National / Social Issues

Dementia treatment making progress in urban centers, but rural areas still lacking

Kyodo

In May, a nurse and other members of a team that supports people with dementia visited a man in his 80s living in Machida, on the outskirts of Tokyo, and urged him to “accompany” his wife to the hospital.

They struck up a natural conversation, but carefully avoided the word “dementia.”

As a team that provides early-stage support for those with dementia in the municipality, they offer advice to patients and their families in seeking medical attention as well as local government services.

The man, who lives with his wife, recently took a turn for the worse.

He regularly goes to a nearby medical clinic for diabetes treatment, but lately he has been missing appointments or going two days in a row, forgetting he had been the day before. When his wife notes how forgetful he’s become, the man brushes her concerns aside.

His doctor at the clinic consulted with the city’s dementia support team, and together they formulated ways to persuade the man to seek medical attention.

As he used to be a teacher, the man’s pride may have prevented him from accepting that he had dementia, team members suggested. So they attempted to persuade him to seek treatment without angering him.

A month after team members first visited his home, the man “accompanied his wife” to see another doctor specializing in dementia. From there, his home doctor and a dementia doctor started cooperating. Soon, medication for the mental disorder was being filled alongside the diabetes prescription, with no need to mention the fact out loud.

In Machida, there are four such teams offering consultation to 45 people between August 2014 and June.

As with the Machida man’s case, it often takes time for patients with suspected dementia to actually see a doctor for treatment.

According to a survey conducted in 2013 by a Kyoto-based group on dementia patients and their families, it took an average of 9½ months for patients to seek medication after family members noticed symptoms of the disease.

Citing reasons for this lag between display of symptoms and treatment, 38.7 percent said the patient didn’t want to visit a hospital, 33.6 percent said they thought it was simply due to old age and 21.2 percent said family members couldn’t tell the patient to seek medical attention.

Getting medical attention or nursing care at an early stage will reduce the burden on family members, the health ministry said, which is why such support teams are needed.

But there is another dimension to the issue.

The number of doctors who have taken training sessions on dementia — a necessity to be recognized as an expert in the field — stood at 3,895 as of the end of March 2014. It varies by prefecture, from 18 in Aomori and Kagawa to 665 in Tokyo.

The venues for such training sessions are often urban, making it hard for doctors in rural areas to attend.

But regional governments in rural areas have been making efforts.

Of Hokkaido’s 179 municipalities, only 6.7 percent have set up a dementia support team. This is because many municipalities had to send doctors to Tokyo for training, requiring a costly overnight trip.

This year, however, Hokkaido negotiated with the National Center for Geriatrics and Gerontology, which organizes the training sessions, to hold the event in Sapporo, allowing more than 100 doctors in the prefecture to attend.

“Many municipalities are likely to be able to set up new teams from next fiscal year,” a Hokkaido prefectural official said.

Other municipalities opt to share doctors with expertise.

The city of Nagai and the town of Shirotaka, both in Yamagata Prefecture, share a dementia doctor.

“In a municipality with (a) low population, it is hard to find a doctor with expertise that fulfills the condition,” said an official from Nagai, which was later than Shirotaka in setting up a support team.

“There are patients and families who are having trouble because they can’t receive sufficient treatment and services at an early stage,” said Kumiko Nagata, an official at Dementia Care Research and Training Center in Tokyo. “Even if it’s not perfect, I hope the local governments will do what they can.”