Dementia care in Japan

Manabu Ikeda

Department of Psychiatry,

Osaka University Graduate School of Medicine

Contents

• The present circumstance of “super-aged

society” and the current situation of dementia in

Japan

• The Kumamoto dementia care model

• Future direction of dementia care in Japan

The present circumstance of

“super-aged society” and the current

situation of dementia in Japan

3

International comparison of aging

Source: Labor and Welfare white paper in Japan, 2018

Western Countries Asia Countries

Japan Japan

Japan Japan

Germany

US France

UK

[Year] [Year]

Sweden Indonesia

China India

Korea Singapore

Materials: Results up to 2010 are based on the Population Census by the Ministry of Internal Affairs and

Communications and estimates from 2015 onward are based on middle estimates for births and

deaths in “Japan’s Future Estimated Population (Jan. 2012 Estimates)” by the National Institute of

Population and Social Security Research

14,000

107 139 164 189 224 284 366 471 597 717 900 1,160

1,407 (11.1%)

1,646 1,879 2,179 2,278 2,245 2,223 2,257 2,385 2,401 2,336

(26.9%)

309 338 376 434 516 602 699 776

892 1,109

1,301

1,407

1,517 (11.9%)

1,749 1,733

1,479 1,407 1,495 1,645 1,600 1,383 1,225 1,128 (13.0%)

4,150

4,646 5,109

5,650

6,295

6,786

7,056

7,353

7,590

7,861

7,873

7,752

7,497 (59.0%)

7,089

6,783 6,559 6,278 5,910

5,393 4,978

4,643 4,368

4,105 (47.3%)

3,846

3,883

3,781

3,648

3,432

3,517

3,578

3,501

3,249

2,857 2,596

2,409 2,287 (18.0%)

2,176 2,015

1,849

1,698

1,562

1,467 1,386

1,297

1,199

1,104 (12.7%)

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060

12,000

10,000

8,000

6,000

4,000

2,000

0

8,411

9,008

9,430

9,921

10,467

11,194

11,706

12,105 12,361

12,557 12,693 12,777 12,806 12,660

12,410

12,066

11,662

11,212

10,728

10,221 9,708

9,193

8,674

Total population (figures on bar graph)

Actual values Estimates (10,000 people)

50.0

0.0

(%)

45.0

40.0

35.0

30.0

25.0

20.0

15.0

10.0

5.0

4.9 5.3 5.7

6.3 7.1

7.9

9.1

10.3

12.1

14.6

17.4

20.2

23.0

26.8

29.1

30.3

31.6

33.4

36.1

37.7

38.8 39.4

39.9

Aging rate (ratio of population

aged 65 years or older)

Population aged 19 years or younger

Population aged 20 – 64 years

Population aged 65 – 74 years

Population aged 75 years

or older

(year)

(Note) Totals from 1950 to 2010 include people of unknown age

Aging Fluctuations and Future Estimates in Japan

P-ART1632AKE#5

Changes in mean life expectancy at age 65

11.82 11.62 11.88 12.5

13.72 14.56

15.52 16.22 16.48

17.54 18.13

18.74 19.46

14.13 14.1 14.56

15.34

16.56

17.68

18.94

20.03

20.94

22.42 23.19

23.8 24.31

0

5

10

15

20

25

1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015

Male

Female

Prepared based on Annual variation in Life Expectancies at Specified Ages, Reference 2, “Abridged Life Tables” 2015

+10.18

+7.64

Number of elderly people

who live alone in Japan

(2,202,000)

Dementia prevalence in urban areas and response to lifestyle function impairment caused by dementia

General Research Report by the Dementia Countermeasure Comprehensive Research Project (FY2011 –- 2012)

90

0

60

40

20

70

50

30

10

(%)

(years)

Ratio o

f dem

entia p

atients

65 -- 69 70 -- 74 75 -- 79 80 -- 84 85 -- 89 90 -- 94 95 or older

Age range

80

Men

Women

Overall

According to a large-scale study by a research team of the Ministry of Health, Labour and Welfare targeting approximately

9,000 residents aged 65 years or older in 10 cities throughout Japan the prevalence of dementia in people aged 65 years or

older was 15% in 2012, indicating an estimated total of approximately 4.62 million people with dementia throughout Japan.

It was also estimated that there are approximately 4 million people with mild cognitive impairment (MCI), which is

observed prior to dementia onset.

Estimated number of elderly people with dementia: Approx. 4.62 million people

P-ART1632AKE#8

Specialists for dementia

• Years of foundation : 1986

• Number of members : 2,598

• Number of psychogeriatric specialist : 1,497

• Years of foundation : 1982

• Number of members : 3,150

• Number of dementia specialist : 890

The Japanese Psychogeriatric Society

Japan Society for Dementia Research

Specialists for Dementia : Patients with dementia = 1 : 2000

Important Points in the Comprehensive Strategy to Promote Countermeasures for Dementia (New Orange Plan)

– For Regional Development that is Kind to Elderly People with Dementia

The aim is to realize a society in which the wishes of people with dementia are respected and where they can continue to live as they wish in the good environment of their familiar regional residence for as long as possible.

Basic stance on New

Orange Plan

Seven pillars

(1) Raising awareness to deepen understanding of dementia

(2) Providing appropriately timed and adequate medical and long-

term nursing care in accordance with the patient’s condition

(3) Enhancing measures for early-onset dementia

(4) Supporting caregivers of people with dementia

(5) Promoting the creation of regions that are kind to elderly

people including those with dementia (6) Research and development of methods for dementia

prevention, diagnosis, treatment, rehabilitation and long-term

nursing care, and promoting increased awareness of the results

(7) Focus on the viewpoint of the person with dementia and their

family Source: Ministry of Health, Labour and Welfare website http://www.mhlw.go.jp/stf/houdou/0000072246.html

Important Points in the Comprehensive Strategy to Promote Countermeasures for Dementia (New Orange Plan)

– For Regional Development that is Kind to Elderly People with Dementia

The aim is to realize a society in which the wishes of people with dementia are respected and where they can continue to live as they wish in the good environment of their familiar regional residence for as long as possible.

Basic stance on New

Orange Plan

Seven pillars

(1) Raising awareness to deepen understanding of dementia

(2) Providing appropriately timed and adequate medical and long-

term nursing care in accordance with the patient’s condition

(3) Enhancing measures for early-onset dementia

(4) Supporting caregivers of people with dementia

(5) Promoting the creation of regions that are kind to elderly

people including those with dementia (6) Research and development of methods for dementia

prevention, diagnosis, treatment, rehabilitation and long-term

nursing care, and promoting increased awareness of the results

(7) Focus on the viewpoint of the person with dementia and their

family P-ART1632AKE#11 Source: Ministry of Health, Labour and Welfare website http://www.mhlw.go.jp/stf/houdou/0000072246.html

‘Kumamoto (dementia care) model’

12

13

The Kumamoto Model

Medical service network with cultivating

human resources for dementia in Kumamoto

Example of the Dementia-related Medical Center

operation project （Kumamoto Model）

Core center

Community-based center

General hospital in the community

Main roles of the core center ① Provision of expert consultation ② Care for complications, early diagnosis ③ Manpower development （Enrichment of the training

system）

Main roles of community-based centers ① Provision of expert consultation ② Differential diagnosis and early care （especially for

BPSD） based on the diagnosis ③ Care for complications ④ Establishment of community alliance system for the

medical care of dementia

Core center

The entire area of the prefecture is

covered by the double structure

model where Kumamoto University

Hospital is regarded as the “core

center”, with 9 medical institutions

with a Department of Psychiatry as

“community-based centers”.

Textbook for Dementia （edited by Japan Society for Dementia Research, ChugaiIgakusha）, p208.

Community general support center Primary care

physician Community-based center

・Kumamoto Univ. Hospital

・Yamaga Kaisei Hospital ・Mashiki Hospital ・Kumamoto Shinryou Hospital ・Kumamoto Seimei Hospital ・Amakusa Hospital ・Heisei Hospital ・Aso Yamanami Hospital ・Yoshida Hospital ・Arao Kokoronosato Hospital

10 Dementia-related Medical Centers in Kumamoto

(mean time to access these centers)

(n = 845)

Yoshida Hospital (22min)

Heisei Hospital (19min)

Mashiki Hospital

(24min)

Aso Yamanami

Hospital (31min)

Yamaga Kaisei Hospital (21min)

Arao Kokoronosato

Hospital (16min)

Kumamoto Seimei

Hospital (15min)

Kumamoto Shinryo

Hospital (23min)

Amakusa Hospital

(29min)

Kumamoto University

Hospital (35min)

16

Community-based centers’ operation Assistance of regional support system for dementia 1. Specialized outpatients clinic for dementia

2. Home visit consultation by community-based

centers’ staffs

3. Holding lectures and case conferences for local GP

and care staffs

Clinical achievements of Kumamoto Dementia-related

Medical Centers

2009.12 2010.12 2011.12 2012.12 2013.12

Tel Consultation

(No. of times)

143 471 571 578 647

New outpatients

(n)

106 203 223 194 229

Total

outpatients

(n)

2,777 3,200 3,876 3,982 4,245

No. of Medical

care centers

8 8 10 10 10

Monthly average of ten centers in 2013

Consultation cases: 621 New outpatients: 221

Follow-up outpatients: 2,679 Hospitalized patients: 52

Core center’s operation

Education & training & clinical research

1. Development of expert doctors on dementia

(Dispatch them to the community-based centers)

2. Education and training for the staffs of community-

based centers

(Holding of dementia training meetings)

3. Clinical researches based on the common database

among centers

18

Supporting the community-based centers

Regional centers

Core center

Leading to improvement of skills in the members of regional center

・ Dispatch of expert doctors to the

regional centers

・ Outpatient clinic for dementia by the

expert doctor ・ Urgent hospitalization for

demented patients.

(Keeping one bed available for

one patient everyday)

The brand-new Kumamoto model Three-layered system with GP, care stuffs, & dementia supporters

Future direction in Japan

21

Check points

☆Handrail in the bathroom

☆Chair in the bathroom

☆Her movements when taking a bath

☆Install handrail

(lengthwise direction）

☆Purchase stable bathroom chair

☆training for taking a bath

Early diagnosis & professional care

Preparation for safety life

78yr Female DLB

MMSE 22/30

Living alone in the apartment care lank 1

Visiting with her care manager and daughter

Visiting older people’s

home by students

Supporting dementia café

Training to question older people who is

puzzled in the community

listen volunteer

Dementia supporters activities in Kumamoto

Movement of ‘Dementia-friendly libraries’

in Japan

Miyamae Library in

Kawasaki City

Hyuga City

Office and

Kyushu College

of Health and

Welfare

Osaka

University and

libraries in

Kansai-Region

Tokyo

metropolitan

area

Hyuga City in Miyazaki Prefecture

Mini Library in a Community Center

By Prof.Ogawa from Kyoto Tachibana University

• More than 100 books

on dementia and care

• Introducing a story of

an old man with

dementia and his

family who live in the

local community

Involvement of younger generation

- children read aloud picture books on elderly people and dementia at a local public library to other kids and adults in the community in Takasago city

- children perform a play of a family story in collaboration with a local association for early onset dementia. The scenario is kept and presented by the local public library.

Acknowledgments

Colleagues: Mamoru Hashimoto, Ryuji Fukuhara, Tomohisa Ishikawa,

Yusuke Yatabe, Hibiki Tanaka, Yusuke Miyakawa, Naoko Ichimi,

Masateru Matsushita, Asuka Koyama, Akiko Katsuya

Department of Psychiatry, Osaka University

Hiroaki Kazui, Hideki Kanemoto, Shunsuke Sato, Yukiko Suzuki,

Takuya Matsumoto, Naoko Hotta, Miyae Yamakawa, Kamae

Kazue

The 10th International

Congress of Asian

Society Against

Dementia in Kumamoto

（2015.9.14-16）