An aging country becomes a dementia pioneer How Japan deals with its soaring elderly population has lessons for the rest of the world — including Canada
TOKYO— In December 2007, a 91-year-old man left his home in the city of Obu and ambled onto railway tracks, crossing just as a commuter train hurtled into the station.
In the eyes of the public, this was a tragic accident. The man had dementia and had wandered away when his 85-year-old wife dozed off.
But to the Central Japan Railway Company, it was negligence. They argued the family had failed to care for the man, and 54 trains were cancelled or delayed as a result. The company sued — and won. Last year, a court ordered the family to pay $39,000 in damages.
This is a dramatic example of a collision happening daily in Japan: the clash between people living with dementia and the sharp corners of a fast-paced society that was never built for them.
Japan is far from alone. Dementia is increasing across the globe — 47 million people already live with the disease, with more than 130 million projected by 2050.
But the first waves have crashed over Japan. 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.
In the early ’60s, Japan was the youngest of today’s G7 countries. Now, it is the oldest — a dramatic shift fuelled by plummeting birth rates and the world’s highest life expectancy, according to the World Health Organization, with an average of 84 years (in Canada, it’s 82).
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, director general 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.
In July, 83-year-old Kyuji Takahashi was accused of stabbing his wife. He allegedly told police: “My wife has dementia and I am worn out from looking after her.”
Right now, these stories are still the exception, but Japan’s challenge is to stop a public health crisis from unspooling — while battling the world’s highest debt.
There is little any government can do about changing the course of dementia. The only thing Japan can change is Japan.
“We see the crisis point as 2025,” said Mayumi Hayashi, a research fellow with the Institute of Gerontology at King’s College London. “And to cope with that crisis point, Japan is trying to create a society where everybody contributes and people with dementia have a better experience and quality of life.”
Grassroots efforts play a leading role in building this new society, with volunteers spearheading efforts to increase awareness and to form networks to find wanderers — those who go missing after becoming disoriented or confused.
Over the past 15 years, Japanese policymakers 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 govern- ment made an unusual announcement: chiho would know be known as ninchisho, meaning “cognitive disorder.”
“After the change of the name, the knowledge and acceptance of dementia has spread widely all over this country,” said Dr. Takashi Asada, a psychogeriatrician who was a member of the renaming committee.
Japan’s all-hands-on-deck dementia strategy — introduced in 2012 and revised last year — involves not just the health ministry but 11 other ministries and agencies. The strategy funds research but also prioritizes early detection, training front line health workers, support for caregivers and creating “dementia-friendly” communities.
But the single most important — and radical — change Japan has made to improve dementia care came in 2000, when the government introduced mandatory longterm 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.
This system also created something crucial in the field of long-term care: a market.