DEMENTIA IN JAPAN


2017@


'Restaurant of Order Mistakesf fosters empathy for dementia patients, as elderly numbers climb

SEP 17, 2017
The Straits Times

A dementia patient serves guests during the first pop-up run of the Restaurant Of Order Mistakes in June. The concept returned for a second run this weekend.

TOKYO At a pop-up restaurant in upmarket Roppongi this weekend, visitors who ask for soup could get a salad while those who order a hamburger might instead be served pasta.

There should, however, be no complaints at what is quirkily known as the Restaurant Of Order Mistakes.

Its team of wait staff comprises 17 dementia patients, and executive committee member Shiro Oguni, a television producer, has said of his hopes to foster a spirit of tolerance, empathy and acceptance towards dementia patients.

This is the three-day pop-up affairfs second run, following the success of the first event in June. A limited number of tickets has been set aside for walk-in customers, although the bulk of it is reserved for donors in an online fund-raiser which won nearly 5 million yen (S$60,700) more than the targeted 8 million yen.

The event ends Monday (Sept 18) as Japan celebrates, as a public holiday, a day it has christened Respect For The Aged Day.

Estimates show that already one in five senior citizens in Japan suffer from dementia, and their numbers are still set to rise as the nation grapples with an ageing population.

Japan defines its elderly as those aged 65 and above.

The Statistics Bureau, in its annual update released Sunday (Sept 17) in line with Respect For The Aged Day, noted that the proportion of elderly to the total population stands at 27.7 per cent. The figure, already a record high, is projected to reach 35.3 per cent by 2040.

Meanwhile, the data also showed that the numbers of those who are aged 90 years and above have crossed the 2 million mark for the first time.

Japanfs life expectancy, as of last year, was 87.1 years for women and 81 years for men.

Last Friday (Sept 15), Japanfs Health, Labour and Welfare Ministry noted that the number of centenarians ? or those aged 100 years and above ? has risen to a record 67,824 people. Nearly nine in 10 of them are women.

Japanfs oldest woman, Ms Nabi Tajima, 117, was born in August 1900 in Kagoshima in the south-west. Its oldest man, Mr Masazo Nonaka, 112, hails from northern Hokkaido and was born in July 1905.

Meanwhile, nearly 12 per cent of Japanfs workforce are seniors who choose not to retire. Most Japanese firms require full-timers to retire at 60, with the option of extending for another five years on a contractual basis with reduced terms.

Yet their numbers, too, are set to rise as the elderly look for ways to spend their time while seeking to supplement their household income.

Some 7.7 million seniors continue to be employed ? or 11.9 per cent of the total workforce. Three-quarters of them are doing either part-time or contractual work.

Amid the gloomy population trends, a committee of experts from the Japan Gerontological Society and the Japan Geriatrics Society are calling on Tokyo to add 10 years to its definition of what it means to be an elderly.

By redefining "elderly" as those aged 75 and above, Dr Yasuyoshi Ouchi, 68, told a recent briefing, would acknowledge the grejuvenationh of Japanfs seniors physically and intellectually given better healthcare as well as nutrition and sanitation standards.

But this plan has had its critics who are concerned that any increase in the age definition for an elderly would, too, delay pension payouts and affect the numbers of those who receive social security assistance.

Sociologist Emi Kataoka of Tokyofs Komazawa University told The Straits Times: gAn old man who is able to work will have to continue to pay taxes, and if the plan is realised, it means a shift towards a system where social security support in the ultra-ageing society will be propped up by other elderly.h

She said social safety nets must be enhanced before such a plan is considered, adding: gThere is also the risk that pension annuities are not paid out until 75, leaving those aged between 65 and 74 who are ill or unable to work in limbo.h

Insurers debut dementia-liability coverage as Japan grays

JUL 4, 2017
Japan times

Insurance policies covering various expenses relating to dementia are growing more common as Japanese demographics shift to an older population.

One in five Japanese age 65 or older are projected to suffer from dementia in 2025, according to estimates by the Health, Labor and Welfare Ministry.

In January, Mitsui Sumitomo Insurance Co. started selling a fire insurance product for households with a special clause to cover damages stemming from halted train operations caused by dementia patients wandering onto rail tracks.

The product was developed following a damages suit filed by a railway against the family of a man with dementia who was fatally struck by a train in an accident that disrupted railway operations. If families lose such cases, they face large compensation payments.

Fire insurance policyholders can obtain the special coverage by paying an extra \2,500 a year, according to Mitsui Sumitomo Insurance.

gWe added the special clause to the fire insurance service purchased by many people because long-term care providersf (liability) risk is growing,h a company official said.

Taiyo Life Insurance Co. started selling an insurance product covering treatment for dementia in March 2016. Insured people can receive a lump-sum payment of up to \3 million if they continue to show symptoms of dementia for 180 days.

Combined with related products, about 220,000 such insurance policies had been sold as of June, according to the company.

Taiyo Life found through interviews with consumers that their most common concern was anxiety about dementia, which prompted the company to develop the product.

One of the interviewees said, gI donft want to cause trouble for my family,h while another said, gI would like to reduce payments (related to dementia) from an early stage of long-term care,h according to the company.

Taiyo Life also began dispatching personnel to help customers complete the procedure of insurance claims in response to their complaints that filling out documents was bothersome, an official said.

In April, Sompo Japan Nipponkoa Himawari Life Insurance Inc. started selling health insurance products with a special clause enabling a lump-sum payment for long-term nursing care.

According to a government survey, dementia is one of the major causes behind the need for long-term care.

If insured people are certified as level one or above in the five-point scale of long-term care need measured under the public nursing care insurance system, holders of the insurance policy can receive a lump sum ranging from \100,000 to \5 million.

gWe responded to a rapid rise in the number of people with lower-level need for long-term nursing care. We hope the allowance will be used for such purposes as renovating their residence (to aid those in need of care),h an official of the company said.

Japan raises dementia support training goal to 12 million by 2020

JUN 17, 2017
japantimes

The government aims to train some 12 million people nationwide by the end of fiscal 2020 on how to support dementia patients, informed sources said.

The numerical target will be included in the gOrange Plan,h the national strategy on dementia care compiled chiefly by the health ministry in 2015, the sources said Friday.

Anyone can become a supporter of people with dementia after completing a municipal or corporate training course.

The governmentfs initial goal was to train 8 million people by the end of fiscal 2017, which started April 1. But it raised the target because 8.8 million people had already become supporters by the end of fiscal 2016, the sources said.

In Japan, there are expected to be some 7 million dementia patients 65 or older by 2025. In 2012, there were an estimated 4.6 million.

Last week, the National Police Agency said the number of people with dementia reported missing hit a record high in 2016, highlighting the difficulty of dealing with the issue in a rapidly aging society.

Providing better care for dementia patients

The Yomiuri Shimbun
8:13 pm, May 18, 2017
The Yomiuri Shimbun

photo(from left): Heii Arai, Tomofumi Tanno

The International Conference of Alzheimerfs Disease International for dementia patients, their families and dementia researchers was held at the end of April in Kyoto, marking 13 years since the conference was last held in this nation. Amid an increasingly aging population, our society will have to face the effects of dementia. A major theme of this yearfs conference was discussing what is required to build a society that can better care for and accommodate dementia patients. We spoke with two participants of this yearfs conference to learn more.

(From The Yomiuri Shimbun, May 3, 2017)

Share correct knowledge widely

Heii Arai / Professor at Juntendo University

In terms of maintaining and improving quality of life for patients of dementia, the most important thing is early detection of the dementia and any diseases that can cause it. For example, there is medicine that can be taken to delay the progression of Alzheimerfs disease, a cause of dementia. This enables the patient to continue working and lead a fulfilling life every day, which also relieves some of the worry and pressure on family members.

Diagnostic technologies have progressed significantly in the past 10 years. Medical devices have improved, and data regarding dementia has been collected through a variety of research. Today, itfs possible to detect mild cognitive impairment (MCI) causing light forgetfulness, a precursor to the onset of dementia. Symptoms of MCI can even be alleviated by resolving lifestyle diseases such as diabetes or high blood pressure or by getting sufficient exercise and sleep, without relying on medications.

Treatment and diagnosis has progressed as such, but the role of a physician is not simply to diagnose conditions and prescribe medicine. As more people seek outpatient care for dementia from hospitals and as there is a limit to what care can be provided during the time each patient is seen, physicians will have to team up with caregiving and welfare specialists to support dementia patients and their families.

The care that can be provided by family is limited. Places such as dementia cafes, where families can consult about caregiving services and connect with their communities, are essential. In some cases, the patientfs workplace or industrial physician needs to be involved. A physician who can observe not only observable symptoms but also get an overall view of the patient from their personality and environment must play a primary role in these types of partnerships.

In addition to this type of support, a proper understanding of such conditions is necessary to build a society that can better care for dementia patients.

Dementia patients are always trying their hardest not to inconvenience those around them. Through my interactions with them, I have observed this type of behavior is stronger in them than in people without dementia. Understanding and judgment requires more time for dementia patients. When things are explained to them, they may not sufficiently understand and become frustrated with themselves. In some cases, they may even get angry at the person with whom they are interacting. However, frustration and uneasiness when we do not understand something is a natural reaction for anyone. This anger is caused by being human, not having dementia. I want everyone to understand these are natural emotions dementia patients are showing.

To build a society where we can all live in harmony with those suffering from dementia, we must continue to spread correct knowledge about the condition.

(This interview was conducted by Yomiuri Shimbun Staff Writer Shigeyoshi Itagaki.)

¡ Arai specializes in psychogeriatrics. He established an outpatient care facility in 1999 specializing in early onset Alzheimerfs disease and is chairman of the Japanese Psychogeriatric Society. He is 64.

Donft take away what we are capable of

Tomofumi Tanno / Diagnosed with early onset dementia

When I was diagnosed with early onset dementia at the age of 39, I was so scared and full of worry for the future that I couldnft stop crying. I thought having dementia meant the end of my life. But since then Ifve met new friends whofve also been diagnosed with dementia but still lead cheerful, happy lives, and that helped give me a positive outlook on things as well. So from then on I was able to live in peace with dementia instead of regretting my condition.

There is still a stereotype that people with dementia canft do anything, so many people canft tell others about their diagnosis. Dementia patients themselves may hold on to stereotypes about the condition, as they worry what those around them may think.

I use public transport like the bus and the subway to commute to work by myself, but sometimes I forget where I am halfway through. I put a card in with my commuter ticket that says gI have early onset dementiah on it, and if I show that to people and ask them where I need to go, theyfll always kindly tell me what station to get off at.

When I went to a reunion party of old club members from junior high and high school, after some deliberation I decided to tell them I have dementia. When I told them, gIfm sorry, but the next time I see you all I may not remember you,h one of my seniors responded, gDonft worry, even if you forget us, wefll never forget you,h which was nice to hear.

Once I tell people I have dementia, I can feel comfortable asking them for help if I need it. I think a society where people with dementia can have this sort of conversation easily is one that can better care for dementia patients.

I started a consultation service in 2015 in my hometown of Sendai called Orange Door, where dementia patients can listen to each othersf stories. Sometimes family members or supporters have come with patients, saying, gThis person canft speak,h and then spoken for them. But some of those patients could talk to me when I was alone with them.

I want them to be able to do what they can, even if it takes time. I ask the people around these patients to be patient and refrain from getting angry even if the patients fail at doing something.

Last year when I visited some dementia patients in Scotland, I saw they were very adamant about doing what they could for themselves, and their caretakers also placed high importance on assisting them in their independence. However, in Japan the debate centers only around how to support dementia patients once they reach a critical stage, whether through nursing insurance or other means. The problem is that if you simply aim to do everything for the patient, theyfll ultimately lose confidence in themselves and end up losing independence altogether.

I worry about the progression of my dementia, too, but I want to continue to lead a fun life with the support of those around me while doing whatever I can by myself.

(This interview was conducted by Yomiuri Shimbun Staff Writer Mieko Furuoka.)

¡ Tanno was diagnosed with dementia in 2013. He currently lives in Sendai and works at a company that sells automobiles. He has a wife and two daughters who are in high school. He is 43.

An estimated 7 million cases by 2025

Dementia is when nerve cells in the brain deteriorate, resulting in the exhibition of core symptoms such as memory impairment, which hinders the lifestyle of the patient. This may also coincide with peripheral symptoms such as insomnia and wandering. As of 2012, 4.62 million people in the country had dementia, and the number is expected to reach 7 million by 2025.

The New Orange Plan national strategy was established by the Japanese government in 2015 as a pillar of measures to support the ability for dementia patients to continue living in a familiar environment, with an emphasis on the perspective of dementia patients and their families. However, in recent years there have been notable cases of dementia patients involved in accidents or other incidents, prompting an urgent need to establish broader support systems and care.

Behind the Scenes / Finding dementia early can prevent tragedies

The Yomiuri Shimbun
May 05, 2017

An accident occurred in October last year in which a light truck crashed into a line of children on their way to school in Yokohama, killing or injuring eight. An 88-year-old man was arrested on suspicion of negligent driving resulting in death or injury, but was ultimately diagnosed with dementia and exempted from prosecution due to insufficient grounds for charges.

With Japanese society rapidly aging, the number of elderly people with dementia is expected to greatly increase. Early detection of dementia is necessary to prevent accidents.

Yasuyuki Onishi, 79, a volunteer in Wako, Saitama Prefecture, visited the home of a 93-year-old woman to check her living situation on April 10.

gAre you having any problems with meals or shopping?h After checking the womanfs mailbox and other things, he decided that there was no problem.

Once every three years, the city of Wako conducts a survey with about 90 questions for about 10,000 citizens aged 65 or older, excluding those living in elderly nursing care facilities.

Due to the increasing number of traffic accidents involving elderly people, a question about whether the respondents drive was added to the list this fiscal year.

After analyzing the survey results, when the city finds elderly people suspected of having dementia, or elderly people or couples living alone but still in good health, it targets them for regular visits or observation by neighbors. The visits are made about once every three months.

About 60 people ? some volunteers, employees of the cityfs regional comprehensive support center (see below), or a counseling organization for elderly people operated by local governments or other entities ? visit all the elderly people who did not respond to the survey. In fiscal 2016, 23 of the 962 people who did not respond were suspected of having dementia and examined by a doctor.

gPartly due to the effects of the declining birthrate and an increasing number of nuclear families, there are all kinds of problems we cannot prevent unless we actively tackle them,h said Kyoichi Tonai, executive director of the cityfs public health and welfare department.

In the city of Kanazawa, which has about 115,000 residents aged 65 or older, about 1,000 case workers, as well as the cityfs regional comprehensive support center employees, visit the homes of people over 65 who do not live with anyone from a younger generation.

Based on the information they obtained on about 19,000 elderly people living alone, about 2,000 volunteers now regularly visit their homes. A city official in charge said, gIn the future, we also want to visit elderly people living with their families.h

Different approaches

There are gaps among municipalities in terms of their efforts to tackle these issues. While some regions mainly use regional comprehensive support center employees, many municipalities do not share information about elderly residents on the grounds of protecting personal information.

The head of a regional comprehensive support center in a government-designated city in the Tokyo metropolitan area complained: gWe have to employ a strategy of ewaiting,f meaning we can only support the people who come in to the center. There are around 6,000 elderly people in the area we are in charge of alone, and we cannot cover the area with only our employees.h

According to estimates from the National Institute of Population and Social Security Research, the percentage of households where the head of the household is 65 or older will increase to 40.8 percent in 2035 from 31.2 percent in 2010. Of those, the percentage of households consisting of an elderly person living alone will increase from 30.7 percent to 37.7 percent.

A research team of the Health, Labor and Welfare Ministry estimates that there were around 4.62 million dementia sufferers in 2012, increasing to 7.3 million in 2025 and 9.53 million in 2040.

As a way to deal with dementia in elderly drivers aged 75 or older, the revised Road Traffic Law that came into effect in March requires anyone gsuspected of dementiah in the cognitive function test that is conducted once every three years for driverfs license renewal to see a doctor. If the person is diagnosed with dementia, their license is revoked or suspended.

However, some experts say this is not enough. Early detection and care of dementia seems to be an issue entire regions need to urgently work together on.

(From The Yomiuri Shimbun, April 14, 2017)

eNo problemsf in license renewal

When responding to an investigation by the Kanagawa prefectural police, the 88-year-old man behaved and spoke unnaturally, saying, gI donft remember where and how I drove.h

For this reason, the Yokohama District Public Prosecutors Office conducted a psychiatric examination. He was diagnosed with dementia and thus exempted from prosecution at the end of March because it could not confirm that he had been negligent.

The accident took place on the morning of Oct. 28, 2016. In the cognitive function test he took to renew his driverfs license about three years before in November 2013, he was judged to have gno problemsh and his license was renewed, according to an investigative source. It seems that he had no illnesses requiring regular hospital visits and no family doctor.

Regarding whether he had used Yokohama cityfs regional comprehensive support center, the city official in charge said, gThat is personal information, so we cannot reveal it.h

According to investigative and other sources, the man was living in his home with a female relative in Isogo Ward, Yokohama, at that time, but had never before been suspected of dementia. In the morning on Oct. 27, 2016, he left his home in the light truck. He drove around Tokyo and Yokohama almost without stopping.

A prosecutor said, gHe got lost and could not drive properly due to fatigue, and was not aware of his own situation.h At around 8:05 a.m. of the following day, the light truck crashed into the line of children.

The father of Yu Tashiro, a first-grade elemen-tary school student who died in the accident at the age of 6, said, gI strongly hope for strict regulations for elderly drivers, wider knowledge of the voluntary driverfs license return system and, accordingly, better support for the elderly by all of society.h

Regional comprehensive support center

A type of center that provides consultation services to elderly people, established in April 2006 based on the Nursing Care Insurance Law. Municipal governments operate them directly or outsource their operations to social welfare or medical corporations. There were about 4,700 centers across the country as of 2015. Senior care managers, health workers, nurses, case workers and other staff members play a role in preventive measures in nursing care as well as early detection of abuse. The centers are expected to be a hub in their regional networks that watch out for elderly people.Speech

In tests across Japan, new tech allows speedy tracking of lost dementia patients

Japan Times
MAY 3, 2017

Japanfs rapidly aging society is spurring technological innovation, including the use of a tracking system designed to help families and nursing facilities locate people suffering from dementia when they lose their way or go missing.

As the country with the most aged population, Japan is poised to see its postwar baby-boomer generation ? currently the biggest age demographic ? form a population stratum aged 75 or older by 2025.

With the help of a smartphone app, thumb-size portable electronic devices developed by Sohgo Security Services, popularly known as ALSOK, that can be placed in pockets, wallets or attached to shoes are expected to help quickly find dementia sufferers who go missing.

The system works using Bluetooth wireless technology ? the standard for exchanging data over short distances.

It might be difficult for a resident of a community to notice a person with dementia who is simply wandering the streets.

But if the person is carrying the gadget, dubbed gMimamori Tag,h and passes a volunteer who has downloaded the free app to their smartphone, the positioning data of the person who has gone missing are automatically sent and stored on ALSOKfs computer servers.

The system also features tabletop detectors that can be installed at local businesses. These can also pick up the signal and store the data on ALSOKfS servers. As the data are sent anonymously, there is no concern about leaking private information.

Family members or those conducting the search can then find the missing person by checking the stored data via the app, pinpointing their current location and where they may be headed.

As more people download the app and more tabletop detectors are distributed, the amount of data stored will increase, making it easier and quicker to find missing people.

The Mimamori device ? mimamori can be translated to gwatch overh ? is much less cumbersome and lighter than a typically fist-sized GPS gadget, commonly used by hundreds of municipalities across Japan for the same purpose.

In a trial conducted in the city of Kitakyushu in January, the security service company gobtained a good result,h according to Daiki Shimamura, an ALSOK official promoting the system.

Two search teams consisting of six people each were both able to find a person holding the device within 10 minutes in a 2-sq.-km area, assisted by 30 tabletop detectors. It took dozens of people about 30 minutes to find a person without using the system. The test subjects were not actual dementia patients.

ALSOKfS devices are expected to be sold to municipalities for \2,200 per individual, plus \200 per month for their use. The tabletop detectors cost \23,000 per unit and can be rented on a monthly basis for \1,400. ALSOK is aiming to begin commercial sales of the equipment before next spring.

The number of people who went missing due to dementia jumped 27.1 percent to 12,208 in 2015 from 2012, accounting for 14.9 percent of the total number of missing persons, according to the National Police Agency.

The figure is expected to rise further as the ratio of elderly people ? those aged 65 or older ? is forecast to reach 40 percent in 2060 from 26.7 percent in 2015, according to a projection by the Cabinet Office.

Anticipating demand, Eisai Co., a Tokyo-based pharmaceutical firm that has developed medications for dementia, has created a device similar to ALSOKfs with a Tokyo-based technology venture. The two companies are conducting trials in a number of municipalities and also plan to begin commercial sales before spring 2018.

The city of Tama in suburban Tokyo began employing ALSOKfs system in April to support elderly residents and their families following the decision by the infrastructure ministry to adopt the service for pilot projects around the nation.

Tama will receive government subsidies until 2019 as a way of promoting the business model to help make the community more livable for the elderly.

The city encompasses part of Japanfs largest residential development, Tama New Town, which was developed from the mid-1960s during an era of high economic growth in response to the rising demand for affordable housing for people who commuted to central Tokyo. The town occupies 60 percent of the cityfs total land area today.

About two-thirds of the communityfs population of about 150,000 is living in the residential development. According to the local government, the ratio of people 65 and over was 29.4 percent in March, higher than the national average.

Tama represents a prime example of the task that faces the nation. One in 3 people in the city are expected to be at least 75 years old in 2025, as all the baby boomers who were born between 1947 and 1951, about 8.5 million people, will have reached that age around that time.

Since 2006, Tama has expanded its budget for elderly care, including building networks to closely watch seniors in accordance with the central governmentfs policies for promoting support measures for the elderly, particularly for dementia patients.

The state has been raising awareness about dementia, estimating the number of patients will grow to 7 million in 2025.

Over 2,000 Mimamori Tags are being provided for use in 10 cities nationwide by ALSOK, including Inagi, a city adjacent to Tama that is cooperating in the effort.

gElderly residents come and go across city borders to visit hospitals in both cities, sometimes by train. We can prepare to care for those in need by using the system,h said Koji Takeda, a Tama official.

The hope is that Tamafs effort to support the elderly and ALSOKfs detection system will create a synergy effect in the community.

Twenty-three companies and organizations, including Seven-Eleven Japan, the leading parcel delivery service Yamato Transport, post offices, nonprofit organizations, co-op supermarkets and care service providers have agreed to cooperate.

gWe call on (these companies) to voluntarily download the app into their employeesf smartphones in addition to placing the tabletop detectors at a number of their bases,h Takeda said.

Additionally, the city is seeking the help of hundreds of senior citizen volunteers in Tama who regularly clean public elementary and junior high schools and various buildings across the city to participate in a neighborhood watch.

gIf many of them cooperate by downloading the app, we could have a very reliable network to detect the elderly that covers the entire city,h Takeda said.

Early-onset dementia patients tackle symptoms through 'clinical art'

April 30, 2017
Mainichi Japan

Early-onset dementia patients are facing their symptoms head-on through a "clinical art" program to stimulate their brains at the Nagisa Warakuen facility for the elderly in Tokyo's Edogawa Ward.

"Ashitaba Art" is a monthly program that the facility began holding roughly two years ago that challenges dementia patients who began developing symptoms before the age of 65 to maintain their current mental functions through creating works of art.

At a meeting of the group on April 18, instructor and clinical artist Kanako Obata, 36, led the roughly 10 participants in creating "bamboo shoot"-themed sculptures. Participants first held a bamboo shoot in their hands, paying close attention to the shape and the feel of the object, even being prompted by Obata to smell the shoot, all to stimulate their brains through their five senses. She also asked the participants for examples of dishes made with bamboo shoots. At the suggestion of "sashimi," Obata promptly answered, "Wow, fancy!" to the smiles of the participating family members of the patients and other facility workers.

The artwork itself was made from newspapers rolled up to form the shape of a bamboo shoot before being decorated with bits of traditional Japanese handmade paper. Staff kindly guided a woman who did not understand the process and was just tracing the brush meant for glue over the materials.

Seventy-four-year-old Gen Ito of Katsushika Ward has been participating in the event since the very first meeting with his wife, who has early-onset dementia. He said his wife also attends the daytime nursing care service provided by Nagisa Warakuen called "Ashitaba" three times a week. "Ashitataba Art is an activity that we have spent time cultivating. As a family member, I want to help keep it lively," Ito commented.

In addition to creating sculptures, clinical art also includes a wide variety of programs, like listening to the sound of rain while painting on panes of glass or imagining what it's like inside dirt while painting on a flower pot. The effectiveness of the treatment on dementia is still being researched, but according to Obata, "Art is just a tool. Having fun and smiling is what's most important."

About an hour later, the bamboo shoots of various shapes and colors have been completed. Obata goes around the room to offer compliments about each individual piece. Participants then share their thoughts and praise with each other, and by the end of the session, everyone has a satisfied expression on their face.

The activities that patients with dementia are able to carry out slowly decrease with the progression of the disease, and for many people, their self-confidence decreases as well. Through spending time enjoying themselves with their peers, the treatment is thought to offer comfort and encouragement for patients with low self-esteem. "Even if they forget that they made the piece, how they felt while making it definitely still remains," Obata said.

According to a nationwide survey carried out by the Ministry of Health, Labor and Welfare in 2009, an estimated 38,000 people have early-onset dementia. Compared with the more than 4.6 million people aged 65 and over suffering from dementia, there are a smaller number of early-onset patients, and the reality is that there is a lack of facilities and programs to support and meet their needs.

The causes and symptoms are the same as the dementia that occurs in those 65 and above, but the average age for the onset of symptoms is 51 years old, and there are even cases of those in the prime of their lives being affected. Because of the age factor, while they may feel changes in their body, they often put off going to the doctor and are forced into early retirement, many ending up unable to support themselves financially. Because they still have their physical strength, their struggle to find a place to feel comfortable at or a reason to live is an issue that needs to be addressed.

"There needs to be more effort put into deepening knowledge about early-onset dementia among nursing care workers," said Nagisa Warakuen regional director Megumi Ikeda. In the 2009 fiscal year, Nagisa Warakuen began its "Ashitaba" daytime nursing care service as a Tokyo Metropolitan Government pilot program. Even after the pilot service ended, the facility continued to offer care on its own, and has had participants such as a man on a leave of absence from work and a woman in the middle of childrearing.

"Our staff were worried about how we should treat those patients whose bodies were healthy but whose dementia was advancing," Ikeda said, looking back on the Ashitaba program. As for "Ashitaba Art," Ikeda said that she can see improvements in patients' concentration and communication abilities. Realizing that support for family members was also indispensable, the facility established a family association in 2012.

"Ashitaba Art" will hold its first exhibition on May 3 and 4 at Tower Hall Funabori in Edogawa Ward. The exhibition will run from 12 p.m. to 6 p.m. on May 3, and 9 a.m. to 5 p.m. on May 4, with chances to experience the art-making process on both days. Juntendo University Medical School research associate Akiko Furuta, a dementia researcher, will also hold a seminar from 2 p.m. on May 4. Admission is free. For more information, contact Nagisa Warakuen at 03-3675-1201 (Japanese only).


Kyoto dementia meet highlights Japan-initiated support program

April 27, 2017
The Asahi Shimbun

KYOTO--A Japanese "dementia support" program is in the spotlight at the annual International Conference of Alzheimerfs Disease International here through April 29.

About 3,000 people from about 70 countries and regions, including dementia patients and professionals in the medical and social welfare fields, are attending the four-day gathering.

The program was started in 2005 by Japan's health ministry to promote understanding and abolish prejudice against dementia patients and their families, as people suffering from the disease are still regarded with deep-rooted disdain in many regions.

The program has been expanding worldwide and now involves 12 million people in 11 countries.

Numerous presentations by dementia patients are one of the most notable characteristics of an event that Japan is hosting for the second time, the last one being in 2004.

An official certificate is granted to people who listen to a free, 90 minute-long lecture to learn more about what dementia symptoms are, how to interact with patients and also the best ways to support them.

According to overseas training groups and the Tokyo-based National Caravan-Mate Coordinating Committee, which educates people in the support program, about 8.8 million people in Japan, and about 2 million people in England and Wales have become members.

The idea is also catching on in the United States and elsewhere.

Britain played an important role in expanding the program. In 2013, the British charity Alzheimerfs Society started "dementia friend" programs which identified with the Japanese support program.

That same year, a G-8 dementia summit was held in London in response to a call by David Cameron, the British prime minister at the time. Also, a World Health Organization gathering in 2015 concluded that countries, including developing nations, should make a joint effort working beyond national boundaries.

Philippa Tree, the international affairs official of the Alzheimerfs Society, said it is important that counties cooperate in activities and measures to develop a friendly society for dementia patients.

She said to achieve the goal, the dementia friends program is an effective plan from which to work from.


88-year-old driver avoids indictment over fatal accident due to dementia

April 1, 2017
Mainichi Japan

YOKOHAMA -- Prosecutors have decided not to indict an 88-year-old man over a fatal traffic accident that left an elementary school boy dead, after deeming that he cannot be held responsible for negligence because he has been diagnosed with dementia.

The man, whose name is being withheld, set out from his home in his light truck on Oct. 27 last year, a day before the accident. He got lost because of his dementia, but continued to drive the vehicle for nearly 24 hours, according to prosecutors.

The man eventually crashed the truck into a group of elementary school children on their way to school in Konan Ward, Yokohama, at around 8 a.m. on Oct. 28. The accident claimed the life of Masaru Tashiro, 6, and left seven others injured, according to law enforcers. The man is believed to have been driving his vehicle at 40 to 50 kilometers per hour.

Police arrested the man on suspicion of negligent driving resulting in death and injury. However, he reportedly told investigators, "I don't remember the route I took to the accident scene," prompting prosecutors to conduct a medical test on him. He was subsequently diagnosed with dementia.

The Yokohama District Public Prosecutors Office deemed that the man was unable to predict any danger and decide to stop driving due to his dementia. Prosecutors also determined that he was unable to properly control his vehicle partly because of his fatigue after driving for nearly 24 hours. Therefore, they concluded that he cannot be held criminally responsible for his actions.

The father of the victim said prosecutors' decision is unacceptable.

"My son was deprived of his hopeful future in a moment. But law enforcers deemed that the driver who caused the accident can't be held responsible. It's totally unacceptable," Masaru's father said in a statement released by his lawyer. "I strongly hope that strict regulations will be enforced."


Tougher dementia checks for Japanfs elderly drivers come into force

Japan Times
MAR 12, 2017

The nationfs revised Road Traffic Act came into force Sunday, introducing tougher tests for drivers aged 75 or older to detect signs of dementia in an effort prevent traffic accidents.

Under the law, elderly drivers will be required to undergo 30-minute cognitive tests to measure memory and judgment if they commit any of 18 traffic violations, such as running a red light or driving on the wrong side of the road. In addition, they will have to renew their licenses every three years.

Drivers that test positive for possible dementia will need to undergo further examination by a doctor.

With the increase in frequency of such checks and the testing, police hope to prevent future accidents, officials said.

Dementia sufferers are not allowed to drive. The National Police Agency expects that about 50,000 drivers annually will need to undergo medical examinations after the cognitive tests. About 30 percent are expected be diagnosed with dementia and have their licenses revoked or suspended, according to the agency.

With prefectural police departments calling on drivers to relinquish their licenses if they feel uneasy about driving, authorities face the challenge of helping the elderly who lose their daily means of getting around find new modes of transportation.

Previously, drivers aged 75 or older did not have to undergo cognitive tests other than when they renewed their licenses. Even if the tests raised suspicions they may be suffering from dementia, drivers were not required to take medical examinations unless they committed a specific traffic violation.

In 2016, licenses were revoked or suspended for 1,844 elderly drivers, according to preliminary data. Under the new system, about 15,000 drivers a year, 8.1 times the 2016 level, are expected to have their licenses revoked or suspended after medical checkups.

The police have secured the cooperation of about 3,100 doctors across the country who will be available to provide a diagnosis should the cognitive tests show signs of possible dementia.

The revised law also reformed the mandatory 150-minute lecture given to elderly drivers who renew their licenses. The time will be shortened to 120 minutes for drivers found through the testing to be free of dementia, but expanded to 180 minutes for those who show signs of dementia or are suspected of having suffered a decline in their cognitive abilities.

Drivers will also need to take the lecture if their scores drop while taking the extraordinary tests carried out after committing one of the specified traffic violations.

The number of people aged 75 or older who have driverfs licenses stood at 5.13 million at the end of 2016, having doubled over the past decade. A record 160,000 such drivers voluntarily surrendered their licenses last year, while the number of traffic accidents caused by elderly drivers remained almost unchanged at 459.

Worried about a possible increase of such accidents, the agency is discussing a range of countermeasures with experts.

Alzheimer's disease may be curable at very early stage: research

January 31, 2017
Mainichi Japan

Japanese version

A team of scientists have succeeded in recovering rat brain nerve cells in a very early stage Alzheimer's-like state to an almost normal condition by removing the causal substance, it was announced on Jan. 31.

The finding by researchers from the National Center of Neurology and Psychiatry (NCNP) and other institutions is hoped to lead to the development of treatment and preventative methods for Alzheimer's disease, whose patients number an estimated 2.5 million or more in Japan.

While the pathogenic mechanism of Alzheimer's disease remains unknown, it is believed that the disease develops after oligomer -- an aggregation of amyloid beta protein, which is an unnecessary substance -- accumulates in the brain and leads to the gradual deaths of nerve cells. It is reportedly the first time for researchers to have demonstrated that the removal of oligomer can work to recover nerve cells from an Alzheimer's-like state.

During the experiment, the researchers added oligomer to rat nerve cells and cultured them for two days so they develop abnormalities in proteins related to communication and other substances. They then separated those nerve cells into two groups and cultured them for another two days -- one in a solution laced with oligomer and the other in an oligomer-free solution. As a result, the researchers found that nerve cell abnormalities had further progressed in the oligomer-laced solution, while the other group had recovered to a near normal state.

Alzheimer's disease can possibly be cured and prevented if oligomer is removed from human brain nerve cells in a very early stage of oligomer accumulation. Research has been underway worldwide for the development of drugs to prevent oligomer accumulation and for identifying the best timing for starting treatment by grasping the oligomer accumulation status.

The latest finding was published in the British online scientific journal Molecular Brain on Jan. 31.


2016


Eisai, Keio University enter joint research pact to discover & develop new drugs targeting dementia

Saturday, December 24
pharmabiz.com

Eisai Co., Ltd. and Keio University announced that they have entered into a new joint research agreement for the discovery and development of new drugs targeting dementia. For this collaborative research, a research lab will be established, and researchers from Eisai and Keio University will work together to identify and validate novel drug targets and biomarkers that could potentially lead to the development of new therapeutics and preventive medicines for dementia.

Under this joint research agreement, Eisai and Keio University will establish the Eisai-Keio Innovation Lab for Dementia (tentative name) as a base for industry-academia collaboration within Keio University's Shinanomachi campus (Shinjuku ward, Tokyo) that will hopefully spur new innovation in the treatment of dementia. The lab will be an integrated research site for clinical medicine and basic medicine, and will be staffed by experienced researchers from both organizations.

Beginning with the Center for Supercentenarian Medical Research, Keio University possesses strengths in researching medicine and medical care through unifying basic and clinical science. Keio University has also published extensively about its world-class research into human iPS cells.

Eisai, which utilizes a drug development technology that produces small molecule compounds, mid-size compounds derived from natural products and antibodies, has been active in the field of developing new dementia drugs for over 30 years. Together with information provision activities relating to Aricept (donepezil hydrochloride), Eisai has accumulated a vast amount of experience and knowledge in the field of dementia.

At the Innovation Lab, Eisai and Keio University will bring together their respective strengths and, using new approaches that focus on genetic backgrounds, environmental factors, and protective mechanisms based upon healthy longevity, aim to speed up research of new drug targets and biomarkers for dementia as well as increase the probability of success in new drug discovery. The Innovation Lab will perform three functions: Clinical Omics Analysis, utilizing the latest mass spectroscopy technology; Data Science, utilizing artificial intelligence to determine new drug targets; and Biological Validation, which makes use of human iPS cell technology to advance the study of drug target biology. These research functions, along with the central concept of "Bidirectional Translation Cycle", which repeatedly generates new hypotheses based on human biology and validates them with models, will lead to accurate understanding of the disease, through which useful biomarkers and drug targets can be discovered and applied towards new therapeutics.

"Dementia is one of the major social and medical issues in an aging society, and Eisai's mission is to contribute to overcoming this issue" said Teiji Kimura, chief discovery officer of the Eisai Neurology Business Group. "Eisai's strengths are its computational technology, drug discovery and biomarker research capabilities in the field of neurology. Through this Innovation Lab, we can collaborate with Keio University which has world-class iPS cell technology and expertise in basic medical science and clinical science, leading to new innovations, and allowing us to get new treatments to patients as soon as possible."

Hideyuki Okano, Dean of Keio University School of Medicine remarked "The establishment of this innovation lab allows us to combine Eisai's accumulated experience of dementia drug discovery such as Aricept with Keio University's supercentenarian medical research and dementia research, mutually boosting our competitive power, and culminating in an amazing opportunity to develop practical applications."

Keio University promotes comprehensive research on topics directly related to fields of life science and medical care through close cooperation among various faculties, graduate schools, and advanced research centers, such as the Faculty of Medicine, Faculty of Nursing and Medical Care, Faculty of Pharmacy, Faculty of Science and Technology, and Faculty of Environment and Information Studies; as well as the Institute for Advanced Biosciences (IAB).

Eisai Co., Ltd. is a research-based human health care (hhc) company that discovers, develops and markets products throughout the world.

Japan tracks dementia patients with QR codes attached to fingernails

BBC
08/12/2016

A Japanese city is keeping track of elderly dementia sufferers by attaching barcodes containing personal information to their fingers and toes, officials say.
A company in Iruma, near Tokyo, has developed a tagging system for members of the public at risk of getting lost.
The 1cm (0.4in) square stickers hold an address, telephone number and unique identity number for each user.
The free service, launched this month, is a first for Japan.
The initiative, which uses a system of QR codes, was set up to help reunite family members with their elderly loved ones in the event that they go missing, according to the Iruma welfare office.

The technology allows police to obtain details of a person's local city hall, along with contact telephone numbers and personal details, simply by scanning the code.
An official told the AFP news agency that this new method was a "great advantage".
"There are already ID stickers for clothes or shoes but dementia patients are not always wearing those items."
The water-resistant stickers, which remain attached for an average of two weeks, can be more discreet than other items such as badges as they can be attached to toenails and worn beneath socks.
Japan is facing an ageing population, with more than a quarter of its citizens aged 65 or over.
This is set to increase to 40% by 2055, with the population expected to shrink from the current 127 million to 90 million.

University of Tokyo to join Alzheimerfs international study

October 17, 2016
The Yomiuri Shimbun

The University of Tokyo plans to participate in a U.S.-led international research project to determine whether the pre-onset preventive treatment of Alzheimerfs disease, which is found in more than half of dementia patients in Japan, can be effective.

If the research produces results, a preventive treatment might be introduced in Japan earlier.

The research is being promoted by the National Institutes of Health, a biomedical research agency in the United States, and other entities. Japan would be the third other country to participate in the U.S.-led research, after Canada and Australia.

Titled gA4,h the joint public-private sector project was launched in 2014 by the NIH in conjunction with major U.S. pharmaceutical firm Eli Lilly and Company and others.

It has been found that an abnormal protein called beta-amyloid accumulates in the brain 10 to 20 years before the onset of Alzheimerfs disease. The research therefore targets elderly people aged from 65 to 85 who have normal cognitive function, but were found through imaging tests to have accumulated beta-amyloid in their brains.

The participants are separated into two groups ? the members of one are given a drug via intravenous drip to eliminate the abnormal protein, and the members of the other get a placebo missing the active component. The objective is to see whether the drug is effective in preventing the lowering of cognitive function.

A total of 1,150 people around the world will take part in the research by next spring. Administration of the drug will continue for three years, with results anticipated as early as 2020.

In Japan, about 100 people will undergo brain imaging starting in late October, with 10 to 20 eventually participating in the research.

g[The research] could change the direction of future Alzheimerfs treatment and is drawing attention around the world,h said Takeshi Iwatsubo, a professor of neuropathology at the University of Tokyo and leader of the research in Japan.

gWe want to get many people to participate and proceed steadily to bring about the latest results for domestic patients,h Iwatsubo said.Speech

65,000 dementia exams seen each year under revised law

September 14, 2016
The Yomiuri Shimbun

Mandatory dementia examinations for elderly drivers aged 75 or older may need to be performed on about 65,000 people every year after the revised Road Traffic Law (see below) is enforced in March next year, a Yomiuri Shimbun survey found.

This would be about 40 times the 1,650 drivers aged 75 or older who were examined last year under the current system. With less than six months until the new system is introduced, police departments are rushing to find doctors to perform the exams and make other preparations.

Relevant departments at police headquarters in all 47 prefectures were asked to take part in the survey, which ended in August. The poll asked for estimates of how many elderly drivers suspected of having dementia in a cognitive function test would need to be diagnosed by a doctor.

Responses were received from police departments in every prefecture except Tokushima, and the total estimated number was 64,968 people per year.

The estimates were based on the number of elderly drivers who were assessed as possibly having dementia in 2015 ? about 54,000 nationwide ? plus an expected increase in the elderly population and the number of infractions.

By prefecture, the largest figure was from Fukuoka at 3,300 people, followed by Saitama and Shizuoka at 3,000 each. Tottori estimated only 200 people and Okinawa 440.

Nearly all the prefectures expected a major increase from 2015, reflecting the rapid aging of society.

When asked what issues they faced in implementing the new system, 19 prefectures said it would place a major burden on staff at drivers license centers. Thirteen prefectures said license renewals would be delayed because of holdups at medical institutions, and the same number said there were not enough dementia specialists. Multiple answers were allowed.

Eleven prefectures said there were not enough doctors to perform the exams. Many prefectures also indicated that cooperating with municipal welfare administrations, medial associations and other entities would be essential.

Twenty-seven prefectures, or about 60 percent of the total, said they were trying to educate the public about the new system. Since revoking a drivers license would have a major impact on an elderly personfs life, many other issues also need to be addressed, such as figuring out transportation for elderly people in more rural areas.

Masaru Miura, a professor of geriatric psychiatry at Keio University who was involved in revising the law as a member of a National Police Agency committee, called the new system ggroundbreaking.h

gWith the increasing number of elderly drivers, itfs a necessary system. However, it will impact many people, so society as a whole needs to be educated about it. Itfs also important to promote community-building, to ensure that elderly people who lose their licenses have access to transportation,h he said.

Revised Road Traffic Law

Drivers age 75 and older undergo cognitive function tests when they renew their licenses every three years. If dementia is suspected, they will have to be examined by a specialist, their regular doctor or a medical institution designated by the public safety commission. Tests will also be conducted after every traffic violation. If diagnosed with dementia, their license will be suspended or revoked. Under the current system, licenses are renewed as a rule even if dementia is suspected. An examination is required only if a driver commits an infraction.Speech
photo : Memory and judgment capability tests are conducted at a driving school in Yokohama.

Japanese City Takes Community Approach To Dealing With Dementia

NPR
August 23, 2016
INA JAFFE

Early mornings are routine for 69-year-old Hiroyuko Yamamoto(photo). He's typically at a busy intersection in the city of Matsudo, near Tokyo, where he volunteers as a school crossing guard. But one rainy morning a little over a year ago, an old woman caught his attention.

She was pushing a bicycle. She was kind of disheveled. Despite the rain, she didn't have an umbrella. When Yamamoto spoke to the woman, she said she was trying to get to the city of Kamisuwa. That's about four hours away by train.

Yamamoto recognized that the woman had several signs of dementia he'd learned about when he took his city's dementia awareness training.

Yamamoto volunteers with Matsudo's Orange Patrol. The organization's formal name in Japanese ? Olenji koe kake tai ? translates awkwardly into English as "Troop that calls out to the elderly." But the name accurately describes what the members do. Yamamoto says that just a simple, "Hello, what a nice day," can tell you if someone is OK or needs help.

Because of his training, Yamamoto says, he knew how to talk with the old woman pushing the bicycle.

"I talked to her about things that, according to the training manual, would not upset her," he says. "And I spoke in a gentle manner." These things helped him persuade the woman to stay with him until the police arrived about 20 minutes later.

If it hadn't been for her chance encounter with Yamamoto, the woman might have gone missing, or worse. Last year, 12,208 people with dementia were reported missing to the National Police Agency in Japan. Most were found alive within a week. But 479 were found dead, and 150 were never found.

These numbers have been increasing every year as the number of older people in Japan continues to rise. Nearly 27 percent of the Japanese population is now 65 or older. And, as the number of older people grows, so does the number of people with Alzheimer's disease or other dementia. The Japanese government expects that by 2025 more than 7 million of the nation's residents will have dementia.

A comprehensive plan for dealing with that expected rise in dementia cases was passed by the national government last year. But Matsudo has been providing dementia awareness training for city residents since 2010. Thousands of people have taken it.

Atsuko Yoshioka conducts dementia awareness classes for the city of Matsudo. She says the sessions are brief ? just 60 to 90 minutes ? so she tries to customize the content for students.

For example, pharmacist Takayuki Yoshida says he sometimes had clients who "even after I gave the medication to them, they'd come back and say they didn't get the drugs." Now he knows that may be a sign of dementia, and he contacts the patient's doctor.

Many post office workers have also taken the training. In Japan, post offices also conduct some banking transactions. Hiroki Yaita says sometimes an older client will come in several times to say that someone has stolen their bankbook. Now, because of the training, "we would think that maybe that person has dementia and we would talk to the family about that possibility."

The purpose of the training isn't to make Matsudo residents experts in dementia, says Tadashi Watanabe, chief of the city's Welfare and Longevity Department. The goal, he says, is just "to support those with dementia, as well as their families, and make this a town where it's more comfortable for them to live."

Some communities in the United States have begun similar programs. And in Japan what's been going on in Matsudo is now national policy. The comprehensive plan adopted by the government last year includes research and prevention and nursing services. It also includes a campaign for increasing dementia awareness among the general public. The country is on track to train 8 million people by the end of the next fiscal year.

Hidenori Kawashima, deputy director for dementia policy in Japan's Ministry of Labor, Health, and Welfare, says the expected rise in dementia cases should not be seen as a threat. Interacting with people with dementia will become normal.

"It would be a familiar thing," says Kawashima. "So we wanted the plan: First, to create a structure in the local communities to support those with dementia and, second, to create a society where it will be natural for them to live."

No government plan can keep people with dementia from wandering. But health officials in Japan hope there eventually will be entire communities prepared to help keep them safe, if and when they do.

Manga artist offers lessons on treating people with dementia

August 21, 2016
The Asahi Shimbun

KYOTO--A once-struggling manga artist has revived his career by drawing cartoons based on his experiences and observations of working with people with dementia.

Natsu Kitagawa, 44, said his works now are intended to help people with dementia and offer advice on care giving.

He recommends treating patients as individuals instead of lumping them together as people whose minds have been taken over by the brain disease.

The title of his latest book can be translated as: gWhy do people with dementia often get themselves into trouble?h

Previously, Kitagawa, who is based in Kyoto, primarily published his works in comic anthologies for young men. But he gave up his manga career after poor sales.

When he was past 30, Kitagawa entered the nursing-care industry despite having no experience in the field.

He worked for about seven years at a special nursing home for the elderly and became a senior staff member at a group home for people with dementia.

Kitagawa also passed the national exams for nursing-care workers and care managers.

Around 2009, he started drawing manga again while continuing his work. He said he felt uncomfortable whenever he saw reports that only played up the difficult challenges associated with dementia.

gEven if you have dementia, every situation is different depending on those around you and the circumstances,h Kitagawa said. gThere are many moments when we can laugh and spend some serene time together.h

He decided to use his artistic skills to show the realities on the front line of nursing care.

Although the subject matter of his short manga stories can be heavy, the episodes carry a message of hope and are full of humor. His drawings are characterized by round figures and a rich use of colors.

He recalled a woman in her 90s who refused to bathe. On one occasion, she gave the straightforward excuse that taking a bath was too troublesome. On another day, she claimed to be having her period.

Staff members used a whole bag of tricks to get her to take a bath, often with failed results. But once she got into the bathtub, she always said, gSo comfy.h

Another woman constantly hurled bitter insults at staff members. But every now and then, the sweetest smile appeared on her face and she would say, gThank you, much appreciated.h

Kitagawa initially posted such manga episodes on his blog. In 2012, he compiled these stories into a self-published book. A new edition with additions and revisions was released in May this year.

The artist said he gave the book the candid title because that was the question on his mind while working in the nursing-care industry. He admits that he himself raised his voice when his assistance was rejected.

But he eventually realized that how the residents were treated influenced their symptoms of dementia.

Kitagawa suspected that people with dementia got into trouble because they were all broadly viewed simply as gdementia patientsh by caregivers and others who would lose it if things didnft go as planned.

The book shows home-care workers using their imagination to guess how residents see the world and explore ways to treat them. One resident continuously strolls on the floor while another never lets go of a doll because she believes it is her child.

Caregivers are constantly left wondering if the residentsf behavior is triggered by dementia or is an intrinsic response, Kitagawa said.

gThere are many things I donft understand,h he said. gNot because they have dementia, but because they are people after all. I donft want to stop thinking about what they are feeling right now even if I canft find the answer.h


Elderly woman with dementia safe because of 16-year-old boy

THE ASAHI SHIMBUN
August 19, 2016

TAGAWA, Fukuoka Prefecture--It was the sort of exchange that happens all the time between a bus driver and an aged passenger, but a high school student who happened to eavesdrop on this occasion felt something was not quite right.

Following up on his intuition, Hiroto Kitaoka got off the bus with the woman. His decision may well have saved the life of the 91-year-old. She suffers from dementia and had been reported missing by her family.

Hiroto, 16, was on his way home after finishing a drill of the kendo club at Inatsuki Shikokan High School in Kama in this southwestern prefecture. He boarded the bus around 7 p.m. on July 7 for home in the neighboring city of Iizuka.

The woman sat behind him and asked the driver whether the bus was going to Inatsuki, which is part of Kama.

The driver said no and recommended she get off.

gI felt she definitely should not be left alone,h Hiroto recalled feeling after hearing the exchange.

After the the woman got off the bus, he did, too, and immediately contacted his mother for help. She turned up in her car, and the three drove to Kama, where the elderly woman apparently lived.

After reaching Kama, Hirotofs mother drove slowly and asked the woman to try to recall what her neighborhood looked like.

As soon as the three got out of the car to search for the woman's home on foot, they came across a Kama city employee who was hurrying to her house.

By a stroke of luck, they were standing right in front of the woman's home. After talking with the employee, Hiroto and his mother realized that the woman had been reported missing.

It was past 9 p.m., six hours after the woman vanished while visiting the Tagawa Museum of Art in Tagawa in the prefecture with her son.

gIf Hiroto had not been on the same bus, we have no idea what would have happened to her,h said Iwao Ikeda, chief of the section tasked with the care of elderly people at the Kama city government. gHis courageous action may well have saved her life.h

The boy said he acted the way he did because it could have happened to his own grandmother.

gI am glad that she made it OK,h he said.

The Tagawa police handed Hiroto a letter of appreciation for his quick-witted action.

gIf she had been left by herself, the worst possible outcome could have resulted,h said Keiji Watanabe, head of the Tagawa police station.

eCosmetic therapyf said to stem dementiafs effect on seniors

JUL 17, 2016
The Japan Times

Applying makeup may halt the progress of dementia among elderly people, helping keep their brains active, recent studies say.

Cosmetic therapy also appears to be effective in treating depression in younger people and stress.

In 2013 Shiseido Co., the nationfs largest cosmetics firm, launched what it called a gcosmetic therapy programh for elderly people and organized makeup lessons at about 400 care facilities across the nation.

Nursing Plaza Kohoku in Yokohama organizes Shiseidofs makeup lesson for residents in their 80s and 90s twice a month.

During the hourlong event, participants do stretching exercises and apply makeup with partial support from staff.

An official of the nursing home said some residents are now able to sit up straight and eat without assistance, while others have developed enough muscle strength to support their own bodies and walk to the toilet by themselves.

A Shiseido official said the process of applying foundation and rouge to the face apparently helps gchange the state of mind and stimulate both the brain and body.h

Kaoru Sakatani, a professor specializing in brain science at Nihon Universityfs College of Engineering, conducted a separate study about the effects of cosmetic therapy on development of dementia by comparing two groups of elderly patients in the early and moderate stages.

In the study, one group took makeup lessons for three months, while the other took none.

The research showed the level of cognitive decline in the first group was milder than in the second. Sakatani concluded the therapy prevented early-stage dementia from worsening.

The professor said cosmetic therapy will also likely benefit younger people suffering from stress, fatigue or depression.

Some psychiatric clinics have introduced such therapy for their patients.

Sapporo Ota Hospital in Sapporo started a makeup program in 2003.

gThis makes me feel cheerful and will be useful for my job interview,h said a 43-year-old woman who participated in a lesson in June. She is looking for a job while coming to the hospital on a regular basis.

Instructor Rina Kurosu said, gWhen wearing makeup, the patients seem to be able to forget the troubles they face.h

Miyako Harasaki, chairman of the Makeup Therapy Association of Japan, said many patients hospitalized for long periods no longer care about their appearance.

But their self-confidence gets a boost when they get compliments after applying makeup, Harasaki said.

Record 12,000 people with dementia reported missing in Japan in 2015

JUN 16, 2016
Japan Times

A record 12,208 people with dementia were reported missing in 2015, mainly as a result of wandering off, the National Police Agency said Thursday. The figure is up 1,425, or 13.2 percent, from the previous year.

The same year, 12,121 people were located, of which nearly 70 percent, or 8,310, were found on the day they went missing and almost 98 percent, or 11,872, were tracked down within a week. But 479 were found dead, and 150 people remain missing, including some who went missing prior to 2015, according to the agency.

The Health, Labor and Welfare Ministry said about 4.62 million people had dementia in 2012. It expects the figure to rise to 7 million by 2025.

The NPA began compiling data on missing dementia sufferers in 2012, and the number has continued to rise.

As a result, police have enhanced efforts to locate missing dementia sufferers.

In 2014, however, they failed to detect signs of dementia in an 83-year-old man who had wandered off from a day care facility in Yokohama despite police officers questioning him several times on the streets in Tokyo. He later died from dehydration in a park.

To address the issue, municipalities are joining with local cooperatives, gas station operators and taxi companies to watch out for dementia patients who may have wandered off.

According to the Japanese Consumersf Co-operative Union, about 800 out of 1,741 municipalities had signed agreements as of December with 90 co-ops across the country to keep an eye on people with dementia and respond in times of emergency.

Under the agreement, co-op delivery personnel will check for signs something is wrong, such as unopened mailboxes when they visit the homes of those with dementia, and report any irregularities to authorities.

To alleviate the burden on families taking care of dementia patients, the city of Kushiro in Hokkaido has set up a system with police, taxi companies and other outlets to look for dementia patients who go missing.

The scheme has helped locate up to 50 sufferers who have wandered off every year since it was implemented.

In Takasaki, Gunma Prefecture, the city offers a global positioning system service free of charge that allows police to track down dementia patients if their families report them missing.

Dementia's growing impact on corporate Japan

May 20, 2016
Nikkei Asian Review

TOKYO -- As the Japanese population ages, the impact of dementia continues to widen across all facets of society and age groups, and the corporate world is no exception.

What happens when business leaders start to exhibit the memory loss, delusions and other symptoms that attend the disease?

Japan's health ministry estimates that some 4.6 million seniors were afflicted with dementia in 2012. That figure is expected to jump 50% to roughly 7 million in 2025, meaning one in five people over 65 will suffer from the illness.

Now consider this: 23% of Japanese corporate presidents are over 70, according to Tokyo Shoko Research. Perhaps more worryingly, nearly 60% are over 60. Last year, the average age of a Japanese corporate boss was 60.8, up a year from five years earlier.

Let's look at two cases that highlight how the disease can manifest itself in the business world.

Case 1: During a meeting with clients at one Tokyo-based company founded over a century ago, the president, then in his 80s, started disclosing information that should have remained confidential due to compliance reasons. When a junior colleague stepped in to stop his boss from saying more, the president berated him in front of everyone. The employee was able to steer the conversation back to safe ground, but it was a close call.

Starting from around the beginning of the year, the president had been making inappropriate comments, leaving his colleagues confused and concerned. Finally, the problem got so bad that they decided they had to take action.

The president's family was briefed on the situation and decided it was time for him to retire, which he finally did in April. The move was greeted with relief by those who had to deal with the executive regularly. Said one colleague, "His doctor diagnosed him with dementia, and it appears that he accepted that diagnosis."

Case 2: "I should have noticed it sooner," said a man in his 40s who lives in Saitama Prefecture, north of Tokyo. His father was running a midsize parts manufacturer and had been exhibiting signs of dementia. By the time the son realized the problem, the dementia had become so pronounced that his father was incapable of making important business decisions. At the time, the company was engaged in fierce competition and the profits were slim. Last year, the son quit his previous job on short notice and took over his father's business. He is now agonizing over whether to close up shop.

Care concerns

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.

(Nikkei)

NPA eyes March 2017 for extra elderly driver dementia tests

MAY 12, 2016
Japan Times

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 lawfs 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 driverfs 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 lawfs 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 agencyfs 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 driverfs 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 driverfs 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.

Japanfs dementia time bomb

APR 22, 2016
Japan Times

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 dementiah 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 driverfs 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 wheelsh 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 driverfs license renewed and that he had continued to drive despite his doctorfs and familyfs 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, Alzheimerfs 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 Alzheimerfs. 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 Japanfs 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 glighth 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
channelnewsasia

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.

'INCREASE UNDERSTANDING'

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)

- Reuters

Diet enacts law to promote adult guardianship as dementia cases rise

APR 8, 2016
Japan Times

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 Courtfs Third Petty Bench when the ruling was handed down on Tuesday afternoon.

While the Supreme Courtfs 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 manfs 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 familyfs 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 boyfs 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 manfs 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.

Vague areas

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 personfs 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 Courtfs 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.

2 opinions

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 fatherfs 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 personfs 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

Otanifs 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 caregiverfs 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 dementiafs 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

Japan Times
MAR 2, 2016

Tuesdayfs 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 familyfs responsibility in supervising dementia patients.

gThe ruling should be an opportunity to change peoplefs 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 Consumersf 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 couplefs house. The police were able to contact her fairly quickly because a phone number had been sewn onto the manfs clothes and hat.

One year later, the manfs 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 sonfs wife, who had been living in Yokohama, moved nearby, and together with the manfs 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 manfs 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 neighborfs 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 canft 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 Courtfs decision as an opportunity to have more in-depth discussions.hSpeech


Behind the Scene / Training vital for dementia patientsf 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.

Brute force

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

Unqualified staff

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

Confirmation difficulties

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.

channelnewsasia
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 Japanfs population of 128 million are above the age of 65 and categorised as gelderlyh. 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 countryfs 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 Alzheimerfs, 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 Alzheimerfs 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, AEONfs Japanese malls engaged the help of Japanfs 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 matesh.

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 AEONfs 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 itfs great that we learn how to see things from the customerfs point of view."

photo1: TOKYO: At malls in Japan run by AEON, Asiafs 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.


Dementia in Japana 2010`2015