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Japan’s dementia time bomb

Senile dementia is causing serious social problems in Japan and much of the blame lies with the Health, Labor and Welfare Ministry as it attaches importance to aiding those who have physical difficulties while neglecting those with low degrees of dementia.

It is estimated that in the 2020s, 1 in 8 elderly people aged 65 years or older will fall into that “low degree dementia” category, with the potential of related wandering and reckless driving increasing.

According to six companies operating toll expressways, there were 739 cases of vehicles driving in the wrong direction from 2011 to 2014. People 65 or older were involved in about 70 percent of these incidents, and about a tenth of these drivers were suspected of having dementia. This would mean that about 7 percent of cases of driving the wrong way on expressways involved people with dementia.

It is difficult to detect dementia in its early stages, especially among those who are capable of driving. It is all but certain, though, that those in such stages will keep increasing in number in line with the aging of the population. So will cases of driving the wrong way by such people.

To cope with this situation, the National Police Agency adopted new rules in 2009 requiring people aged 75 and older to take a dementia test before renewing their driver’s license.

But of the roughly 1.45 million people who took the test in fiscal 2013, an infinitesimally small 118 had their license suspended or revoked. Given that about 15 percent of the people 65 or older in Japan are believed to have dementia to some extent, the test apparently fails to catch a large number of drivers in the early stage of dementia.

Thus the burden of looking after and controlling elderly drivers with dementia falls on their family members. But according to a survey conducted by a physician at Kochi University on 7,300 patients with dementia, 11 percent continued to drive even after they were diagnosed as having the disorder and 16 percent of these people caused accidents leading to injury, death or material damage. Thus such elderly people become “lethal weapons on wheels” while they have no sense of guilt.

In October 2015, a 73-year-old man made the news when his car hit six pedestrians and bicyclists, killing two people and injuring four. It was subsequently revealed that he had been under treatment for dementia for several years, that he had his driver’s license renewed and that he had continued to drive despite his doctor’s and family’s advice against it.

Worse still are cases in which a person is in such an early stage of dementia that it goes unnoticed until he or she actually causes a traffic accident. In December 2014, at a railway crossing in Nagano, a limited express train hit a car standing on the tracks and dragged it 300 meters. Nobody, including the 77-year-old driver — who was standing outside the car — was injured, but he was later determined to be in an early stage of dementia. In March 2015, an 85-year-old man drove his car the wrong way on the Tomei Expressway in Shizuoka Prefecture and hit a truck. Although he was not seriously hurt, he said he did not know where he was driving and was later found to have dementia.

In both cases, the drivers had not been diagnosed as having dementia prior to their accidents. As a result, although people close to them may have noticed symptoms such as them repeating the same thing or becoming forgetful, it did not occur to them to advise against driving.

Of the various types of dementia, Alzheimer’s disease is the most difficult to handle. It accounts for 50 percent of dementia cases in Japan, followed by cerebral vascular disorder and Levy body dementia, each at 20 percent. A 1998 study by the Carolinska University Hospital in Sweden showed that of 98 elderly people who had died while driving and whose brains had been anatomized, 47 percent showed signs of Alzheimer’s. The study pointed to a high possibility of drivers in the early stages of this illness causing fatal traffic accidents.

Why is it that sufficient care is not being extended to those in the early stages of dementia? A doctor specializing in treatment of patients with dementia says the reason lies in the present nursing care insurance system, which places primary emphasis on looking after those who have physical disabilities. This, he says, is a fatal shortcoming in Japan’s system of caring for those with dementia.

The degrees of care that an individual is entitled to receive under the insurance system is determined on the basis of the amount of time a care giver needs in helping an elderly person with such daily activities as going to the bathroom and eating. Thus, those who tend to go wandering or have fits of anger are not certified to be in need of a high degree of care. This system discourages entities engaged in the nursing care business from taking care of such people.

Figures released by the National Police Agency show that during fiscal 2014, 10,783 elderly people with dementia were reported missing and the whereabouts of 168 of them were not known at the end of 2014. The number of such people is bound only to increase. But given its tight fiscal conditions, the government will tinker with the nursing care insurance system in the direction of continuing its policy of neglecting senior citizens with dementia.

This kind of policy is a boon to entities in the nursing care business because the more serious the physical conditions of elderly people taken care of by these entities become, the greater amounts of money are poured into the sector from the publicly administered insurance system.

But the number of people with dementia, which stood at about 4.6 million in 2012, is forecast to rise sharply to more than 7 million by 2025. Of them, about 4.7 million are expected to be in “light” stages of the disorder, which means that 1 out of every 8 people aged 65 or older will have the potential to go wandering or to cause traffic accidents.

Economic burdens caused by those types of elderly people are immeasurable. If they cannot be accommodated at cheaper care facilities under the nursing care insurance system, they have to be looked after either by their families or at expensive private-care facilities. But only the wealthy can afford to use private residential homes with care provided, which usually require an up-front payment of about ¥5 million and monthly fees of no less than ¥150,000 to ¥300,000. In most cases, children of the residents will have to pay the cost.

A family that has to take care of an elderly relative with dementia has to put in an average of 1,300 hours a year for the care, which translates into lost profits of ¥3.82 million a year per person with dementia for the family and ¥6.2 trillion for the whole society — close to the ¥6.4 trillion for care covered by the nursing care insurance system, according to studies by Keio University doctors. Those families also tend to lose contact with other members of society, with their mental and physical health deteriorating under this crushing burden.

There has been a growing number of cases in which elderly people with dementia have been murdered by family members who had found it no longer possible to care for them. Etsuko Yuhara, an associate professor at Nihon Fukushi University, says that there have been at least 672 such murder cases during the past 17 years — accounting for about 4 percent of the total number of homicides in Japan. But this is just a tip of the iceberg because about 15,000 cases of cruel treatment of the elderly by care-givers are reported every year.

The health and welfare ministry shows no signs of correcting its wrong approach to the problem. Although it has proposed various plans, they are clearly designed to increase the practice of people caring for elderly family members with dementia at home. The plans are just pie in the sky because it is simply impossible for elderly people to care for family members with dementia on their own without any assistance.

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. There will also be many tragic cases in which people with dementia are murdered by their family caretakers because they can no longer cope with such a heavy burden.

This is an abridged translation of an article from the April issue of Sentaku, a monthly magazine covering political, social and economic scenes.