14th January 2018
It took a round of golf to convince Masashi Tsuda that something was really wrong with his memory. Then in his mid-50s, the sales rep couldn’t remember the four-digit number for his changing-room locker. Months earlier, he had struggled to get to grips with his office’s new computer system. On another occasion, his mind went blank as he was about to give a work presentation.
Despite twice being reassured by doctors that stress was the cause of his moments of absent-mindedness, Tsuda was eventually diagnosed with early-onset Alzheimer’s disease five years ago.
His wife, Kazuko, wipes away tears as she recalls the ensuing trauma. “We had just rebuilt our house, but all of the plans we had made together were shattered in an instant,” she tells the Guardian at a cafe she runs in Matsudo city, east of Tokyo. “I lost eight kilograms in weight and all my hair fell out. When it grew back, it was white.”
At 84 years Japan has one of the highest life expectancies in the world whereas Nigeria has one of the lowest at 53 years
Her husband is not alone. Japan is at the forefront of a dementia crisis that experts warn will affect other societies with burgeoning elderly populations in decades to come. According to the health ministry, 4.6 million people are suffering from some form of dementia, with the total expected to soar to about 7.3 million people – or one in five Japanese aged 65 or over – by 2025.
Faced with spiralling health and welfare costs and a shortage of professional caregivers, towns and cities across Japan are attempting to move away from a medicine-based, institutional approach towards care to one that involves the entire community
In 2015, Japan’s government released its Orange plan – a comprehensive package of measures to tackle dementia ranging from more specialised medical staff and the development of new drugs, to regular home visits and support for family caregivers.
Matsudo, however, put services for people living with dementia at the centre of its welfare policy much earlier, in 2010. And for good reason. By the end of the decade, more than 28% of the city’s 480,000 people will be aged 65 or older.
It means a commensurate rise in the number of people living with dementia, says Junko Yoshida, of Matsudo’s elderly welfare department. “We realised a while ago that with the rising number of older people living here dementia was going to be a huge challenge,” says Yoshida.
Currently, just over 11,000 people in the city in receipt of nursing care have some form of dementia, compared with around 8,000 just seven years ago. But they do not include a large number of people who have yet to be diagnosed. If they are included, local officials estimate Matsudo will be home to as many as 26,000 dementia sufferers by 2025.
Spearheaded by city hall, the plan includes raising public awareness among residents as well as businesses, such as banks and taxi services, which regularly come into contact with older people. There are cafes and drop-in centres for dementia patients and their families.
When they are not on patrol, dozens of dementia supporters run cafes for people with the condition and their families.
“It’s a casual place for people to come and talk openly over a cup of tea,” says Yukari Sakamoto, a cafe volunteer whose 69-year-old mother has the condition. “I can see that she gets a lot out of being able to talk at her own pace.”
After a series of minor mishaps at home while she was out at work, Kazuko Tsuda persuaded her husband to attend a day-care facility, where he and other people with dementia do light exercise, sing karaoke, grow vegetables and go on supervised walks.
Kazuko, who bought her cafe shortly before he was diagnosed, still struggles to cope with Masashi’s mood swings, but takes comfort from signs that he still appears to recognise her as his wife of more than 30 years.
“If I had one wish, it would be for my husband and I to do things together,” she says. “He’s a proud man … so it would help if he could also be given some sort of easy work to do. Yes, he has Alzheimer’s, but that doesn’t mean he has no dignity.”