200 and 300 people. If Kawashimafs findings are repeated, git would be a really big breakthrough,h Teperi believes.
The father of four boys, Kawashima is critical of modern lifestyles which, he says, may worsen dementia in years to come. Ironically, he is highly critical video games. Playing for too long can inhibit the prefrontal cortex, he explains, because it is a passive activity, like watching TV.
gI only allowed my sons to play video games on Saturday and Sunday, for one hour each,h he says.
Do You Know What My Name Is? recently won the Audience Favourite award at the 2013 American Documentary Film Festival. The movie uses photos and family testimony to show the mental decline of accomplished, vibrant people until they eventually forget even the names of their heartbroken children.
A care worker repeatedly introduces himself to his elderly charges with the documentaryfs eponymous question. By the end of the film, remarkably, some patients can recall this information.
gItfs an example of how we can make the lives of older people liveable again,h says Kawashima.
Scientists Test A Potential Treatment Of Alzheimer's In Vitro
A Team of Researchers in Japan have been reprogramming cells from patients with Alzheimerfs into neurons to model the progress of the disease and develop potential therapies that can aid at least a subset of patients suffering from it.
As Ifve written before, many researchers expect that the biggest breakthroughs with stem cells are in the short term more likely to be in the realm of drug discovery rather than tissue or organ regeneration. (Not to take away from the crucial progress being made there.)
A major cause of Alzheimerfs is a protein called amyloid-À (beta) peptide, which builds up in the brain as a form of plaque.
In certain Alzheimerfs patients with a familial mutation in amyloid proteins, the build up of AÀ molecules, or oligomers, in neurons and astrocytes causes stress on a particular organelle of the cell called the endoplasmic reticulum.
Among other functions, this organelle is responsible for the transporting of proteins within the cell.
The Japanese team, which included 2012 Nobel laureate Shinya Yamanaka, differentiated cells from these Alzheimerfs patients into neurons and then treated them with docosahexaenoic acid (DHA), a solution that alleviated the stress response in the neurons.
According to the paper in the April 4th issue of Cell Stem Cell:
gUsing patient neurons and astrocytes, we addressed the accumulation and possible pathological roles of intracellular AÀ oligomers in familial and sporadic AD. We found that AÀ oligomers were not proteolytically resistant and that docosahexaenoic acid (DHA) treatment attenuated cellular phenotypes of AD neural cells with intracellular AÀ oligomers in both familial and sporadic AD patients.
Granted that this is just one study looking at a small set of people that suffer from a disease that effects millions, I followed up with one of the paperfs authors, Haruhisa Inoue (photo right) of the Center for iPS Cell Research and Application at Kyoto University, to see if their research might lead to a concrete treatment.
gSo far several companies have showed an interest in our work,h he told me in an email. gBut not specific to DHA.h
Inoue pointed out that DHA clinical trials have been reported in the past few years, and the treatment was effective only for a group of patients with mild to moderate symptoms, and largely but not completely ineffective in another study.
gOur data might suggest that, if we identify individual patient perspective by iPSC-based analysis,h he said, gand classify the phenotypes of patientsc DHA treatment might be effective to a part of the moderate-symptoms group in addition to the mild-symptoms group.h
This is provisional, to be sure. But as the iPSC process itself improves and the neurons of thousands of Alzheimerfs patients can be studied more speedily, we may soon see many niche therapies that can be customized for different groups of Alzheimerfs sufferers.
Modeling Alzheimers Disease with iPSCs Reveals Stress Phenotypes Associated with Intracellular AÀ and Differential Drug Responsiveness
Cell Stem Cell, Volume 12, Issue 4, 487-496, 21 February 2013
Copyright 2013 Elsevier Inc. All rights reserved.
Takayuki Kondo, Masashi Asai, Kayoko Tsukita, Yumiko Kutoku, Yutaka Ohsawa, Yoshihide Sunada, Keiko Imamura, Naohiro Egawa, Naoki Yahata, Keisuke Okita, Kazutoshi Takahashi, Isao Asaka, Takashi Aoi, Akira Watanabe, Kaori Watanabe, Chie Kadoya, Rie Nakano, Dai Watanabe, Kei Maruyama, Osamu Hori, Satoshi Hibino, Tominari Choshi, Tatsutoshi Nakahata, Hiroyuki Hioki, Takeshi Kaneko, Motoko Naitoh, Katsuhiro Yoshikawa, Satoko Yamawaki, Shigehiko Suzuki, Ryuji Hata, Shu-ichi Ueno, Tsuneyoshi Seki, Kazuhiro Kobayashi, Tatsushi Toda, Kazuma Murakami, Kazuhiro Irie, William L. Klein, Hiroshi Mori, Takashi Asada, Ryosuke Takahashi, Nobuhisa Iwata, Shinya Yamanaka, Haruhisa Inoue
EFamilial and sporadic Alzheimers patient iPSC-derived neural cells were analyzed
E Intracellular AÀ oligomers accumulate in lines from some patients
EAÀ oligomer accumulation is associated with ER and oxidative stress
EDHA-alleviated ER and oxidative stresses improve cell viability
Oligomeric forms of amyloid-À peptide (AÀ) are thought to play a pivotal role in the pathogenesis of Alzheimers disease (AD), but the mechanism involved is still unclear. Here, we generated induced pluripotent stem cells (iPSCs) from familial and sporadic AD patients and differentiated them into neural cells. AÀ oligomers accumulated in iPSC-derived neurons and astrocytes in cells from patients with a familial amyloid precursor protein (APP)-E693 mutation and sporadic AD, leading to endoplasmic reticulum (ER) and oxidative stress. The accumulated AÀ oligomers were not proteolytically resistant, and docosahexaenoic acid (DHA) treatment alleviated the stress responses in the AD neural cells. Differential manifestation of ER stress and DHA responsiveness may help explain variable clinical results obtained with the use of DHA treatment and suggests that DHA may in fact be effective for a subset of patients. It also illustrates how patient-specific iPSCs can be useful for analyzing AD pathogenesis and evaluating drugs.
Group homes lack sprinklers / 25% of small facilities for dementia patients unequipped for fires
More than 500 small group homes for dementia patients, or about a quarter of such facilities nationwide, are not equipped with sprinklers, a survey conducted by The Yomiuri Shimbun has found.
As small homes with less than 275 square meters of total floor space are not legally required to install sprinklers, the government has urged those facilities to install them by providing subsidies according to size.
But experts are calling for measures that better promote the installation of fire safety equipment.
"Even if facilities are small, the cost of installing sprinklers could be high in some cases because of issues with the structure or location. [The government] should consider a subsidy system that can accommodate actual conditions," one expert said.
The nationwide survey was conducted from Feb. 19 to March 22 in the wake of a fatal fire at a small group home for dementia patients in Nagasaki. Five patients died in the incident.
According to the survey results, 524 facilities, including the Nagasaki home, were not equipped with sprinklers. The survey covered 2,047 facilities in 44 prefectures. The three remaining prefectures--Akita, Yamanashi and Tottori--said they did not have the total numbers of small group home facilities.
A 2010 survey by the Health, Labor and Welfare Ministry found 2,113 small group homes nationwide.
Given these figures, it is estimated that about a quarter of small group homes are unequipped with sprinklers.
Most group homes with 275 square meters or more of floor space are equipped with sprinklers, the Yomiuri survey found.
In 2009, the ministry made it mandatory for such facilities to install sprinklers. The measure was taken after seven people were killed in a fire at a group home with about 280 square meters of floor space in Omura, Nagasaki Prefecture, in 2006. Smaller facilities became eligible for subsidies from 2010.
An official said the ministry is also investigating the actual conditions for sprinkler installment. "Based on results [of the investigation], we hope to consider improvement measures, including how financial assistance should be provided," the official said.
Prof. Yasumichi Kurata of Nishikyushu Universityiphoto right), an expert in social welfare affairs, said: "As various types of buildings including private homes are used as small group homes, it isn't always possible to install sprinklers at low costs. The subsidy system must be improved, for example, by having it cover a certain portion of actual costs spent [for installation], rather than providing subsidies according to the amount of floor space."
(Dairy Yomiuri@ Mar. 25, 2013j@
Team alleviates Alzheimer's symptoms in mice with gene therapy
A research team has used gene therapy to alleviate Alzheimer's symptoms in mice to the point where their memory became comparable to that of normal mice.
The treatment marks the first ever such success, and was accomplished by a team including Takaomi Saido(photo upper rightt), senior team leader at Riken Brain Science Institute, and Nagasaki University professor Nobuhisa Iwata(photo lowere rightt). The results were published in a British science journal on Aug. 18, and the team plans to proceed with tests on primates and then do clinical tests once they can confirm the safety of the treatment.
Alzheimer's disease occurs when an unnecessary protein called beta amyloid overstocks in the brain, destroying nerve cells. The research team in 2001 discovered an enzyme called neprilysin that breaks down beta amyloid. Afterwards, research around the world found that when this enzyme's activity falls, Alzheimer's10+ sets in.
The research team developed a virus carrying genes that produce neprilysin and injected it into mice with early-stage Alzheimer's disease. The beta amyloid in the mice fell by half to near the amount of a healthy mouse. When measuring the time needed by the mice to reach a goal in a maze as a test of their memory, they were about the same as regular mice.
There are around 2 million Alzheimer's patients in Japan, and it is thought to take around 20 years after the beginning of beta amyloid accumulation for symptoms to appear. Saido says, "Getting immunization after reaching a certain age could lead to prevention."
(The Mainichi March 19, 2013)
Report: Global brain delivery of neprilysin gene by intravascular administration of AAV vector in miceiScientific Reports@18 March 2013j
International Symposium on National Dementia Strategy in Tokyo
Tokyo Metropolitan Institute of Medical Science.
With the support of Tokyo Metropolitan Government, Ministry of Health, Labour and Welfare, The British Embassy, The Australian Embassy, The Netherlands Embassy, Royal Danish Embassy and Embassy of France.
Tuesday 29th, January 2013 10:30`17:15
Main Hall, 3rd Floor, Belle Salle Kudan
Sumitomo Fudosan Kudan Bldg, 1-8-10 Kudan-Kita, Chiyoda-ku, Tokyo
Alistair Burns(UK),Benoit Lavallart(France),Russell de Burgh(AUS),Nis Peter Nissen(Danmark), Julie Meerveld(Nederland), Anne Higgins(UK), Paul McCrone(UK)
Session 1 : Reports from Japan, England, and France
Masaaki Matsushita CEO, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology
Atsushi Nishida, Tokyo Metropolitan Institute of Medical Science
(1) "Dementia Policy in Japan" Katsunoiri Hara, Chief, Health and Welfare Bureau for the Elderly, Ministry of Health, Labour and Welfare(pdf1.9M)
Session 2 : Reports from Australia, Denmark, and the Netherlands
Shinichi Ohshima President, National Center for Geriatrics and Gerontology
Satoko Hotta, The Japan Institute for Labour Policy and Training
Session 3 : Dementia Care and Health Economics
Masahito Sekiyama, General Coordination Officer for Dementia Policies, MHLW
Mitsuhiro Sado, Keio University
Session 4: Panel Discussion
Yoshiko Shiotani, Board Chairperson, Japan College of Social Work
Shinsuke Kondo, The University of Tokyo
Website: International Symposium on National Dementia Strategy in Tokyo
Scientists discover possible new treatment for Alzheimer's
OSAKA--Japanese scientists have discovered a new way to destroy the chemical thought to cause Alzheimer's disease.
Alzheimer's is believed to result when a protein found in nerve cells degenerates into amyloid beta 42, a highly toxic substance, which then accumulates in the brain. This takes place under the influence of gamma-secretase, an enzyme that acts like a pair of scissors on the protein.
A team of scientists led by Masayasu Okochi(photo), a lecturer in clinical psychiatry at Osaka University, found that further in-vitro reactions involving the same enzyme could result in A-beta 42 being broken down into a less toxic form, A-beta 38.
Adding a form of catalyst improved the enzyme's activity, roughly doubling its efficiency in human cells, the researchers said.
So far, research into Alzheimer's therapies has focused on blocking the enzyme in order to suppress A-beta 42 generation. But this new work suggests it could be worth helping the enzyme to do its work.
"An enzyme-activating drug could have better therapeutic effects," Okochi said.
The findings have been welcomed by other experts in the field.
"The latest discovery will provide logical grounds for developing new types of drugs," said Toshiharu Suzuki, a professor of neuroscience at Hokkaido University's School of Pharmaceutical Sciences and Pharmacy. "It is also a key milestone in the efforts to understand how enzyme activity weakens."
The research results were published Jan. 3 in Cell Reports, a U.S. scientific journal.
iAsahi shimbun January 05, 2013)
Robot therapy gains popularity
"You're gentle and smart. You're a good pet, aren't you?" Tomoe Wakabayashi, 92, says as she affectionately caresses her companion Paro. Paro, a seal-shaped robot, replies with a loving "Kyuuu" while wagging its tail.
Wakabayashi is a resident at Lumiere, a group home for people who suffer from dementia in Kanagawa Ward, Yokohama.
She began suffering from gaps in her memory due to dementia about five years ago. She became a resident at the facility in October 2011 after she began suffering from other dementia symptoms, including violent outbursts at her family.
When she first started living at the facility, she always sat alone in her room and didn't speak to other residents. At dinnertime, she insisted the facility let her go home.
However, since spending time with Paro, she has vastly improved.
Using robots such as Paro, a method known as "robot therapy," has been reported to help soothe and ease depression among dementia patients.
As a result, its use has become more popular in Japan and overseas.
Whenever facility employees ask her to take care of Paro, Wakabayashi begins chatting away with the robot. She smiles more often and sometimes sleeps with Paro in her arms at night.
"I'm surprised that Paro has had a better therapeutic effect than we expected," said Misako Kawasaki, the facility's manager.
According to Kawasaki, Wakabayashi seems to remember raising her children and grandchildren.
"Being with Paro probably reminds her of happy times. It seems the experience brings more energy to her life, too," Kawasaki said.
Paro has also helped cheer up and reduce stress for 17 other residents at the facility.
The robot seal was developed by the National Institute of Advanced Industrial Science and Technology (AIST) in Tsukuba, Ibaraki Prefecture, and was first sold commercially in 2005.
Paro's unique features lie in its movements. The robot has visual, touch and audio sensors built into its body, and its programming allows it to recognize stimuli by moving seven body parts in a charming manner.
Many academic theses have been written acknowledging its beneficial therapeutic effects.
So far, more than 2,200 units have been manufactured for sale in Japan and overseas.
After being put on sale, Paro was soon primarily used to help care for elderly dementia patients in the United States and Europe, where the effects of animal therapy have already been recognized.
Using real animals in therapy is difficult at medical and welfare facilities as they may potentially carry contagious diseases or bite patients. Paro, however, carries no such risk.
In the United States, the U.S. Food and Drug Administration certified Paro as a type of medical equipment. In Denmark, many local governments have introduced the robot to care for dementia patients at nursing homes.
Meanwhile, in Japan, the robot was initially bought by individuals as a pet.
However, it has been reported that an increasing number of medical and welfare facilities are buying the robot after hearing it was highly evaluated in the United States and Europe.
"[Being with Paro] probably stimulates the remaining healthy parts of the brain [in dementia patients] and calms them down," said Takanori Shibata, the senior AIST researcher who developed Paro.
"I hope Paro will play a more important role in aging societies," he said.
However, Paro costs about 400,000 yen per unit due to its complicated, high-performance technology. The price will have to be reduced if it is to be used more widely.
(Daily Yomiuri Oct. 14, 2012)
65% of mental hospitals polled by Mainichi in 3 disaster-hit prefectures see rise in inpatients
Twenty psychiatric hospitals in quake- and tsunami-hit Iwate, Miyagi and Fukushima prefectures have seen increases in the number of inpatients comparedwith before the March 2011 earthquake disaster, a recent Mainichi survey has found.
The increase reflects growing hospitalization of people who have suffered from dementia12 following their families' and neighbors' moves into temporary housing. It also reflects failure by mental patients to be released from hospital even if their conditions have improved.
The Mainichi polled 64 hospitals and 12 public hospitals belonging to the Japan Psychiatric Hospitals Association in the three prefectures in late August, and received responses from 31 of them.
The survey asked the 31 institutions about the number of inpatients each month in 2010, 2011 and 2012. Of them, 20 hospitals, or 65 percent -- nine in Fukushima, six in Iwate and five in Miyagi -- reported increases in the number of inpatients and seven hospitals -- four in Fukushima and three in Miyagi -- attributed the jumps to effects of the March 2011 disasters.
Kodama Hospital in Ishinomaki, Miyagi Prefecture says the number of inpatients rose by 219 between March 2011 and February 2012 to total 4,144, up from 3,925 a year before. The number has been growing since March 2012. The hospital cites a lack of houses and other local facilities as well as manpower to accommodate mental patients such as those with dementia. There are many mental patients whose symptoms of schizophrenia have worsened due to psychological shock caused by the disasters.
There were a number of hospitals which reported jumps in the number of inpatients who had been transferred from disaster-hit hospitals.
In addition to the seven hospitals, Murakami Hospital in the city of Fukushima and Minamihama Chuo Hospital in Iwanuma, Miyagi Prefecture, reported rises in the number of inpatients with dementia.
Katsutoshi Furukawa, associate professor of geriatrics at the Institute of Development, Aging and Cancer at Tohoku University (photo left), pointed out that the disasters destroyed local communities in which families had taken care of people with dementia, causing a shortage of places to accommodate those people. The conditions of some inpatients have gotten worse as people have moved from their homes to temporary houses and other locations, Furukawa said, adding it is necessary to provide places for people at risk to interact with others to prevent them from become isolated from society.
When asked about requests to local and central governments, 10 hospitals called for establishing a regional system to enable mental patients to be reintegrated into society. Izumi Hoyouin Hospital in Iwaki, Fukushima Prefecture, says it seeks specific support to provide subsidies to rehabilitation facilities such as group homes.
( The Mainichi September 15, 2012)
New 'flow of care' to steer dementia patients away from hospitals
The health ministry will step up efforts to address the increase in elderly people suffering from dementia, aiming to change the "flow of care," under a five-year program starting in fiscal 2013.
"We will create a society where people (with dementia) can continue to live in familiar places as they wish," says Kazue Fujita(right above photo), parliamentary secretary for health, labor and welfare.
With the population aging rapidly, the ministry forecasts that the number of senior citizens with dementia will reach 2.89 million in 2020, or 8.4 percent of people aged 65 or over, 3.53 million in 2030, or 10.2 percent, and 3.85 million in 2040, or 10.6 percent.
At present, if dementia patients become violent or harm themselves in their daily lives, they may be sent to a mental hospital if their families or group homes are unable to cope with them. In 2008, there were some 52,000 people with dementia in mental hospitals, up from 28,000 in 1996, and their long-term stays have become a serious problem for such facilities.
A project team set up by the ministry pointed out in a report that delays in initial responses to people who show symptoms of dementia contribute to unnecessary hospitalizations.
Fujita said that it has been widely believed people with dementia must be kept in mental hospitals or related facilities. But this "flow of care" needs to be changed, she added.
The steps the ministry will launch in fiscal 2013 include the formation of support teams of about three nurses and other dementia experts to visit families and advise on early diagnosis.
Akira Honma (right below photo), who heads a research and training center in Tokyo for caregivers of people with dementia, said that the advance of the condition is predictable if patients receive treatment from an early stage.
(The Japan Times@Sep. 6, 2012)
Promote at-home care for dementia sufferers
As the number of elderly people suffering from dementia continues to rise rapidly, it is crucial for all sectors of society to create a system that will enable such people to live at home.
According to estimates released on Aug. 24 by the Health, Labor and Welfare Ministry, more than 3 million elderly people across the country suffer from dementia. This is one out of every 10 people aged 65 or older.
The ministry estimates the figure will reach 4.7 million in 2025. The growth in the number of the aged with dementia is alarmingly faster than projected.
The faster pace is due both to the rapid graying of society and to the increased number of people who are examined and diagnosed because of successful programs to raise awareness of the problem.
Advanced dementia can lead to such symptoms as wandering away, incontinence and even violence.
In many cases, family members of people suffering from dementia have become physically and mentally exhausted taking care of them and have opted to put them into mental hospitals. Such hospitalization tends to be long-term, averaging two years and seven months.
Support teams envisaged
The symptoms of people suffering from dementia are often aggravated after hospitalization, apparently due to such causes as changes in living environment and inadequate medication.
It is necessary to shift the priority in supporting elderly dementia patients from hospitals to home care.
Sixty percent of the approximately 52,000 people currently hospitalized with dementia could be discharged if arrangements were put in place to support them, including a system to promote home care.
Those who are hospitalized for dementia must feel frustrated that they cannot be at home, where they accustomed to being.
To help avoid longtime hospitalization of dementia patients, the health ministry plans to implement a new set of measures to promote their care at home, starting in fiscal 2013.
Under the program, the ministry will set up support teams nationwide that will comprise such experts as nurses, public health nurses and rehabilitation therapists for intensive care of people in the early stages of cognitive decline.
The support teams will visit the homes of the elderly to hear from them and their family members, while providing suggestions about how to deal with dementia symptoms at home.
In Britain, where a similar system was introduced in 2009, the number of people hospitalized for dementia has begun to decrease sharply. We hope to see such a favorable effect in this country, too.
Securing personnel urgent
To deal with elderly people with advanced dementia, the ministry plans to designate about 300 medical institutions as dementia centers. To facilitate quick responses to urgent requests from the families of dementia sufferers, the ministry is studying ways to enable doctors to make house calls on short notice.
The biggest obstacle to such measures remains a shortage of personnel. It is a matter of urgency to secure medical doctors, nurses and caregivers who are well versed in caring for patients with dementia.
Securing budgetary appropriations needed to implement the envisioned programs is also difficult.
Although people suffering from senile dementia tend to be viewed as unable to perform everyday activities, in many cases they remain emotionally stable and can engage in a range of activities.
Many people with dementia serve as volunteer workers, hoping to help others in spite of their own problems.
People providing medical and nursing care to those with dementia are urged to pay due attention to them to help them live in a way suited to their needs.
Efforts in local communities to establish frameworks that will facilitate helping the aged are also important.
To this end, some local governments have taken the initiative in enhancing support for the elderly, such as encouraging members of shopping district associations to learn about dementia.
Attention should be paid to such examples.
(From The Yomiuri Shimbun, Sept. 2, 2012)
(The Daily Yomiuri Sep. 3, 2012)
Number of elderly with dementia doubles to 3 million
The number of seniors with dementia has doubled over the past 10 years to exceed 3 million, meaning 1 in 10 people aged 65 or older suffers from it, a health ministry estimate showed Friday.
The number is estimated to reach just over 3 million this year, up from almost 1.5 million in 2002, accounting for 9.9 percent of those aged 65 or older, according to the Ministry of Health, Labor and Welfare.
The estimate is based on data collected in 2010 on those in need of nursing care.
The rapid increase reflects growing public awareness of dementia and a rise in the number of people consulting with doctors and being diagnosed with it.
The ministry estimates the number of dementia patients will reach 4.1 million in 2020, or 11.3 percent of the overall elderly population, and 4.7 million in 2025, or 12.8 percent.
The ministry is planning to introduce a program in fiscal 2013 to offer medical support to dementia patients in the early stages of the disorder by forming a group of nurses and therapists to make home visits.
iJapan Times@Aug. 25, 2012j
Early care for people with dementia eyed
The Health, Labor and Welfare Ministry plans to implement from next fiscal year measures to provide at-home care for people suffering from dementia to cope with the rapidly increasing number of people with the condition.
The new measures aim to enable people with dementia to live at home for as long as possible, by having teams of specialists visit their homes during the initial stages of the condition.
The ministry also hopes the measures will keep dementia sufferers from developing progressively worsening conditions that require long-term hospitalization.
The ministry will compile a five-year plan for the measures, which local governments will incorporate into their medical and nursing care plans.
Dementia refers to a typically progressive condition characterized by memory loss and deteriorated cognition due to the death or improper functioning of brain cells as a result of diseases or other causes.
There are several types of dementia, including Alzheimer's disease.
The government estimates that there were 2.08 million people suffering from dementia in 2010, and projects this number will rise to 3.53 million in 2030--indicating that about 10 percent of elderly people will have the condition.
A central pillar of the new measures is the creation of teams comprising dementia specialists such as nurses, health care workers and therapists to provide care to people in the early stages of the condition.
The ministry plans to deploy these teams to about 4,000 nursing care consultation counters of local governments nationwide. The teams will visit the homes of elderly people who have shown symptoms of dementia, conduct interviews with them or family members and refer them to medical institutions if necessary.
For elderly people with the condition whose cognitive abilities remain intact, the team will explain how they expect the symptoms to develop and advise them on managing their assets and nursing care options.
The teams also will help them improve their living conditions, making such changes as replacing gas stoves with electric ones, and offer psychiatric care for family members of dementia sufferers.
Another pillar of the plan is "near-home" medical facilities for dementia patients, which will collaborate with the specialist teams. The ministry plans to designate 300 clinics and small and midsize hospitals for the purpose.
There have been many cases in which dementia sufferers whose symptoms escalated to include wandering and violent behavior were asked to leave nursing care facilities, and were subsequently hospitalized.
To prevent this, the specialist teams will not only visit the homes of dementia sufferers, but also relevant facilities to improve the quality of treatment and care. As a result, the ministry also will consider whether to raise medical service fees at these facilities.
These measures to deploy teams of specialists and designate near-home medical centers will be reflected in municipal governments' nursing care insurance plans and prefectural governments' regional medical care plans.
The ministry will begin trials of the system in several areas across the country this year and will produce manuals on available assistance methods.
Following the trials, the ministry aims to introduce the measures across the country. But a major obstacle remains over how to secure and develop the necessary human resources.
Britain launched a similar initiative in 2009. As a result, the number of hospitalizations due to dementia in areas where the measures were implemented was one-third that in areas without the measures.
As there have been past cases in which excessive medication has resulted in worsening symptoms, the ministry also will draw up guidelines for treatment using medication.
(The Yomiuri Shimbun@Jun. 18, 2012j
Giving a kind ear to dementia / Expert urges patience, asking the right questions to help patients express selves
Conversing with a dementia sufferer can be a challenge--for both sides. But according to dementia expert Kazuo Hasegawa, a little bit of patience by the person asking questions can make a world of difference.
Hasegawa is known for creating the "Hasegawa Dementia Scale," a widely used method for detecting dementia in elderly people. After several decades diagnosing and treating the disease--whose symptoms include memory loss, mood changes and problems with communication--Hasegawa has found that rather than pressuring a dementia patient to make a quick response, waiting until they find their own finds can help them communicate.
Hasegawa, 83, was an assistant professor at Jikei University, a professor and president at St. Marianna University School of Medicine, and also served as head of the Tokyo Dementia Care Research and Training Center.
The following is an excerpt of an interview with Hasegawa.
The Yomiuri Shimbun: What is the "Hasegawa Dementia Scale"?
Hasegawa: It's a simplified index to check whether a person might be suffering from dementia. The test uses nine questions, including "What is today's date, day, month and year?" An official decision on whether a person has dementia is made later after hearing from themselves and their family, checking images of their brain, and other factors.
In 1966, the professor who was my academic supervisor advised me to devise a criteria for diagnosing dementia patients. I completed development of the criteria in 1974. Before that, I specialized mainly in epilepsy and depression. Since developing the criteria, however, I've focused on dementia in earnest. Even now I treat dementia patients while working some days as a doctor at local clinics.
Q: How has treatment for dementia changed over the years?
A: Doctors can now administer medicine that slows the progression of symptoms, and this has become a familiar practice. They could do almost nothing years ago.
I'll never forget a pastor whom I treated in 1983. He was an expert on church music. When he began to show symptoms of dementia, he became bothered by the fact that he couldn't read scores. He then wrote down his feelings on a music sheet, such as: "I can't feel a melody in my mind. Return to me, my spirit."
After he died, I had an opportunity to see the music sheet and it deeply shocked me. I asked myself whether I could bear the sorrow of the pastor. This encounter became the starting point for me to begin treating dementia patients and keep myself mindful of the fact that I want to help them and their families.
Q: How did you devise concrete ways to treat dementia?
A: When a dementia patient is asked a question, it often takes time before he or she starts talking. It's best not to put pressure on them for a quick answer, but instead to wait patiently. It's also important to ask a question that allows them to speak in their own words.
For example, when a dementia patient is asked, "It's cold, isn't' it?" he typically responds by only saying, "Yes, it is." Patients also sometimes noncommittally nod at questions without actually listening to the words.
When I examine dementia patients, I don't ask them yes/no questions such as, "Did you sleep well?" or "Are you hungry?" These questions would only elicit one-word responses and the conversation would end right there. To avoid this, I first give them an open-ended question, such as, "Any changes in your life recently?" I look into their eyes and wait for their answer. Then, in many cases I can hear what they really want to express.
In this day and age, it seems speed is required in all aspects of life. When I meet dementia patients, I feel as if they are teaching me the importance of living in a relaxed way.
Q: Are you worried you might suffer from dementia one day?
A: It's certainly possible, and it could happen at any time. The risk of developing the disease's symptoms rises with deteriorating health or poor lifestyle habits, so I'm trying to stay in good shape by not catching colds, frequently walking and refraining from eating fatty foods.
Q: What are the important things to do to help treat dementia?
A: It is vital to establish a system in which the whole community supports dementia patients and their families. Every resident in a community needs to be involved in keeping a close eye on dementia patients and avoid prejudice against them. If neighbors are united in caring about these people, dementia patients will surely find peace of mind in a safe living environment.
(Yomiuri Shimbun @Mar. 25, 2012)
Family of three die from apparent starvation in Japan
Discovery raises questions over the official response to rising poverty levels among the elderly and the unemployed in Japan
Authorities in Japan are under pressure to explain how three members of the same family were allowed to die of apparent starvation, after their bodies were discovered two months after their deaths.
Police found the bodies of a couple believed to be in their 60s and their son, thought to be in his 30s, at their apartment in Saitama, north of Tokyo, after the building's owner said he had been unable to contact them.
Officers entered the apartment to find the victims' badly decomposed corpses lying on futons, along with the carcass of their pet cat. The fridge was empty, the cupboards contained very little food, and a few one-yen coins appeared to all the money they had.
The discovery has raised questions over the official response to rising poverty levels among the elderly and the unemployed in the world's third-biggest economy.
As far as welfare officials in Saitama were concerned, the family, residents of a city of 1.2 million, had simply ceased to exist.
The victims appear to have been left to fend for themselves, despite their failure to pay their rent and utility bills. The cause of death is still unknown, but officials believe they either starved or committed suicide.
The family was not on a list of vulnerable households that are regularly visited by officials from the city's government. Some neighbours were unaware the apartment was even occupied.
Local media reports suggest the family were too ashamed to admit they needed financial help. When approached by the firm that manages their apartment, the wife reportedly said her son was working and her husband was unable to work due to chronic back pain.
A neighbour had tried unsuccessfully to persuade the wife to contact welfare authorities after she asked for money at the end of last year, saying the family was "in trouble".
Experts voiced disbelief that the authorities had not been informed, even after the family failed to pay rent for six months and had their gas and electricity cut off. They had reportedly not received welfare payments since 2003, two years after they moved into the apartment.
"Some people have a resistance to the idea of receiving welfare or contacting local authorities," Takehiro Yoshida, a welfare lawyer, told the Asahi Shimbun newspaper. "Others are left isolated in their own communities."
Yoshida called on utilities to report cases of repeated non-payment of bills to welfare agencies.
Tokyo Electric Power and Tokyo Gas have said they do not assume poverty to be the cause of non-payment, and do not notify welfare agencies unless asked to do so by the residents themselves.
Despite enjoying one of the highest standards of living in the world, Japan is struggling to address rising rates of poverty, particularly among the elderly and disabled, a growing number of whom die in complete isolation.
In the summer of 2010, a 76-year-old man in Saitama died of heatstroke after his electricity was cut off for non-payment.
Last month, two sisters in their 40s, one of whom had a mental disability, were found dead in their freezing apartment in Japan's northernmost prefecture of Hokkaido. An 84-year-old man living in the same region was found dead alongside his wife, who had been suffering from Alzheimer's.
More than 700 people have died of apparent starvation since 2000, according to the health ministry. Fears are growing that job losses among middle-aged men and the impact of the 11 March disaster will push the number higher in the coming years.
"This is not something you'd expect in a developed country like Japan, but people are struggling to find jobs," ABC News quoted Norimichi Goishi of the Tokyo Institute for Municipal Research as saying.
"Local officials can't always reach those in need. Deaths related to starvation are a lot more common than we think."
iguardian.co.uk, 24 February 2012j
Nurturing guardians for the elderly
As the graying of the population progresses, Japan will see a rapid increase in the number of elderly people living alone or suffering from senile dementia. In the past, their relatives acted like their guardians. But the spread of nuclear families will make it difficult for relatives such as siblings and children to protect elderly people.
The welfare ministry predicts that the number of senile dementia sufferers who often get lost or who cannot properly do such things as shopping, money management, taking medicine and answering phones will increase from 2.08 million in fiscal 2010 to 3.23 million in fiscal 2025. The number of households consisting of a single elderly member (65 years old or older) is predicted to rise from 4.66 million to 6.73 million in the same period.
According to the Supreme Court, under the current guardian system introduced in April 2004, some 30,000 people applied with family courts for appointment as guardians of aged people in fiscal 2010. Besides relatives, professionals such as lawyers, judicial scriveners and licensed social welfare workers were appointed as guardians.
But given the expected societal changes, it is clear that there will not be enough relatives and legal and other professionals who can serve as guardians of elderly people living alone or suffering from senile dementia. Municipal governments can play a role by giving necessary training to residents in communities so that they can serve as guardians of aged people who need them.
Under the current system, municipal mayors can ask family courts to appoint ordinary nonrelative citizens as guardians if necessary. In 2008, 1,876 such applications were made. The number increased to 3,108 in 2010. In accordance with a June 2011 revision of the welfare for the aged law, the welfare ministry, in cooperation with the Supreme Court and the Justice Ministry, is pushing a project to have nonrelative citizens serve as guardians.
Under the welfare ministry's fiscal 2011 model project with a \100 million budget, 37 municipalities, including Osaka City, are training citizens in legal matters, skills and ethics so that they can serve as guardians. It is hoped that more municipalities will nurture citizen guardians so that elderly people everywhere can live safely. Care must be taken so that guardians' ethical standards stay high.
(Japan Times 12/30/2011)
Dainippon Sumitomo to launch Alzheimer's disease drug donepezil HCl tablets in Japan
Dainippon Sumitomo Pharma Co., Ltd. (DSP) plans to launch in Japan donepezil hydrochloride tablets/OD tablets 3mg/5mg gDSPh on December 2, 2011 for the treatment of Alzheimer's disease (AD).
In domestic pharmaceuticals, DSP designates the Central Nervous System (CNS) field as one of its focus marketing areas, and offers various treatments such as atypical antipsychotics gLonasenh and gLullanh, Parkinson's disease drug gTreriefh, norepinephrine-activating neural function ameliorant gDOPSh, anti-epileptic drug gExcegranh, and serotonin-agonist antianxiety drug gSedielh. Approximately 230 CNS MRs in the CNS Sales & Marketing Division newly established in April 2011 are developing activities to provide information on these products.
DSP decided to handle a CNS generic drug as part of a plan to strengthen its product lineup in the CNS area. On June 24, 2011, DSP created gEstablished Products & Chain Pharmacies Groupsh dedicated to generic drugs in the CNS area under CNS Sales and Marketing, each under the CNS Higashi-Nippon Region, CNS Capital Region, CNS Kinki-Tokai Region and CNS Nishi-Nippon Region with the aim to promote sales of generic drugs in the CNS area.
In regard to the detailing of Donepezil hydrochloride tablets/OD tablets 3mg/5mg gDSPh, full-time CNS MRs will detail in their representative areas, while in the representative areas for general MRs, detailing will be in conjuction with the Established Products & Chain Pharmacies Groups and general MRs.
In the future, DSP will positively invest in products to contribute to the treatment of CNS disorders regardless of whether they are new or generic drugs.
Dainippon Sumitomo Pharma Co., Ltd., a Japanese-based company that broadly contributes to society through value creation based on innovative research and development activities for the betterment of healthcare and fuller lives for people worldwide.
(pharmabiz.com@November 29, 2011
Activities seen as dementia-prevention key
"Use it or lose it," an increasing number of local governments are advising their senior citizens as part of efforts to delay or prevent dementia.
To that end, more and more municipal governments are suggesting activities that allow seniors to enjoy themselves at the same time they are protecting their brains.
Such activities include making their own travel plans for trips they can take with friends and developing and using new recipes at home.
Even when the participants complete the activities, many continue to participate in similar activities on their own.
On a clear day in late September, three housewives in their 60s and 70s gathered at JR Shin-Matsudo Station in Chiba Prefecture. They had a detailed itinerary they had made themselves for a day trip, the theme of which was "admiring 800,000 red spider lilies."
The three formed a group they call "Himawari" (sunflower) to plan trips as a way to prevent dementia. They first met two years ago at a seminar on dementia prevention organized by the Matsudo municipal government in the prefecture.
Although the seminar ended four months later, the three continued to gather twice a month to discuss their original trips. They continue to take day trips together every two or three months.
Their destination this time was Gongendo, a riverbank in Satte, Saitama Prefecture, that is famous for its red spider lilies in autumn. They had obtained reference materials, including sightseeing brochures for the area, and studied the tourist attractions, history and means of transportation beforehand. They made a detailed itinerary after carefully checking bus timetables.
They reached the destination on schedule and walked along the riverbank, admiring lilies before stopping to eat lunch. One of the three, Shizue Koshiba, 75, said: "We use our brains naturally when studying the history of our destination and considering effective means of transportation. It's good to continue these activities while enjoying ourselves."
Local governments like to use travel planning to prevent dementia because they do not need to prepare special facilities, which helps to minimize the costs of such programs.
According to Ninchisho Yobo (dementia prevention) Support Center, a nonprofit organization based in Setagaya Ward, Tokyo, the number of local governments that have antidementia programs has been increasing since about three years ago, and there are now at least 20 nationwide.
The Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, under the jurisdiction of the Tokyo metropolitan government, has developed a community-based antidementia program of seminars. Matsudo and many other local governments are using the program as a reference.
In addition to travel planning, the Tokyo program suggests such activities as cooking, using personal computers and walking for exercise. Under the program, seniors are advised to arrange and carry out activities on their own.
For travel planning, for example, they are urged to choose a theme and destination and to prepare a detailed itinerary without using a commercially available guidebook. It also urges participants to continue their activities voluntarily in groups after the seminars are completed.
The Tokyo institute, with the cooperation of the Setagaya ward government, conducted a survey on the effectiveness of the activities in the program. The survey showed that those who continued the recommended activities for three years scored higher marks in tests of memory and attention than a control group of people who did not participate in such activities.
Naomi Yatomi, a researcher at the institute who was involved in the joint survey, said: "They showed an improvement in functions that normally start to decline before the onset of dementia. We believe the program will at least delay symptoms of dementia and that people can improve their brain functions by planning and carrying out activities on their own."
Concerning the seminars organized by local governments, Yatomi said: "They are meant to be educational, but only a handful of elderly people participate. As travel planning is not difficult, I hope more people will start doing it on their own."
(Yomiuri Shimbun @Nov. 20, 2011)
Dementia patients at risk after being moved into new care facilities
Thousands of nursing home patients from three disaster-hit prefectures are living in different facilities now, raising concerns about worsening cases of dementia caused by stress from new, unfamiliar environments.
Of the 1,309 inpatient elderly care facilities in heavily damaged Iwate, Miyagi, and Fukushima prefectures, around 80 were closed after the March 11 disasters because of their buildings being destroyed or other reasons. Around 3,300 elderly patients, 500 from Iwate, 1,200 from Miyagi, and 1,600 from Fukushima, who lived in these facilities are now living in other locations. None of the three prefectures have a completely clear grasp of how many of those patients have dementia, but in total it is thought to be about 400 to 600 people, or about 20 percent, and many of these patients are showing worsening symptoms since being moved.
One nursing care facility, "Group Home Taro" in Miyako, Iwate Prefecture, had its building lost to the tsunami. The facility had nine patients with dementia, who were evacuated by facility staff. Currently, they are living in another facility, "Hohoemi no Sato," located in the same city and owned by the same organization.
Although Hohoemi no Sato has a ward dedicated to patients with dementia, there is still a problem, as the stress caused by being in an unfamiliar place or with unfamiliar people often causes worsening of dementia. Some of Group Home Taro's dementia patients were there since the facility opened in 2005. There are already said to be cases of patients becoming more difficult to communicate with.
The managing organization plans to rebuild their lost facility, but the costs present an obstacle. The organization spent about 10 million yen to convert the previous building, which had been a private inn, but because the organization was renting the property, it is not eligible for reconstruction aid money from the national government. Neither is there any such support from the local government. The organization plans to again rent a property, but it will have to once again cover the costs of converting a building.
Meanwhile, at Hohoemi no Sato, there are now 114 patients, even though the facility's maximum capacity is only 100. This came about because of the facility taking on extra patients after the disasters. The facility has managed to secure the extra help needed by rehiring former workers and taking other measures, but personnel costs have increased.
The Iwate Prefectural Government is planning to construct 22 facilities including temporary nursing homes and day rehabilitation facilities across 18 areas in three cities and two towns.
However, a person in charge at the organization in Miyako said that more help is needed: "We want the prefectural government to take patients with dementia into consideration and extend support to rebuilding facilities that can take such patients on for the long-term."
(Mainichi Japan@June 5, 2011)
Disaster hits elderly with dementia
Life as evacuees from the Great East Japan Earthquake has been extremely hard for elderly people with dementia, many of whom appear to be deteriorating as a result of stress.
Experts predict that within 30 years, 10 percent of the people in this nation will have dementia, making care for the elderly a vital aspect of disaster preparedness that some feel requires closer attention.
Staff and 18 residents of Senior Garden, a group home for aged dementia sufferers in Tomiokamachi, Fukushima Prefecture, had to evacuate the premises on March 12 due to the troubles at the Fukushima No. 1 nuclear power plant.
They moved into the building of a soba noodle shop in Kawauchimura in the prefecture.
Frequent aftershocks caused many of the residents to develop extreme anxiety and panic. One wanted to go to the toilet every 30 minutes. Another wandered around the room, repeating over and over, "I want to go back. I want to go back." Another resident began singing loudly.
The staff tried their best to calm the residents down, but manager Yoko Suzuki, 61, realized it would be difficult to care for the residents in the noodle shop.
Four days later, the group relocated to a nursing home in Fukushima. Even though the living environment there was much better, the residents' conditions continued to deteriorate.
A 100-year-old man said, "It's more terrifying than wartime." He was constantly scared and wandered around the home at night. He was eventually hospitalized with a high fever.
An 86-year-old man once ran out of the building without shoes, and was not found until an hour later by police. He developed a gastric ulcer and began coughing up blood, at which point he too was hospitalized.
"The changes to their lifestyle were too drastic," Suzuki said.
The residents are now staying with staff in eight apartments in Fukushima that Suzuki rented for use as a temporary group home.
"The residents have finally calmed down," she said. "But I want to move them back to a group home like before, with individual rooms, as soon as possible."
For relatives, caring for elderly people with dementia brings extraordinary new stresses that can be too much too handle.
Fukuchanchi, a group home in Fukushima, accepted three elderly people who after evacuating had at first moved in with relatives, but their family members were unable to take care of them adequately.
Fukuchanchi manager Kinuko Narita, 59, said: "Their symptoms have gotten worse. They wander around more, and refuse to bathe or have their clothes changed. Caring for someone with dementia is a very hard job for family members to take on by themselves."
Major threat for graying nation
"Though it's often said Japan is a graying nation, caring for people with dementia has not been factored into disaster management at all," said Satoshi Takahashi(photo@right upper), a doctor and an associate professor of Iwate Medical University.
Takahashi has been touring coastal areas of Iwate Prefecture hit by the quake and tsunami since just after March 11, visiting shelters and examining dead bodies.
More than 60 percent of people killed in the disaster were aged 60 or older.
"Many of the elderly victims probably had dementia," Takahashi said, noting that dementia sufferers might not understand evacuation instructions and could easily become lost outdoors.
In Iwate, Miyagi and Fukushima prefectures, it is estimated that at least 115,000 elderly people have dementia. Nationwide, the figure exceeds 2 million.
It is predicted that in 2040, over 3.8 million people in Japan, or about 10 percent of the nation's population, will suffer from dementia.
But there are concerns that disaster management plans do not give sufficient consideration to people with dementia. Even if they are able to evacuate, sudden changes in their living environment could be too great a burden for them.
According to a Japan Geriatrics Society guide on medical treatment for the elderly in the event of a disaster, 43 percent of dementia patients in areas affected by the Great Hanshin Earthquake showed symptoms of deterioration within a week of the disaster.
Katsuya Iijima(photo right lower), a lecturer at the department of geriatric medicine at the University of Tokyo Hospital, helped to compile the the guide. He said people with relatively mild dementia can be more vulnerable in disaster situations, because they are more aware of changes in their surroundings and living conditions.
"People with mild symptoms tend to be more prone to deteriorate," he said.
Comprehensive planning needed
Ensuring quality care for elderly people in disaster situations, and reducing the burden on family members and nursing staff who are responsible for them, must be made an urgent priority. It is wrong to expect that people will settle in temporary housing units and things will be fine.
Akiko Takahashi, a nurse at a health care center in Minami-Sanrikucho, Miyagi Prefecture, said: "It's hard to keep a close watch on dementia patients who live in temporary housing units. Their condition can worsen if they're isolated in those units. Some kind of monitoring program is needed."
The government plans to build temporary housing facilities dedicated entirely to accommodating the elderly, as well as more than 100 day-care centers and other facilities, in disaster-hit areas. But so far, land has not been secured and no staff have been recruited.
Medical and nursing staff to provide everyday assistance, as well as legal guardians to manage elderly people's financial affairs, will also be necessary.
(May. 15, 2011 Takeharu Yasuda, Keishi Takahashi and Hirofumi Noguchi / Yomiuri Shimbun Staff Writers )
Evacuee with dementia dies of exposure near shelter
TAGAMI, Niigata -- A woman with dementia has died from exposure after getting lost near a shelter here for the victims of the recent earthquake and tsunami, shedding light on the lack of sufficient support for evacuees requiring special assistance.
The 62-year-old woman, a resident of the Fukushima Prefecture town of Tomioka, was found frozen to death on March 28 on a mountain about two kilometers from a shelter in Tagami, Niigata Prefecture. The victim and her family had been moving from shelter to shelter following the magnitude 9.0 earthquake and tsunami that struck northeastern Japan on March 11.
The woman, her 67-year-old husband and three other family members took shelter in the Fukushima Prefecture city of Tamura immediately after the quake. On March 12, the family moved to another shelter in the neighboring city of Koriyama.
According to Niigata Prefectural Police and Tagami Municipal Government officials, the woman began to develop dementia a few years ago. She was able to maintain a normal life when her symptoms were mild, and it was her daily custom to walk the family's dog in the neighborhood. But when her symptoms were bad, she found it difficult to remember what she was doing just a few seconds earlier.
As the woman's life at the evacuation shelters continued, her dementia worsened. She would often forget to close the door of the facility no mater how many times she was told to do so, and her family was too worried to let her stroll around the area.
The woman's family thought her symptoms could get even worse if they continued to live at the refugee shelter, and decided to move to the home of their eldest daughter in Minamisoma, Fukushima Prefecture, on March 24, after they finally made contact with each other.
However, as the residents of Minamisoma -- located less than 30 kilometers from the quake- and tsunami-crippled Fukushima No. 1 Nuclear Power Plant -- had been instructed by the central government to stay indoors to avoid the exposure to radiation, the family had difficulties going out and buying food and other daily necessities.
They searched on the Internet for facilities in other prefectures that would accept evacuees from areas affected by the nuclear accident, and arranged to move into an evacuation shelter in Tagami, Niigata Prefecture.
The woman and her family arrived at their new shelter at around 4 p.m. on March 27. While her family explained her condition to a nurse, her second daughter took her out of the building so that the woman, who hated to be called a dementia patient, would not have to hear the conversation.
About 30 minutes later, however, the woman disappeared on their way back to the shelter from a nearby square. She was found dead by a local volunteer firefighter the next morning on a snow-covered mountain road about 2 kilometers from the facility.
According to investigators, there was about 50 centimeters of snow on the road where the woman was discovered barefoot.
An official with the municipal government of Tagami said workers at the evacuation shelter did not know the woman had dementia when she arrived at the facility.
"If we had known about her condition in advance, we might have been able to better cope with the situation," said the town official.
Following the incident, the Niigata Prefectural Government announced that it would step up efforts to confirm the health status of evacuees who required nursing care in advance and send them to an appropriate evacuation facility where they could receive continuous support.
(Mainichi Japan) April 5, 2011
Elderly residents abused at nursing facility in Tochigi
UTSUNOMIYA -- Workers at a nursing facility here physically abused four elderly residents with dementia between 2008 and 2009, drawing on one patient's face and slapping another patient in the head, it has emerged.
The abuse reportedly occurred at the Utsunomiya Silver Home establishment in Utsunomiya. Hokutokai, the medical corporation that operates the nursing facility, has admitted that there was "psychological abuse," but it did not report the abuse to the Utsunomiya Municipal Government as legally required.
Nursing facility officials said four cases of abuse were uncovered at the establishment. In one case about two years ago, a female worker in her 20s took a photograph of a resident in his 80s, when he was on all fours and was wearing diapers with no shirt on. She reportedly showed the photo to colleagues, laughing at it.
In another incident in 2009, a male worker in his 30s and two female workers in their 20s reportedly drew color circles on the face of a female resident in her 80s. Other reported abuse included slapping a patient in the head and lifting a patient higher up than necessary when transferring them from a wheelchair to a bed.
Four of the workers involved were handed warnings at the end of February this year. Two of these workers plus one other worker have resigned.
The facility surveyed employees on the treatment of residents in February, and was alerted to the abuse by another employee. Facility officials apologized to the family of the resident whose face was drawn on. The other abused residents have already left the facility e and officials have not contacted them.
Under Japan's law to prevent abuse of the elderly, organizations are required to report abuse to local bodies when it is uncovered. Commenting on the reason for not filing a report, an official from Hokutokai's elderly welfare division commented: "When we questioned the workers involved, their actions were not deemed to be malicious, and the incidents were not ongoing."
iMainichi Daily News @April 16, 2010j
Manual advises families of aged, unsafe drivers
Preventing elderly relatives with signs of dementia from driving can be a difficult task, so the health ministry has prepared a manual offering suggestions on how to keep such drivers off the road.
Compiled by a study team with the Health, Labor and Welfare Ministry, the manual urges family members to look for alternative means of transportation as well as other leisure activities for elderly people to enjoy.
Under the Road Transport Law, a driver's license will be revoked or suspended if he or she is judged to be suffering from dementia. Drivers 75 or older have been required since June last year to take tests demonstrating their cognitive functions are sufficient for driving when they renew their drivers' licenses. They also can voluntarily give up and return their licenses.
However, many elderly people are reluctant to give up driving even when suffering from dementia. Family members may feel guilty trying to restrict the activities of an elderly relative and thus do not actively try to persuade them to stop.
To help address the situation, the manual lists actual cases that can serve as useful references. One man in his early 70s, for example, was diagnosed as being in the early stages of Alzheimer's disease. He sometimes forgot where he wanted to go while driving or could not park his car in a garage.
He even had an accident with his car at one point, and his doctor recommended he stop driving. The man refused, however, saying: "Driving is the most important thing in my life. I'll die if I can't drive."
His family members worked to drive for him and persuaded him to use taxis, utilizing the community's transport support service for the disabled. These efforts gradually reduced the number of times he drove a car, and he finally stopped completely of his own accord.
The manual advises family members to take such steps to help elderly people find other ways to get around or find different sources of enjoyment, such as taking hobby classes at culture centers.
Some transportation support services are available for a fee from nonprofit organizations. Local governments also subsidize elderly people's taxi fares.
Programs' contents differ depending on the region, so details should be confirmed with local governments' sections in charge of elderly and disabled people's welfare.
When people have difficulty persuading elderly family members to stop driving, the manual advises them to ride along when the elderly people drive and note whether they display the following behavior:
--Passing over the median line.
--Running over the outside line.
--Unable to park in a garage.
--Easily getting lost on unfamiliar streets.
--Panicking on unfamiliar streets.
--Unable to keep a safe distance from other cars.
The manual recommends family members consult with doctors, police and drivers' license centers if the person has such problems. Sometimes dementia patients forget they promised not to drive again. It is helpful for relatives to put doctors' notes in prominent places saying: "Your memory is failing and it's quite difficult for you to drive safely. The law also says it is very dangerous for such a person to continue driving."
If the patient starts to say, "I want to drive," the manual advises telling them, "Your doctor told you not to drive and you promised you wouldn't."
According to the study team's estimates, about 300,000 people suffering from dementia hold drivers' licenses.
"In many cases, elderly people won't be convinced if family members ask them to stop driving without giving them a chance to think," said Yumiko Arai, head of the Gerontological Policy Department at the National Institute for Longevity Sciences.
(The Yomiuri Shimbun@Apr. 6, 2010)
7 perish in Sapporo nursing home fire
SAPPORO -- Seven residents at a nursing home for elderly people with dementia here died after a fire broke out at the facility early Saturday, razing the structure, police said.
"I'm upset that something like this has happened. I want to do all I can for the bereaved families of the victims," said Michinori Taniguchi, president of the company that opened the home.
Sapporo police and firefighters said that a 24-year-old worker at the home, which was not fitted with sprinklers, made an emergency call around 2:30 a.m. Saturday, reporting a fire spreading from a heater on the first floor of the home.
Police suspect that the kerosene heater, which was reportedly kept running 24 hours a day, was the source of the deadly blaze and they are investigating the incident as a possible case of professional negligence resulting in death.
Police identified the victims as three men and four women aged between their 60s and 90s, all of whom had dementia. The female worker suffered serious injuries in the fire including burns to her throat.
A total of nine residents lived at the nursing home, but one was away at the time. Another 83-year-old woman who lived in a room nearest the entrance of the home was rescued by firefighters and avoided injury.
The nursing home had six rooms on the first floor and four on the second floor. At the time the fire broke out, the residents were believed to have been in their rooms. A dietician at the home said that there were three people who could walk by themselves on the second floor of the home. The residents' rooms were not locked, and were normally left open.
Five bodies were found on the first floor of the home and two on the second floor.
The Mirai Tonden home opened in December 2005, with approval from the Sapporo Municipal Government. Sapporo Fire Bureau officials said that inspections of fire extinguishers and emergency exit lighting -- required once a year under the Fire Service Law -- had not been carried out since August 2006, and the home had not submitted any fire prevention plan. The fire bureau had issued warnings over these two violations in September 2008 and May last year, verbally and in writing. Furthermore, the home was not fitted with sprinklers or fire alarms designed for such facilities.
The home was located in a residential district about seven kilometers northwest of JR Sapporo Station. At the time of the fire winds of over 10 meters per second were blowing in the area and a strong wind warning had been issued.
(Mainichi Japan March 13, 2010)
Editor: A nursing home in this article is a small sized and family-like group home for people with dementia. There are more than 9000 group homes through the country.
SUN Y7017, a treatment of Alzheimerfs Type Dementia to approved to launch in Japan
Daiichi Sankyo announced today that its subsidiary, ASUBIO PHARMA CO., LTD. (submitted a New Drug Application in Japan for the manufacturing and marketing of SUN Y7017 (generic name: Memantine hydrocholoride), which was developed for the treatment of Alzheimerfs type Dementia (AD).
SUN Y7017 is an N-methyl-D-aspartate (NMDA) receptor antagonist developed by Merz Pharmaceuticals GmbH (Head Office: Germany). This drug was approved for use in the treatment of AD by the European EMEA in 2002 and by the U.S. Food and Drug Administration in 2003. As of January 2010, this drug is marketed in more than 60 countries around the world, and is positioned as a standard care for AD.
By offering a new option with a distinct mechanism for the treatment of AD in Japan, Daiichi Sankyo expects to contribute to reducing the unmet needs of patients, their families, and medical professionals.
(Frontier India Pharmacetuicals News February 8th, 2010)
Restraining dementia patient upheld
A hospital acted within its legal right when staff members strapped a patient with dementia to her bed, the Supreme Court ruled Tuesday, overturning a lower court decision.
The Nagoya High Court had ordered the hospital in Ichinomiya, Aichi Prefecture, in September 2008 to pay \700,000 of compensation to the patient, ruling there was no urgent need to tie her up to prevent her
from seriously injuring herself.
"There was no other way than physically restraining the patient to prevent her from falling," ruled Takaharu Kondo, presiding justice at the top court's Third Petty Bench. "The time of restraint was minimum."
Diagnosed with dementia, the patient was admitted to the hospital due to lower back pain in October 2003 at the age of 80. She repeatedly left her bed. To try and protect her from accidents, a nurse tied her arms to the bed for several hours Nov. 16.
Under the mental health act, only mental hospitals are allowed to physically restrain patients. The hospital in Ichinomiya is not designated for treatment of mental diseases.
(The Japan Times Wednesday, Jan. 27, 2010)@
Demetnia in Japna more
Demography of dementia in Japan
1.Estimated number of the whole old people (65 and over) with dementia including AD
(from the report of Ministry of Health, Labor and Welfare)
2.Causes of dementia in the community among old people of the age of 65 and over by year (1987 and 1995)
(From the report of the Tokyo Metropolitan Government)
Surveyon the use of "restraints" in medical and social services of demented elderly
-from the standpoint of families caring for people with dementia-
by Yoshio MIYAKE MD,Kyoto
Aim of research: Use of restraints is a glaring problem that relates directly to the human rights of people with dementia. In Japan, no regulations exist against the use of restraints, which results in their wide usage in medical and social service facilities. This survey attempts to study the situation of use of restraints through a questionnaire survey to families caring for someone with dementia.
Methodology: The study targeted members of AFCDE with a five-year or more history of caring for a person with dementia, as well as availing of the above mentioned facilities
Research method: Questionnaires with self addressed envelopes sent to all members in October 1998 and collected be December 1998. In the survey, restraints included any act, physical or chemical that deliberately put limitations on the mobility of the demented elderly.
Results of Study:
617 answered to queries of which 576 people had a 5 year caregiving history as well as used medical and social service facilities like:
home for elderly, geriatric day service center, geriatric care facility, hospital, day care, care house
,group homes and others
Type of restraints used which will be referred to by the numbers henceforth:
|i. locking up of the whole facility (unit)
which prevented free movement during the
ii. locked in a special floor of the facility, or in a day room
iii. locked up in ones room
iv. hands and feet restrained to the bed
v. restrained to the wheel chair
vi. medicated in order to subdue movement
The survey yielded the following general observations regarding the use of restraints:
|(i) practiced mainly in homes for the elderly
for short stay
(ii) practiced mainly during short stays in geriatric care facilities and homes for the elderly
(iii) hospitals or short stays in homes for the elderly
(iv) was glaring in hospitals
(v) in hospitals and short stays at homes for elderly
(vi) Most during hospitalization
Response of families regarding use of restraints
|Did not think it necessary 27%
Considered it unavoidable 50.9%
What do families think about restraints as
such? (this response was to multiple choice
For the safety of the individual 45.5% of the total
The following are the answers from the 576 people who made use of services
|to continue treatment 16.5%
shortage of staff 43.4%
staff views about care 15.6%
staff's understanding about dementia 10.1%
management policies and philosophy of the director of the institution 17.2%
Improper structure of facilities 12.3%
Whether there was any explanation from the staff
Don't know 3.7%
or the families who received an explanation,
|77.7% answered that they were convinced,
17.9% that they were not, and
4.4% were unsure.
What did the families think was necessary
to abolish the use of restraints for people
36.3% of those who responded to the multiple choice questionnaire answered that staff should be increased.
Of the 576 people who had used the services of institutions
|19.2% answered that staff understanding on
dementia has to be changed and improved
9.2% answered that the facilities should be improved
1.0% felt the need for a third party ombudsman
People with dementia should not be put on restraints of any kind as this hurts their dignity and human rights. In spite of the fact that in the European countries and USA use of restraints is illegal, in Japan, other than in psychiatric hospitals where it is illegal, use of restraints elsewhereis continues with impunity.Until now, information about the situation on use of restraints remained fragmented in Japan. This is what spurred AFCDE to conduct a survey of this kind for the first time targeting the caregiver families who are members of this association. Although the number of participants in this study are small, it gives a clear picture of the situation.
The striking findings are that while homes for elderly; geriatric care facilities make use of mild indirect restraints, hospitals, in contrast make use of more direct restraints. This could be attributed to the difference in the level/condition/stage of dementia of the patient.
We also find answers like "it is for the safety of the individual", "due to shortage of staff" from the family members who try to see the situation more realistically. When medical and social welfare services are forced to resort to restraints, it is their obligation to explain the reason to the family members and obtain their informed consent. This arises from the prerequisite that the hospital staff as well as the family are at a equal footing; yet in reality it is the family that is at a weaker position. The staff should bear this in mind, and the fact that it requires courage on the part of the family to put forward their demands to them.
Although, about 77.7% of the people in our study were convinced with the reasons for use of restraints, we have to be cautious about this figure. Are all of these people at an equal level with the staff of the facilities? What about the ones who are at a weaker position and thus are left with no choice? The most significant problem is the situation when restrains were continued to be used against the patients even when the family members were unconvinced about it.
Most of the families were of the opinion that an increase in the staff members would help in getting rid of the use of restrains, Furthermore, the families felt that the staff should base their care of people with dementia on a correct understanding of the ailment. In other words, one could say that the "quantity and quality" of the staff would be a decisive factor in the use or abolition of restraints.
(Translator:Ms.Shivani Nandi Ph.D.)
Annual Report on the Aging Society: 2004 (Summary) by Cabinet Office, Japan