Japan, with over 30 percent of its population over 60 and with no countervailing trend to stop it, is now facing the scourge of dementia. With a WHO-estimated life expectancy of 84, over 4.6 million Japanese have been diagnosed with it. The Japan Times published an estimate (unfootnoted) that 15 percent of Japan’s over-65 population has dementia to some degree. Will Japan, struggling to implement technology to better manage an aging, shrinking population [TTA 24 Oct], turn out to be a model for Western Europe, the US, and their neighbor China in treating older people with cognitive problems with respect and care –or be a cautionary tale?
Two articles in Canada’s Toronto Star and the Japan Times indicate the struggle and the pressure that dementia has placed on an aging Japanese nation. What makes headlines is an unfortunate 91-year-old man in Obu who wanders onto railway tracks (with the family handed the C$39,000 damage bill), the horrific rundown of pedestrians by a 73-year-old who despite a dementia diagnosis just had his driver’s license renewed, and the violent acts around kaigo jigoku, or “caregiver hell” by both family members and paid carers. This is not readily solvable by robots or Paro seals (although self-driving cars would be one huge help).
Japan has pioneered innovation for a better quality of life with dementia, which as typical not all of which can translate to a larger country:
- In 2000, Japan introduced mandatory long-term care insurance, which is paid into starting at age 40. At 65 (or earlier due to disease), you become eligible for a wide range of caring services, with a 10-20 percent service fee attached to discourage overuse. This semi-market-based approached has proven popular with 5.6 million using it in 2013.
- Dementia daycare, which reportedly is used by 6-7 percent of the over-65 population. Healthy stimulating activities in a local home and small group setting, such as food preparation, art therapy, and storytelling can cost as little as C$10 a day.
- Dementia search and rescue, which is organized again on a local basis. Community teams of social workers and medical professionals actively look for people with dementia in homes where, for instance, a wife is caring for a husband who is increasingly forgetful, and suggest some alternatives and respite. Sometimes the approach works, sometimes not, but it shows that the community does not forget about the person and, importantly, the caregiver.
- Short-term stays or respite care (shokibo takino) gives a regular ‘day off’ or a stay of up to 30 days. This also appears to be organized locally.
The Japan Times/Sentaku ‘dementia time bomb’ article is nowhere near as optimistic as the Toronto Star‘s take, advocating instead:
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.
The JT writer points out that few older people (118 in 2013!) have had their licenses suspended for dementia, even though a law was passed in 2009 requiring a dementia test for drivers over 75. The drain on the economy’s productivity is substantial. A Keio University estimate of the cost of family care, scaled up, is ¥6.2 trillion which approximates the ¥6.4 trillion for care covered by their insurance system. It accurately points out that the current 4.6 million will grow to 7 million by 2025, the accepted tipping point. The Health and Welfare Ministry only wants to enhance current at-home systems, which, while they sound positive, are very fragile and inevitably crush caregivers. But who will pay–and who decides? Hat tip to reader Alistair Appleby of Optalis.