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Japan’s children face a dementia boom


Special To The Japan Times

Confucius said it’s not enough merely to provide for our parents. We must revere them. To fail in filial reverence, he said, is to be no better than the animals.

What did Confucius know? He lived 2,500 years ago, when life expectancy at birth was 22, and 50 was extreme old age. True, he himself lived to 72 — but the general fact remains. A headline such as this one in Shukan Gendai magazine earlier this month would have left him aghast: “Ten million people with dementia!” Not in the world — in Japan. Ten million people — that’s nearly 10 percent of its declining population. Not today — it hasn’t happened yet (the latest round figure is 5.2 million). But 2025, when some experts calculate it will (a less pessimistic estimate is 7 million), is only 10 years away.

In 2004, a book of essays titled “Demographic Change and the Family in Japan’s Aging Society” posed the question of why so little had been done to prepare for what was, after all, a perfectly foreseeable perfect storm: the rapid and unprecedented aging of a nation in which advanced medical care kept death further and further at bay while social changes of other kinds made for fewer and fewer children.

The book’s answer — or one of its answers — was Confucianism. Japan’s traditional morality was Confucian, reverential. Reverential children would reverently see their parents through infirm and dependent old age. The government could count on it. It did count on it. Care would be a family matter, not a government one. But the officials who did the thinking were rooted in another age and failed to see the shape of this one, and now the results are plain: far too few institutions, too many of them desperately understaffed, to cope with an elderly-heavy demography such as the world has never known — and that Confucius, visionary though he was, never dreamed of.

Imagine, for starters, what promises soon to be plainly visible: the sheer absurdity into which mass dementia can plunge society as a whole. It’s visible now at the individual level — a case here, an episode there. In Miyazaki in October, a 73-year-old man allegedly ran his car into a group of pedestrians, killing two and injuring five. In Sendai in March, a 78-year-old man allegedly stabbed his home helper, a woman in her 60s, with a fruit knife. Why? “Because she sealed my lunch with plastic wrap,” he reportedly told police when they came to charge him with attempted murder.

Absurdity: In 2014, 10,783 people with dementia went missing. They wander off and lose their way. Approached and asked where they’re going, they don’t know; where they come from, ditto; who they are, blank. One person in this situation is tragic — and when 10,000 becomes 20,000, as in a decade the math shows it must, barring a sudden medical or pharmaceutical breakthrough? There are simply no words for it. The human species has never been here before.

Far from rising to the challenge, Shukan Gendai says, the government is cutting funding to the already strapped care industry: “No one is working on this at the practical policy level — not politicians, not bureaucrats. The politicians say, ‘This won’t come to a head while I’m in office — it’s not my worry.'” In 2025, 8 million baby boomers will turn 75. But the next election, Shukan Gendai says, doesn’t hinge on what will happen in 2025. It hinges on the economic indicators a week before the voting.

Seventy-five is almost 80, and at 80, says research quoted by the magazine, you have a 20 percent chance of suffering from dementia. If you and your spouse live alone together, there’s an 8 percent chance you both do. And what of the children, on whom Confucius and, until very recently, his Japanese disciples pinned all their hopes?

It’s easy to blame children for not returning the love and devotion their parents lavished on them (assuming they did). But children in their prime and past it are not children. Most of them are busy adults, with demanding jobs and children of their own. It’s not their fault that there are only 24 hours in a day and only so much money at hand. Some try. Some try very hard. They quit jobs to become full-time caregivers. Prime Minister Shinzo Abe has identified that as a problem — not as a solution.

Shukan Gendai profiles a 58-year-old company executive in Tokyo whose parents live in Osaka. Some years ago his mother suffered a brain hemorrhage. His father took care of her, the son coming home to help when he could. Then Dad began showing signs of dementia. Evidently a stalwart character, he insisted he was fine, his son’s worries were groundless, he could carry on. But he plainly couldn’t, and the son, getting on in years himself, lately finds himself shuttling back and forth between Tokyo and Osaka, doing what he can for his parents while meeting his work and family responsibilities at home. An institution? Impossible — his mother’s illness has already drained the family savings, and anyway, would dad stand for being put in one? He still maintains he’s capable.

Institutions pose problems of their own, given dramatic urgency by reports such as those of three elderly people falling to their deaths last year from upper-story balconies at the S Amiyu Kawasaki Saiwai-cho nursing home in Kawasaki. Was abuse involved? Negligence? The extreme stress under which caregivers work is amplified by chronic understaffing and wretched pay: ¥210,000 a month on average, reports Josei Seven magazine — ¥100,000 a month less than average pay in other fields. Current calculations are that in the watershed year 2025, when 2.53 million caregivers will be needed, the number available will fall 380,000 short.

Josei Seven notes a striking anomaly. Television is overflowing with health programs. They get the highest ratings. Weekly magazines are full of health tips, diet recipes and exercise routines. That’s what readers want. It all suggests a love of life and a desire to prolong it.

And yet a survey Josei Seven cites asks 1,000 people aged 40 to 70 whether they’d want to live on into a healthy advanced old age, and hears that only 55 percent do. And what of the dubious 45 percent? Have they seen too much, too close up, of life’s final phase?

Michael Hoffman’s new book, “In the Land of the Kami: A Journey into the Hearts of Japan,” is out now.

  • Karagarga

    Living wills, euthanasia, death with dignity. Why cling on?

  • disqus_vBekJrf7g5

    Yep, the generation that enjoyed the very best of Japan at its very best, and run up a huge national debt doing so, are now the millstone around Japan’s futures neck, dragging it down since they won’t accept any change.
    ‘Après nous le deluge’ indeed.

  • GBR48

    The increasing extension of life by medical science, at a time when our quality of life is rapidly declining, does not always produce a beneficial result and requires more urgent preparation by all.

    Living wills and the option for euthanasia are important features of that (so we need to dump the religious BS, grow up and confront these issues honestly and realistically).

    If the population of Japan stays at home looking after their elderly relatives, then the economy will be entirely screwed, so filial piety is not going to work.

    Those robots that Japan loves so much may well be helpful, if only as an interactive presence amongst those suffering from dementia-related diseases.

    Guide dogs are trained for the blind and partially-sighted. There may be a role for them as trained companions for the elderly. The design of care homes also needs to be looked out. Good design can reduce the chances of mishaps.

    Oft-derided social media software may play a beneficial part in keeping people in the loop that their minds may pull them from.

    A relatively simple solution for those who wander off, is to chip those suffering from dementia issues the way you chip your cat or dog. A single database and the policeman in the nearest koban can rescue them with a simple scan and a check.

    If it was me, I’d prefer to be chipped rather than lost and disorientated.

    And it will be me, and probably you, all too soon. There’s a fair bit of enlightened self interest here. If we don’t establish a system that works, the suffering will only increase as we switch from being the overburdened care-givers juggling work, life and care-giving, to the victims of these cruel diseases.

    • disqus_vBekJrf7g5

      I’m pretty sure the J-police would prefer you to be chipped too, only right now, not in old age.

      • Clayton Forrester

        That would be true of police in every country in the world. No reason Japanese police would be any different.

    • Steve Jackman

      Technology is not the answer.

  • Steve Jackman

    The brain is a muscle like any other. It needs stimulation, curiosity and an open mind towards new ideas and experiences to keep working. An unintended side effect of Japan having created such an insular and closed society devoid of outside stimulation is the dulling of the Japanese mind. I believe this is the real reason behind such high rates of dementia in Japan, since many studies have shown higher rates of dementia in people whose minds are not exposed to enough stimulation.

    It is unfortunate that the vast majority of Japanese live highly regimented, insular, dull and predictable lives which are devoid of much outside stimulus. They value comfort, predictability, order and routine above all else. While this may make their lives more comfortable in the short run, it also takes away from the randomness that can make life more interesting and fulfilling.

    Living life in a coccoon like many Japanese do means that they live their lives within a very narrow spectrum, as compared to what I am used to seeing in my home country of the U.S. for example. Just like it is a fact that people who live more active lives and exercise regularly live healthier longer lives with a higher quality of life, it is also true that people who exercise their brains more live healthier lives. Somehow, this seems to be lost on the majority of Japanese people.

    • tisho

      One of my favorite quotes is from J.K. Rowling(the creator of Harry Potter), she said: ”It is impossible to live without failing at something, unless you live so cautiously that you might as well not have lived at all, in which case you have failed by default”. Life is so short what’s the point in hiding.

  • Christina Tsuchida

    Pace all the comments so far, I am interested in the article itself. Hoffman mentions Confucian piety, but fails to see the central rub of senility: the PARENT, honored and followed as Confucius advised, has become incompetent to lead or give counsel!! There are men who so honored their wives and women are expected to follow our husbands. What if these spouses become inane? Confucius could deal with death by grief-work, but near insanity of mind? What did he say about that in a person above you in his ranking?

  • Magus

    Shhhh, don’t give them any ideas.
    Don’t forget they’re mostly Nippon Kaigi politicians who want to “restore glorious old Japan”, you never know…

    • disqus_vBekJrf7g5

      There was actually a case of that on the morning news last week. Somewhere in Tohoku.