Japanese City Takes Community Approach To Dealing With Dementia

Aug 23, 2016
Originally published on August 29, 2016 1:02 pm

Early mornings are routine for 69-year-old Hiroyuki Yamamoto. He's typically at a busy intersection in the city of Matsudo, near Tokyo, where he volunteers as a school crossing guard. But one rainy morning a little over a year ago, an old woman caught his attention.

She was pushing a bicycle. She was kind of disheveled. Despite the rain, she didn't have an umbrella. When Yamamoto spoke to the woman, she said she was trying to get to the city of Kamisuwa. That's about four hours away by train.

Yamamoto recognized that the woman had several signs of dementia he'd learned about when he took his city's dementia awareness training.

Yamamoto volunteers with Matsudo's Orange Patrol. The organization's formal name in Japanese — Olenji koe kake tai — translates awkwardly into English as "Troop that calls out to the elderly." But the name accurately describes what the members do. Yamamoto says that just a simple, "Hello, what a nice day," can tell you if someone is OK or needs help.

Because of his training, Yamamoto says, he knew how to talk with the old woman pushing the bicycle.

"I talked to her about things that, according to the training manual, would not upset her," he says. "And I spoke in a gentle manner." These things helped him persuade the woman to stay with him until the police arrived about 20 minutes later.

If it hadn't been for her chance encounter with Yamamoto, the woman might have gone missing, or worse. Last year, 12,208 people with dementia were reported missing to the National Police Agency in Japan. Most were found alive within a week. But 479 were found dead, and 150 were never found.

These numbers have been increasing every year as the number of older people in Japan continues to rise. Nearly 27 percent of the Japanese population is now 65 or older. And, as the number of older people grows, so does the number of people with Alzheimer's disease or other dementia. The Japanese government expects that by 2025 more than 7 million of the nation's residents will have dementia.

A comprehensive plan for dealing with that expected rise in dementia cases was passed by the national government last year. But Matsudo has been providing dementia awareness training for city residents since 2010. Thousands of people have taken it.

Atsuko Yoshioka conducts dementia awareness classes for the city of Matsudo. She says the sessions are brief — just 60 to 90 minutes — so she tries to customize the content for students.

For example, pharmacist Takayuki Yoshida says he sometimes had clients who "even after I gave the medication to them, they'd come back and say they didn't get the drugs." Now he knows that may be a sign of dementia, and he contacts the patient's doctor.

Many post office workers have also taken the training. In Japan, post offices also conduct some banking transactions. Hiroki Yaita says sometimes an older client will come in several times to say that someone has stolen their bankbook. Now, because of the training, "we would think that maybe that person has dementia and we would talk to the family about that possibility."

The purpose of the training isn't to make Matsudo residents experts in dementia, says Tadashi Watanabe, chief of the city's Welfare and Longevity Department. The goal, he says, is just "to support those with dementia, as well as their families, and make this a town where it's more comfortable for them to live."

Some communities in the United States have begun similar programs. And in Japan what's been going on in Matsudo is now national policy. The comprehensive plan adopted by the government last year includes research and prevention and nursing services. It also includes a campaign for increasing dementia awareness among the general public. The country is on track to train 8 million people by the end of the next fiscal year.

Hidenori Kawashima, deputy director for dementia policy in Japan's Ministry of Labor, Health, and Welfare, says the expected rise in dementia cases should not be seen as a threat. Interacting with people with dementia will become normal.

"It would be a familiar thing," says Kawashima. "So we wanted the plan: First, to create a structure in the local communities to support those with dementia and, second, to create a society where it will be natural for them to live."

No government plan can keep people with dementia from wandering. But health officials in Japan hope there eventually will be entire communities prepared to help keep them safe, if and when they do.

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No country has an older population than Japan. More than a quarter of the people there are 65 or older, and that number is growing. So are cases of Alzheimer's disease and other forms of dementia, and that means more cases of seniors wandering off and getting lost. Every year thousands of Japan's elderly go missing. Too often they're found dead or not at all. NPR's Ina Jaffe covers aging, and she visited a city near Tokyo that's trying to provide a safety net for these vulnerable people.

INA JAFFE, BYLINE: You can often find Hiroyuko Yamamoto at this busy intersection in the morning. The 69-year-old resident of the city of Matsudo volunteers as a crossing guard for school children. But one rainy day, it was an old woman who caught his attention.

HIROYUKI YAMAMOTO: (Through interpreter) She was pushing a bicycle. She didn't have an umbrella, and she said she wanted to go to Kami-Suwa.

JAFFE: That's almost four hours away by train, so it was one sign that this woman was really confused. But Yamamoto noticed other signs because he'd received training in dementia awareness.

YAMAMOTO: (Through interpreter) The manual for the training I received tells you how to identify people with dementia. It says one of the ways you can identify them is that they don't have an umbrella when it's raining, and also their clothes are not buttoned correctly and so on.

JAFFE: Yamamoto is a volunteer with the city of Matsudo's Orange Patrol. Its formal title translates awkwardly into English as troop that calls out to the elderly. But that accurately describes what they do. Yamamoto says that just a simple, hello, what a nice day, can tell you if someone is OK or needs help. Fortunately for the woman with the bicycle, his training covered not only how to recognize the signs of dementia but how to interact with someone who has it.

YAMAMOTO: (Through interpreter) So we sat here on the bench that morning to stay out of the rain. I talked to her about things that, according to the training manual, wouldn't upset her. I also spoke in a gentle way. So she stayed and talked with me while we waited for the police to arrive.

JAFFE: If it hadn't been for the chance encounter with Yamamoto, this woman might have gone missing, who knows for how long? According to the national police, last year more than 12,000 people with dementia were reported missing. That's a number that's been increasing year by year. Most of the missing were found alive within a week. But 479 were found dead, and 150 people were never found.

This problem was one of the reasons why six years ago Matsudo began training its residents to identify and interact with people who have dementia. Pharmacist Takayuki Yoshida has taken the training. He frequently encounters customers with memory problems.

TAKAYUKI YOSHIDA: (Through interpreter) Even after I gave the medication to them, they'd come back and say they didn't get the drugs.

JAFFE: But now he knows he should contact their doctor. It's a similar story at a post office across town. Workers there also help people with financial transactions. Hiroki Yaita says taking the dementia awareness training helped him understand what it really meant when an older customer said their bankbook had been stolen.

HIROKI YAITA: (Through interpreter) When it happened three or four times, we'd think maybe the person has dementia, and we would talk to the family about that possibility.

JAFFE: Most training sessions last just 60 to 90 minutes, but the purpose of the training isn't to make everyone an expert, says Tadashi Watanabe, chief of Matsudo's Welfare and Longevity Department. It's just supposed to make Matsudo a safe and welcoming place for people with dementia.

TADASHI WATANABE: (Through interpreter) I feel it's very important for more people to have a good understanding of dementia. Some don't, and they act inappropriately toward people with dementia. In Matsudo, we want to support those with dementia as well as their families and make this a town where it's more comfortable for them to live.

JAFFE: Some communities in the United States are trying something like this, but in Japan, it's now national policy. Last year the Japanese government launched a wide-ranging plan to deal with the expected onslaught of dementia cases. It includes medical research and prevention and nursing services. The country is also on track for training 8 million people in dementia awareness by the end of the next fiscal year.

Hidenori Kawashima is the deputy director for dementia policy in Japan's Ministry of Labor, Health and Welfare. He says there will probably be more than 7 million people with dementia by 2025, but that should not be seen as a threat.

HIDENORI KAWASHIMA: (Through interpreter) It would be normal then for everyone to interact with people with dementia. It'd be a familiar thing. So we wanted the plan first to create a structure in the local communities to support those with dementia and second to create a society where it will be natural for them to live.

JAFFE: No government plan can keep people with dementia from wandering, but in Japan, the hope is there eventually will be entire communities prepared to keep them safe when they do. Ina Jaffe, NPR News.

[POST-BROADCAST CORRECTION: In the audio of this story, we give Hiroyuki Yamamoto's first name as Hiroyuko.] Transcript provided by NPR, Copyright NPR.