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 8km in weight and all my hair fell out. When it grew back, it was white.”
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, 4.6mn people are suffering from some form of dementia, with the total expected to soar to about 7.3mn 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.
From last summer, the city began distributing stickers carrying a QR code that can be ironed onto items of clothing to help police locate the families of people who have wandered from their homes.
In return for attending a 90-minute lecture, residents can become “dementia supporters” who identify themselves with a bright orange bracelet. To date, 21,490 people have qualified as dementia-aware, while more than 3,000 regularly take part in neighbourhood patrols.
Several times a month, small groups of volunteers put on bright orange bibs and walk around neighbourhoods to distribute leaflets carrying information on dementia services and, occasionally, to help people in distress.
“We tend to pass by the very new houses as they’re occupied by young families,” says Manami Yoshii, a local welfare official while on patrol in a Matsudo suburb on a chilly January afternoon. “But if we see an older house that has the curtains drawn during the day or a big pile of newspapers in the mailbox, we tell the police.”
Hiroyuki Yamamoto knew exactly what to do when, one morning two years ago, he spotted a woman pushing a bicycle who, despite the rain, did not have an umbrella. She told him she was on her way to a town in Nagano prefecture, hundreds of miles away. Thanks to his awareness training, he managed to keep the woman talking until the police arrived to escort her home.
“A friendly greeting is the start of everything,” says Yamamoto, a regular patroller. “You don’t just suddenly ask people if they’re OK, as that could alienate them. It’s better to comment on the weather, or say something nice about their dog. We can usually tell if something is wrong by the way they respond.”
The number of people with dementia who go missing in Japan has reached crisis levels, reaching a record high of 15,432 in 2016, according to the national police agency – a rise of more than 25% from the previous year.
In Matsudo, the patrol initiative has produced results. Over the past six years, there have been more than 180 cases of people exhibiting signs of the condition found wandering the streets, all of whom were reunited with 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.”
Japan is at the forefront of a dementia crisis, experts warn.
