Help at hand for dementia patients

They would enter the bank and ask for their cash. Yuriko Asahara, behind the counter, would check where they would stash it — in the side pocket of a handbag or perhaps deep down in a shoulder bag.

Asahara wasn’t spying. She knew she’d have to remind them within an hour or two. Many of her clients suffered from dementia, and over the course of two decades the bank manager became a self-taught expert on the disease.

Globally, an estimated 44.4 million people suffer from dementia and the figure is projected to triple to 135.5 million in 2050 as the population ages, Alzheimer’s Disease International estimates. Nowhere is the problem more acute than in Japan, where an estimated 8 million people have dementia or show signs of developing it. By 2060, 40 percent of Japanese will be over 65, up from 24 percent today, according to the National Institute of Population and Social Security Research.

“At first I didn’t understand why they would lose things so many times in a day and I got frustrated,” said Asahara, a former branch manager at Japan Post Holdings Co., the country’s biggest holder of bank deposits. “Gradually, I learned to look them in the eyes and to be sensitive about what could be occupying their minds.”

The government, faced with record debt, is raising premiums and reducing access to state-funded nursing homes. With about 520,000 elderly on waiting lists for placement, many spend their days wandering in shopping malls and making trips to their banks to check their savings.

Companies are encouraging workers like Asahara, 64, who retired last year, to help forgetful elderly navigate their stores. The push stems partly from a sense of civic duty. It’s also a realization that helping seniors is good for business. The market for goods and services purchased by seniors reached ¥100 trillion in 2012, according to NLI Research Institute in Tokyo.

Corporations targeting elderly business is part of a nationwide phenomenon to reckon with a graying Japan. About 5.4 million people, from apartment managers to bank employees, retailers and even children, have taken a government-funded course to learn about dementia and how best to behave with people who show signs of the disease.

Aeon Co.’s program, which began in 2007, has trained about 10 percent of the retailer’s 400,000 employees. Clerks who once scolded customers for opening food packages and for eating without paying are learning to show more empathy, said Haruko Kanamaru, general manager of social affairs at Aeon.

The focus on seniors is “a large portion of our business strategy,” Kanamaru said. “We are improving services handling troubled elderly customers.”

The government-backed training program has inspired Britain to pursue a similar tack, said Jeremy Hughes, chief executive of Alzheimer’s Society, a London-based charity group. Although a leader in dementia treatment, Britain began an educational program called “dementia friends” only last year, aiming for 1 million people by this year.

While the U.S. has no national plan to educate citizens, some communities are running their own programs.

In Watertown, Wisconsin, the “Dementia Friendly Campaign” started in 2013 gives a free educational session to residents and business owners. In Minnesota, a statewide advocacy group, Act on Alzheimer’s, created toolkits to guide communities to become dementia friendly.

Many developed countries’ leaders have pledged to combat dementia, emphasizing community-based care. In December 2013, the Group of Eight nations set a goal of finding a cure for dementia or a way of modifying the disease’s course by 2025.

“There’s an understanding that we shouldn’t lock people up,” said Marc Wortmann, executive director at Alzheimer’s Disease International. Instead, communities should “try to integrate them and keep them in societies.”

More than a dozen customers needed extensive assistance at Asahara’s bank branch, the former manager said. She and five colleagues learned to be patient and to listen.

They spent hours helping those clients find lost passbooks, reset PINs for ATMs, and understand their utility bills. Many elderly clients were obsessed with money, Asahara said. One woman, now in her 80s, constantly lost track of withdrawals from the time Asahara took the job 20 years ago.

When the national program, called Dementia Support Caravan, began in 2005, apartment managers were the first to join. They were dealing with tenants who complained about elderly neighbors banging the wrong doors, failing to sort bins, stealing newspapers and rubbing human waste on communal walls, said Hiroko Suga-wara, who runs the program. Now demand is rising across corporate Japan.

“Companies are proactive because they are desperate to learn ways to respond,” Sugawara said.

The branch Asahara oversaw is in the heart of Nagabusa in Hachioji, west Tokyo, and representative of many of the country’s suburban, aging cities.

The area is filled with rows of industrial-looking apartment buildings.

Built in the 1960s and 1970s, they hosted young families when Tokyo hosted the Summer Olympics in 1964 and when the economy boomed.

Fifty years later, the residents have aged and their children have moved out. Seniors over 65 made up about 29 percent of the area’s population in 2011, above the national average, according to government data.

Asahara, who took over the job from her mother, saw the neighborhood change over the years.

“Little did I imagine that it would be this way when I started,” she said. “But it’s the reality of an aging nation.”

Asahara helped confused customers and, when necessary, reported serious cases to families and social workers.

There were people who wore sweaters on hot days, or frothed at the mouth from dehydration, or looked emaciated. When she spotted her customers lost on streets after grocery shopping, she drove them home.

She arranged to replace house keys three times for a woman suffering from dementia. One morning, the woman said she had spent the night at another elderly woman’s house after losing her keys again. The other woman, a stranger she had met on the street, also had dementia, Asahara said.

Some of the people she has helped over the years have families who live too far away to notice their loved ones’ mental health deteriorating. Others are too scared to share problems with relatives, Asahara said.

“We see their decline closely and perhaps knew more about them than their relatives,” she said. “I can’t ignore them because one day we all get older and can suffer from dementia.”

Now that Asahara has retired, her son, Takushi, 36, who joined Japan Post a couple of years ago, has taken over her position. Eight months into the job, he said the extent of aging in the community exceeded what he had imagined.

He said he is impressed by how the branch’s veteran workers handle elderly customers.

“At first I used to think the branch should focus on expanding the business, rather than spend so much time dealing with the elderly with troubles,” he said. “I learned I was wrong. We must take good care of them for our survival.”