Dementia is a common illness that anyone can develop. The number of people with dementia in Tokyo is expected to increase to approximately 600,000 in 2025. Given this situation, there is a pressing need to promote dementia countermeasures. The Tokyo Metropolitan Government has been promoting various measures to realize a society where people with dementia and their families can live with peace of mind in association with municipalities and related organizations. This report describes the establishment of a specialized medical care system, the development of a community watch-over system, management of an information sharing site for missing/unidentified elderly with dementia, and countermeasures against early onset dementia.
[Fujitsu Forum 2017 Seminar Report]
Why Do We Need to Promote Dementia Countermeasures?
Tokyo's population is predicted to shrink from around 2025; however, the population of elderly (age 65 or older) is expected to continue growing thereafter, and by 2030, about one in four citizens is expected to be 65 or older, and more than half of this group is expected to be 75 or older. In particular, the number of people who suffer from dementia reached approximately 380,000 in 2013, and this figure is expected to increase by about 1.6 times to approximately 600,000 in 2025, which means that nearly 20% of all people age 65 or over is expected to have some kind of dementia symptoms.
Meanwhile, due to an increase in the number of nuclear families and the declining birthrate, the average number of family members per household in Tokyo is already less than 2, and the total number of elderly single households and couples has reached 1.36 million households (2015). Given the current situation in which about half of those suspected of having dementia are living alone or only as a couple, it is necessary to develop a system that allows the elderly to live worry-free lives in the communities where they want to live by enhancing in-home services.
Tokyo consists of various wards and municipalities, including Setagaya Ward (population of about 890,000), Hinohara Village (the only village in the Tama area, with a population of about 2,200), and 9 towns and villages in island areas. Dementia is a major issue for all municipalities, and countermeasures must be promoted according to local circumstances.
Promotion of Dementia Countermeasures in Tokyo
Under the Long-term Care Insurance Act established in 2000, nursing care insurance services are basically provided by wards and municipalities. The Tokyo Metropolitan Government, as a wide-ranging administrative unit, provides support for wards and municipalities and develops medical facilities. At present, dementia countermeasures are implemented based on the "Comprehensive Strategy to Accelerate Dementia Countermeasures (New Orange Plan)" established by the Japanese Government in January 2015.
In this plan, which aims "to realize a society where people with dementia can live with dignity in pleasant, familiar environments as they hope to be as long as possible," seven pillars are set to accelerate dementia countermeasures, including raising awareness and promoting understanding; providing healthcare and long-term care services in a timely, appropriate manner; countermeasures for early onset dementia; supporting those who look after people with dementia; and creating an elderly- and dementia-friendly community. To realize those pillars in an integrated manner, the community-based Integrated Community Care System has been established with municipalities as insurers as well as prefectures based on a concept of regional autonomy and independence, and the Community General Support Center, which serves as the contact point for this effort, has been established by the municipalities.
To prioritize dementia countermeasures, the Tokyo Metropolitan Government allocates an annual budget of 3.8 to 4 billion yen in accordance with the Tokyo Elderly Health and Welfare Plan, which is revised every three years. Specifically, the government focuses on the following four major items: 1) implementation of dementia countermeasures; 2) promotion of regional collaboration and provision of specialized medical care; 3) training of human resources that support people with dementia and their families; and 4) community development to support people with dementia and their families.
As dementia countermeasures, the Dementia Prevention Promotion Council considers specific countermeasures, holds symposiums for citizens, promotes awareness and understanding of dementia by distributing the series of brochures Shitte Anshin Ninchisho (Feel Secure by Learning about Dementia), and provides information through the portal site "Tokyo Dementia Navi."
In addition, the Tokyo Metropolitan Government has been working to establish Dementia Treatment Centers as bases for regional cooperation and specialized medical services in all 53 of its municipalities, except for the islands, in order to provide dementia medical diagnosis and consultation, support for local medical institutions and nursing care facilities, and coordination with family physicians (efforts are still in the planning stage for six municipalities). Also, dementia support coordinators facilitate collaboration between the Centers and municipalities, and dementia outreach teams comprised of doctors and other medical personnel visit the homes of people who have difficulty visiting hospitals in order to promote early detection, early diagnosis, and early treatment of dementia.
To develop human resources, the Japanese national government provides the Dementia Support Doctors (DSD) Educational Program, and the Tokyo Metropolitan Government provides the Family Physician Dementia Educational Program as well as training programs for nurses, pharmacists, dentists, and nursing practitioners to improve responsiveness to dementia.
Information Sharing Site for Missing and Unidentified Persons
Developing an environment in which people with dementia can feel at ease about going out conforms to the New Orange Plan's pillars of "support for families" and "creating a dementia-friendly community." However, in Tokyo, unfortunately there are cases in which elderly people with dementia have wandered away from home and become involved in accidents or have been taken into protective custody as unidentified individuals for an extended period.
To reduce the number of such individuals, the Tokyo Metropolitan Government has shared precedent cases with municipalities in Tokyo and has worked to establish networks connecting municipalities, business operators, and the police for early detection of missing and unidentified persons. Faxes and email have been used to share information between the Tokyo Metropolitan Government and municipalities; however, to ensure more prompt, accurate information sharing, the Tokyo Metropolitan Government has set up an "information sharing site for missing elderly persons with dementia," which started operation in 2015.
Fujitsu created the information sharing site. When family members make a search request to the police and a missing person is reported to a Community General Support Center or other facility of a municipality, the relevant municipality registers the information, which is then shared among all municipalities (except for the islands). The information site is publicly accessible for registering and inquiring about missing persons, and it can also be used to find the persons in charge in six neighboring prefectures and the National Police Agency, which aids in discovering missing persons who have crossed prefectural borders.
As the site handles personal information, high priority is placed on security. To use the site, the approval of the Personal Information Protection Commission, etc. is required. The high level of security and easy-to-use operability for registration, disclosure, updating, cancellation, and refined searching of information have been evaluated highly by those in charge of municipalities.
In addition, municipalities offer the Dementia Supporter Training Lecture, a 1.5-hour training session that allows attendees to deepen their knowledge of dementia so that communities can support people with dementia and their families. The lecture can be given at facilities of each municipality or workplaces, so if you are interested, please consult your municipality.
Countermeasures for Early Onset Dementia (Before Age 65)
The Tokyo Metropolitan Government is also focusing on countermeasures for early onset dementia, which develops before age 65; this is one of the New Orange Plan's pillars. The average age for onset of symptoms is 51 years old for both men and women, and 60% of patients are men. Because in many cases people of working age develop this type of dementia, they must face many problems suddenly, such as those related to employment continuity, housing loans, and children's educational expenses, which throws their families into disarray.
The Tokyo Metropolitan Government has implemented various countermeasures for early onset dementia ahead of the national government. At present, early onset dementia comprehensive support centers have been established in Meguro Ward and Hino City as contact points to provide various support services, such as phone consultation, accompanying patients to their workplaces to explain the situation, accompanying patients to medical appointments, and assistance in carrying out nursing care- and pension-related procedures.
Symptoms of early onset dementia are often noticed sooner at work than at home. The Tokyo Metropolitan Government has created the "Early Onset Dementia Handbook" for human resource and labor personnel in enterprises (scheduled for revision in 2017). It also plans to hold industry seminars aimed at enhancing understanding and support for people with early onset dementia in workplaces. More information will be posted on Tokyo Dementia Navi once the details have been finalized. We hope that employers are interested in these seminars.
Mutsuko Ueno Director for Dementia Policy,
Aging Population Programs Division,
Bureau of Social Welfare and Public Health,
Tokyo Metropolitan Government