Japan: Dementia Lessons From the world’s Oldest Country
( adopted by shortening) Hamilton Spectator By Jennifer Yang
Dementia is increasing across the globe — 47 million people already live with the disease, with more than 130 million projected by 2050.
When it comes to dementia — a group of disorders affecting memory and cognition, for which there is no known cure — age is the greatest risk factor. No country has gotten older faster than Japan, the world’s first “super-aged” nation.
A quarter of Japan’s 128 million people are already elderly, meaning over 65. By 2060, the elderly will make up 40 per cent of the population.Many will spend their dying days addled by dementia, which already affects 4.62 million Japanese. Ten years from now, an estimated 7.3 million people in Japan will have dementia — more people than live in Hong Kong, Rio de Janeiro, or the entire GTA.
“The impact will be so huge,” said Dr. Koji Miura, DG of the Ministry of Health, Labour and Welfare’s bureau for the elderly. “The burden on younger people is very rapidly increasing. If we don’t do anything, society will be in trouble.” Last year, more than 10,700 people with dementia went missing in Japan. The vast majority were found — some dead — but 168 were not. Violent crimes fuelled by kaigo jigoku, the Japanese term meaning “caregiver hell,” are increasingly making headlines.
Over the past 15 years, Japanese policy-makers have also changed everything from the social welfare system to the very word for “dementia.” Before, the commonly-used term was chiho, meaning “idiocy” or “stupidity,” even in medical literature. In 2004, the government made an unusual announcement: chiho would know be known as ninchisho, meaning “cognitive disorder.”
But the single most important — and radical — change Japan has made to improve dementia care came in 2000, when the government introduced mandatory long-term care insurance.
A primary goal was to help seniors live more independently and reduce the burden on relatives — particularly women, who are often the caregivers. So unlike long-term care insurance in countries like Germany, which offer cash, Japan’s system offers services — and consumer choice.
The scheme works like this: at age 40, every Japanese resident pays a monthly insurance premium. When they turn 65 — or get sick with an aging-related disease — they become eligible for a range of services: everything from dementia daycare to lunch delivery and bathing assistance. Depending on income, users also pay a 10- or 20-per-cent service fee — a measure that discourages overuse.
But Japan’s trials and errors are instructive for other nations, marching their own paths toward the destination of super-aged. The country is already living the future that countries like Canada are bracing for.
In September, national anxiety followed Statistics Canada’s announcement that, for the first time ever, Canada’s elderly population had surpassed its population of children. Japan hit this same milestone — in 1997. Clearly, there is good reason to keep an eye toward the land of the rising sun, an article in the Lancet medical journal recently suggested.
“How Japan addresses the challenges — and opportunities — posed by a rapidly aging society will become a model for other countries facing their own demographic time bombs.”
Dementia daycare: In Japan, daycares are a popular option, not just for toddlers but also for people with dementia. “Six or seven per cent of the whole over-65 population goes to daycare,” Campbell says. “It takes people out of their home environment and gives their family caregivers a break.” Inside a charming bungalow, five staff and a nurse care for a dozen people — one of about 300 such daycares in Tokyo’s largest borough.
Today, the sounds of sizzling fish and clinking porcelain spill out of the kitchen; twice a week, the patients, ranging from ages 59 to 98, are encouraged to cook their meals. On the menu: salmon, soba noodles and miso soup.
The daycare’s goal is to keep everyone physically and mentally active, in hopes of slowing the disease’s progression. Daily activities include day trips and art therapy and storytelling sessions. The daycare also provides transportation so that family caregivers don’t have to scramble after work to pick up their loved ones.
Daycares like this one, located on a quiet residential street, are covered under Japan’s long-term care insurance plan. The daily cost depends on each person’s “care level” under the long-term care insurance system. At this particular daycare, people with the mildest disease pay roughly $10 CAD a day, with the rest covered by insurance, the owner says.
Dementia search and rescue: Japan is introducing a kind of search-and-rescue program, where teams of social workers and medical professionals look for people with dementia but have not been diagnosed. Today, a team visits a 92-year-old man in Machida, one of 41 cities testing this program (plans are to have teams in every city by 2018). A former artist, he is increasingly forgetful and prone to waking in the night, shouting. His 86-year-old wife is exhausted but has resisted help, insisting she can care for him.
After three visits, the four-person team coaxes the couple into seeing a doctor. For their fourth visit, the goal is to sign the man up for services covered by Japan’s long-term care insurance system. “What’s important is to support them as a community,” says psychiatric social worker Rei Takagi. “We will support them forever.”
A timeout for caregivers: Welcome to the “shokibo takino,” an in-between option for family members who want to keep their relatives at home but need the occasional break. Families planning an out-of-town vacation — or simply feel burnt out and crave a night off — can bring relatives for short-term stays of between one and 30 nights. “The idea is when they need, they stay,” explains Reiko Suzuki.
In May 2013, Hiroko brought her husband to the shokibo takino, where he stays every Monday and Thursday. “It got easier for me to live,” she says. “It’s very helpful to me.”
Hiroko uses her days off to catch up on chores or watch television. She had stopped going to her choir but has started singing again. Hiroko cares for her husband full-time on weekends — and by Monday, she’s exhausted and ready for a break. “In the morning, I’m like ‘wah,'” she says, laughing. She pretends to collapse on a couch. “I spend my afternoon like this.”
Image reference: www.yegfitness.ca